Diagnostic algorithm for the confirmation of cases of measles and rubella in Mexico

Due to the successful implementation of measles and rubella elimination strategies, Mexico announced the interruption of endemic transmission of measles in 1996 and that of rubella in 2008. After a verification process, the region of the Americas was declared free of rubella and congenital rubella syndrome in 2015 and of measles in 2016. In order to maintain the elimination status in Mexico, it is essential to continue laboratory surveillance within the framework of the Global Measles and Rubella Laboratory Network. The Institute of Epidemiological Diagnosis and Reference, through the National Network of Public Health Laboratories, guarantees timely and reliable results in view of the possible reintroduction of these and other emerging pathogens.

Epidémie de rougeole en période post-conflit dans une zone rurale centrafricaine

Introduction : La rougeole est une maladie infectieuse très contagieuse. Les situations de conflit telles que le cas de la République centrafricaine (RCA), peuvent favoriser la survenue des épidémies. L'objectif de ce travail était de décrire l'épidémie de rougeole survenue dans la préfecture sanitaire de Sangha-Mbaéré en termes de temps, lieu et personnes. Patients et méthodes : Il s'agissait d'une étude rétrospective réalisée lors de l'investigation des cas de rougeole survenus à Nola, dans le sud-ouest de la RCA qui a couvert la période du 30 décembre 2015 au 20 avril 2016. La population cible était constituée d'enfants de moins de 15 ans. Nous avons inclus dans l'étude, après consentement éclairé des parents, tout enfant chez qui un agent de santé a suspecté la rougeole avec une fièvre supérieure ou égale à 38°C, une éruption maculo-papulaire généralisée (non vésiculaire) et un des signes suivants : toux, rhinorrhée ou conjonctivite. Les caractéristiques sociodémographiques et cliniques ont été recueillies à l'aide d'un questionnaire anonyme. La saisie et l'analyse des données ont été faites au logiciel Epi Info 7. Résultats : Au total, 31 malades ont été inclus dont 58% de sexe féminin soit un sex-ratio (F/H) de 1,38. L'âge moyen était de 1,9 ± 1,2 ans. Les enfants âgés entre 1 et 4 ans représentaient 74,19% des cas. Tous les enfants (100%) n'étaient pas vaccinés contre la rougeole. Ils provenaient de la commune de Salo dans 51,61% des cas et de Nola dans 48,39%. Le taux d'attaque était de 0,82‰. Dans la commune de Salo, le taux d'attaque était de 2,97‰ (16/5392) et de 0,46‰ (15/32401) à Nola. Le taux de létalité était de 9,68% (3/31). Ce taux était de 33,33% (1/3) avant l'âge d'un an, de 8,70% chez les enfants de 1 à 5 ans. Conclusion : L'épidémie de rougeole survenue à Nola serait liée à une faible couverture vaccinale. Le renforcement de la vaccination et de la surveillance épidémiologique pourrait contribuer au contrôle et à une prévention efficace de la rougeole ainsi que d'autres maladies à potentiel épidémique

Actualización situacion sarampion y acciones intensificadas de vigilancia y control / Update to measles situation and intensified actions on surveillance and control

El 28 de marzo de 2018 se confirmó un caso de sarampión en un bebe de 8 meses, residente de la Ciudad de Buenos Aires. En función de ello, y teniendo como escenario posible lo que está ocurriendo en la actualidad, desde el Ministerio de Salud de la CABA, se comenzaron a diseñar estrategias de abordaje de carácter preventivo, para promover el control de este evento en la población en general y, en particular, en los niños susceptibles: por un lado, todos los menores de 6 años que cuentan -o deberían contar- con al menos una dosis de triple viral (entre el año de vida y el inicio escolar) y, principalmente, aquellos que por calendario, no les corresponde vacunación (los menores de un año). El 19 de julio de 2018, a poco menos de 3 meses del caso confirmado previo (categorizado como "relacionado con la importación", luego de haber hallado la fuente de infección proveniente de Asia), se notificaron dos casos confirmados que se atendieron en efectores públicos de la Ciudad de Buenos Aires, un residente de CABA y otro de Provincia de Buenos Aires. En este apartado se actualiza la situación epidemiológica a la fecha y se detallan las acciones realizadas y por realizar para la prevención y control de este evento.(AU)

