Measles Outbreak with Unique Virus Genotyping, Ontario, Canada, 2015

Thomas, Shari; Hiebert, Joanne; Gubbay, Jonathan B.; Gournis, Effie; Sharron, Jennifer; Severini, Alberto; Jiaravuthisan, Manisa; Shane, Amanda; Jaeger, Valerie; Crowcroft, Natasha S.; Fediurek, J; Sander, Beate; Mazzulli, Tony; Schulz, Helene; Deeks, Shelley L.

doi:10.3201/eid2307.161145

Cited by 23 publications

(14 citation statements)

References 13 publications

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“…Furthermore, although the risk of measles in Ontario is highest for those who are unimmunized, cases occasionally occur among even two-dose recipients. 30 Even if those with lower antibody titers are still protected from measles, inadequate humoral immunity in women of child-bearing age is still a concern. Since infants are protected from measles through transplacental antibody transfer, lower titers in these women will result in lower titers (and therefore increased susceptibility) in their infants, which is particularly important during their first year of life prior to MMR immunization.…”

Section: Discussionmentioning

confidence: 99%

Assessment of population immunity to measles in Ontario, Canada: a Canadian Immunization Research Network (CIRN) study

Bolotin

Severini

Hatchette

et al. 2019

Human Vaccines & Immunotherapeutics

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Canada eliminated measles in 1998. We conducted a sero-epidemiology study to estimate population immunity to measles in the province of Ontario, Canada and to identify groups at higher risk of outbreaks. We used a previously developed modified enzyme immunoassay to test 1,199 residual sera from patients aged 1–39 years. We re-tested negative and equivocal sera using a plaque reduction neutralization assay. We interpreted our results in the context of Ontario’s immunization program and vaccine coverage data. Of 1,199 sera, 1035 (86.3%, 95% confidence interval (CI) 84.4, 88.2) were above the measles threshold for protection, 70 (5.8%, 95% CI 4.5, 7.2) were equivocal and 94 (7.8%, 95% CI 6.3, 9.4) were negative. The proportion of positive sera was highest for those 1–5 years, with 180/199 (90.5%, 95% CI 86.4, 94.5) positive sera, and lowest for those age 12–19 years, at 158/199 (79.4%, 95% CI 73.8, 85.0). Adjusted for age, females were more likely than males to have antibody titers above the threshold of protection (odds ratio = 1.60, 95% CI 1.14, 2.24). Most of the study cohort were eligible for two measles vaccine doses, and vaccine uptake in Ontario is >90% for school-aged cohorts. We observed a higher than expected proportion of sera with antibody levels below the threshold of protection, suggesting that immunity in some Ontario age-groups may be waning, despite high vaccine coverage. Alternatively, the traditional measles correlates of protection may not be an appropriate measure of population protection in measles-eliminated settings.

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Section: Discussionmentioning

confidence: 99%

Assessment of population immunity to measles in Ontario, Canada: a Canadian Immunization Research Network (CIRN) study

Bolotin

Severini

Hatchette

et al. 2019

Human Vaccines & Immunotherapeutics

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“…13 , 34 , 35 Although challenging, identification of each measles imported case—at least retrospectively—is of utmost importance in elimination settings. When the source of an outbreak is not detected, the number of generations of spread prior to identification of the index case(s) may be unknown.…”

Section: Containment Strategies — Guidance Evidence Challenges and mentioning

confidence: 99%

“…When the source of an outbreak is not detected, the number of generations of spread prior to identification of the index case(s) may be unknown. 13 , 34 Detection of measles virus introductions is a requirement for verification of elimination status 34 and is a key indicator of the adequacy of a measles surveillance system (WHO's target is for ≥80% of confirmed cases to have the source of infection identified). 36 …”

Section: Containment Strategies — Guidance Evidence Challenges and mentioning

confidence: 99%

Public health responses during measles outbreaks in elimination settings: Strategies and challenges

Gastañaduy

Banerjee

DeBolt

et al. 2018

Human Vaccines & Immunotherapeutics

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In late September 2016, the Americas became the first region in the world to have eliminated endemic transmission of measles virus. Several other countries have also verified measles elimination, and countries in all six World Health Organization regions have adopted measles elimination goals. The public health strategies used to respond to measles outbreaks in elimination settings are thus becoming relevant to more countries. This review highlights the strategies used to limit measles spread in elimination settings: (1) assembly of an outbreak control committee; (2) isolation of measles cases while infectious; (3) exclusion and quarantining of individuals without evidence of immunity; (4) vaccination of susceptible individuals; (5) use of immunoglobulin to prevent measles in exposed susceptible high-risk persons; (6) and maintaining laboratory proficiency for confirmation of measles. Deciding on the extent of containment efforts should be based on the expected benefit of reactive interventions, balanced against the logistical challenges in implementing them.

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“…Globally, the annual incidence of measles decreased by 75.0% from 146 to 36 cases per million population during 2000–2015, and the annual estimated measles deaths decreased by 79.0% from 651,600 to 134,200 [8]. Recent outbreaks have been reported in North America [9, 10], South America [11], Europe [12, 13], Africa [14], and Asia [15–17].…”

Section: Introductionmentioning

confidence: 99%

Epidemiological characteristics and trends of a Nationwide measles outbreak in Mongolia, 2015–2016

et al. 2019

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Background Mongolia was one of the four countries that received a measles-elimination certificate from the World Health Organization Regional Office for the Western Pacific in 2014. Following the outbreaks in many countries including China, a large measles outbreak occurred in Mongolia in 2015. This study reports 2015–2016 measles outbreak incidence, mortality, and complications, according to time, geographical distribution, and host characteristics. Methods The epidemiological characteristics and trends of measles outbreak were analyzed using the Mongolian national surveillance data reported to the Center for Health Development, Ministry of Health, from January 2015 to December 2016. Results In total, 23,464 cases of measles including eight deaths were reported in 2015, and 30,273 cases of measles including 132 deaths were reported in 2016, which peaked in June 2015 and March 2016, respectively. Majority of the cases were reported from Ulaanbaatar (35,397, 65.9%). The highest attack rates were 241 per 10,000 population in Darkhan-Uul aimag, and 263 per 10,000 population in Ulaanbaatar. Measles-related death, nosocomial infection, and complications were most frequent among children aged < 1 year. Conclusions Following no reports of measles since 2011, a large nationwide outbreak occurred in Mongolia, despite the high vaccination coverage in the past. The highest incidence rate was reported in Ulaanbaatar city, and Umnugovi aimag in 2015 and Darkhan-Uul aimag in 2016. The most affected age group were aged < 1 year and those aged 15–24 years. Mortality cases were prominent among children aged < 1 year who were not eligible for vaccination. A systematic vaccination strategy is required to prevent another measles outbreak. Electronic supplementary material The online version of this article (10.1186/s12889-019-6511-0) contains supplementary material, which is available to authorized users.

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Measles Outbreak with Unique Virus Genotyping, Ontario, Canada, 2015

Cited by 23 publications

References 13 publications

Assessment of population immunity to measles in Ontario, Canada: a Canadian Immunization Research Network (CIRN) study

Assessment of population immunity to measles in Ontario, Canada: a Canadian Immunization Research Network (CIRN) study

Public health responses during measles outbreaks in elimination settings: Strategies and challenges

Epidemiological characteristics and trends of a Nationwide measles outbreak in Mongolia, 2015–2016

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