Vigilancia de enfermedades febriles exantemáticas y casos de sarampión de la CABA / Surveillance of febrile diseases and measles cases at Buenos Aires City

En esta edición, se expondrán fundamentalmente los casos de sarampión confirmados de la Ciudad. Ante la circulación del virus de sarampión en países de América y el resto del mundo, la importación de casos es actualmente la forma de entrada del mismo al país y la Ciudad. Se deberá tener en cuenta que la Ciudad de Buenos Aires no presenta casos autóctonos desde 1999 y que confluyen en el momento actual varios factores que pueden desencadenar un brote ante la introducción de un caso: el incremento de susceptibles; la vigilancia cuya tasa de detección, durante varios años, no llegó a la establecida internacionalmente; bajas coberturas de vacunación y que la Ciudad representa el punto más importante del país para la entrada y salida de turistas hacia y desde otros países del mundo. La principal medida para evitar la reintroducción y diseminación del virus del sarampión y la rubéola es sin duda la vacunación de la población susceptible; ésta, junto a un sistema de vigilancia (clínica y de laboratorio) de alta calidad y suficientemente sensible son los pilares para impedir la producción de brotes relacionados con la importación y mantener eliminada esta enfermedad. El sistema de Vigilancia cumple el rol fundamental: detectar oportunamente los casos sospechosos a fin de accionar de manera rápida y efectiva.

Progress towards elimination of measles in Kenya, 2003-2016

Introduction: measles is targeted for elimination in the World Health Organization African Region by the year 2020. In 2011, Kenya was off track in attaining the 2012 pre-elimination goal. We describe the epidemiology of measles in Kenya and assess progress made towards elimination.Methods: we reviewed national case-based measles surveillance and immunization data from January 2003 to December 2016. A case was confirmed if serum was positive for anti-measles IgM antibody, was epidemiologically linked to a laboratory-confirmed case or clinically compatible. Data on case-patient demographics, vaccination status, and clinical outcome and measles containing vaccine (MCV) coverage were analyzed. We calculated measles surveillance indicators and incidence, using population estimates for the respective years.Results: the coverage of first dose MCV (MCV1) increased from 65% to 86% from 2003-2012, then declined to 75% in 2016. Coverage of second dose MCV (MCV2) remained < 50% since introduction in 2013. During 2003-2016, there were 26,188 suspected measles cases were reported, with 9043(35%) confirmed cases, and 165 deaths (case fatality rate, 1.8%). The non-measles febrile rash illness rate was consistently > 2/100,000 population, and "80% of the sub-national level investigated a case in 11 of the 14 years. National incidence ranged from 4 to 62/million in 2003-2006 and decreased to 3/million in 2016. The age specific incidence ranged from 1 to 364/million population and was highest among children aged < 1 year.Conclusion: Kenya has made progress towards measles elimination. However, this progress remains at risk and the recent declines in MCV1 coverage and the low uptake in MCV2 could reverse these gains

Exantemas virales: Sarampión / Viral rashes: measles

Las enfermedades exantemáticas son un conjunto de entidades clínicas de diverso origen, generalmente de etiología infecciosa, cuya manifestación cardinal es una erupción cutánea. Dentro de estas patologías destaca el Sarampión, enfermedad producida por el virus homónimo, un virus ARN de la familia paramyxoviridae, de alta contagiosidad en personas no inmunizadas, que se transmite por contacto directo o por aire. El cuadro clínico consta de dos fases, la fase prodrómica caracterizada por fiebre alta, tos, coriza y conjuntivitis; y la fase exantemática de sintomatología florida con la aparición del rush maculopapular eritematoso característico del sarampión. El diagnóstico se sospecha ante cualquier paciente que presente fiebre y exantema característico del cuadro. La confirmación diagnóstica se realiza mediante serología con la detección de anticuerpos IgM específicos del virus en sangre o secreción oral. El tratamiento se basa principalmente en medidas de soporte y administración de vitamina A. En Chile existe la vacuna trivírica, incluida dentro del Plan Nacional de Inmunizaciones, que confieren inmunidad contra este agente. Durante el presente año se han reportado brotes de sarampión en distintos países del mundo, dentro de ellos Chile, por ello que nace la necesidad de realizar una revisión bibliográfica actualizada de la enfermedad.

The exanthematic diseases are a set of clinical entities of diverse origin, usually due to infection, whose cardinal manifestation is a skin rash. Between these diseases, measles is very important, caused by the homonymous virus, an RNA virus family Paramyxoviridae, highly contagious in people who have not been immunized (5), which is transmitted by direct contact or by air. The clinical features consists of two phases, the prodromal phase characterized by high fever, cough, coryza and conjunctivitis; and the rush phase with the onset of characteristic erythematous maculopapular rush of measles. The diagnosis is suspected in any patient presenting with fever and characteristic rash. Diagnostic confirmation is done by serology detection of virus specific IgM antibodies in blood or oral secretions. The treatment is mainly based on support measures and vitamin A administration. In Chile there is MMR vaccine (measles, mumps, rubella), included in the National Immunization Program, which confers immunity against this agent. During this year, there have been reported measles outbreaks in different countries around the world, among them is Chile, for this reason arises the need for an updated literature review.

Measles Elimination Activities in the Western Pacific Region: Experience from the Republic of Korea

We describe the global status of measles control and elimination, including surveillance and vaccination coverage data provided by the World Health Organization (WHO). Since 2000, two doses of measles vaccine (MCV2) became recommended globally and the achievement of high vaccination coverage has led to dramatic decrease in the measles incidence. Our finding indicates that, in the Western Pacific Region (WPR), substantial progress has been made to control measles transmission in some countries; however, the measles virus continues to circulate, causing outbreaks. The Republic of Korea (ROK) experienced a series of resurgence of measles due to the importation and healthcare-associated transmission in infants, however overall incidence and surveillance indicators met the WHO criteria for measles elimination. The ROK was verified to be measles-free along with Australia, Mongolia, and Macau, China in 2014. One of the effective elimination activities was the establishment of solid keep-up vaccination system in school settings. The lessons learnt from the measles elimination activities in Korea may contribute to enhancing the surveillance schemes and strengthening of vaccination programs in member countries and areas of WPR.

Investigation of measles IgM-seropositive cases of febrile rash illnesses in the absence of documented measles virus transmission, State of São Paulo, Brazil, 2000-2004 / Investigação dos casos de doenças febris exantemáticas com IgM reagente contra o sarampo na ausência de transmissão documentada do vírus do sarampo, Estado de São Paulo, 2000-2004

INTRODUCTION: To review measles IgM-positive cases of febrile rash illnesses in the State of São Paulo, Brazil, over the five-year period following interruption of measles virus transmission. METHODS: We reviewed 463 measles IgM-positive cases of febrile rash illness in the State of São Paulo, from 2000 to 2004. Individuals vaccinated against measles < 56 days prior to specimen collection were considered to be exposed to the vaccine. Serum from the acute and convalescent phases was tested for evidence of measles, rubella, parvovirus B19 and human herpes virus-6 infection. In the absence of seroconversion to measles immunoglobulin-G, measles IgM-positive cases were considered false positives in individuals with evidence of other viral infections. RESULTS: Among the 463 individuals with febrile rash illness who tested positive for measles IgM antibodies during the period, 297 (64 percent) were classified as exposed to the vaccine. Among the 166 cases that were not exposed to the vaccine, 109 (66 percent) were considered false positives based on the absence of seroconversion, among which 21 (13 percent) had evidence of rubella virus infection, 49 (30 percent) parvovirus B19 and 28 (17 percent) human herpes virus-6 infection. CONCLUSIONS: Following the interruption of measles virus transmission, thorough investigation of measles IgM-positive cases is required, especially among cases not exposed to the vaccine. Laboratory testing for etiologies of febrile rash illness aids interpretation of these cases.

INTRODUÇÃO: Revisar os casos de doenças febris exantemáticas com IgM reagente contra o sarampo, no Estado de São Paulo, Brasil, durante os cinco anos seguidos a interrupção da transmissão do vírus do sarampo. MÉTODOS: Nós revisamos 463 casos de doenças febris exantemáticas com IgM reagente contra o sarampo, no Estado de São Paulo, Brasil, de 2000 a 2004. Indivíduos vacinados contra o sarampo 56 dias antes da coleta de amostra foram considerados expostos à vacina. Soros da fase aguda e de convalescença foram testados para a evidência de infecção de sarampo, rubéola, parvovírus B19 e herpes vírus 6. Na ausência de soroconversão para imunoglobulina G contra o sarampo, casos com IgM reagente contra o sarampo foram considerados falsos positivos em pessoas com evidência de outras infecções virais. RESULTADOS: Entre as 463 pessoas com doenças febris exantemáticas que testaram positivo para anticorpos IgM contra o sarampo durante o período, 297 (64 por cento) pessoas foram classificadas como expostas à vacina. Entre os 166 casos não expostos à vacina, 109 (66 por cento) foram considerados falsos positivos baseado na ausência de soroconversão, dos quais 21 (13 por cento) tiveram evidência de infecção por vírus da rubéola, 49 (30 por cento) parvovírus B19 e 28 (17 por cento) infecção por herpes vírus humano 6. CONCLUSÕES: Após a interrupção da transmissão do vírus do sarampo é necessária exaustiva investigação dos casos com IgM reagente contra o sarampo, especialmente dos casos não expostos à vacina. Testes laboratoriais para etiologias das doenças febris exantemáticas ajudam na interpretação destes casos.

Rhazes diagnostic differentiation of smallpox and measles

Abu Bakr Mohammad Ibn Zakariya al-Razi, known in the west as Rhazes, was born in 865 AD in the ancient city of Rey, near Tehran and died in the same town about 925 AD. He was the first person who distinguished the infectious rashes, in particular smallpox, from measles in a masterful demonstration of clinical observations, providing valid guidelines for the sound treatment of both. This study compares Rhazes Diagnostic Differentiation of Smallpox and Measles. There is an attempt in this study to compare modern microbiology with the chapters of Rhazes's fi Aljadari wa-al-hasbah. We used this book in its original language [Arabic] along with its Persian and English translations. Rhazes was among the first to recognize the need for sanitation of infected patients in hospitals. Rhazes prepared Al-Jodari Wa Hasbah, the first treatise ever written on smallpox and measles for diagnostic differentiation between these two infections, which is the basis for new medicine to diagnose and treat smallpox and measles, according to his experience of patients in hospital. He also noted that the cause of these infections was the yeast transmitted by the blood route. Today, the cause of smallpox and measles is known to be viruses. Rhazes not only classified the type of infections based on location and the time of the appearance of the symptoms in these two infections, but also he scaled the degree of severity and prognosis of infections according to the color and location of rashes. The method of differential diagnosis of measles and smallpox was precisely described based on his clinical experience and observation in hospitals; it is the best reference in the history of medicine for recognition of these two infections. This article is a review of Rhazes's views in medicine and their comparison with the modern microbiology

Freqüência de sarampo, rubéola, dengue e eritema infeccioso entre casos suspeitos de sarampo e rubéola no estado de Pernambuco, no período de 2001 a 2004 / Frequency of measles, rubella, dengue and erythema infectiosum among suspected cases of measles and rubella in the State of Pernambuco between 2001 and 2004

O estudo teve como objetivo verificar a freqüência de sarampo, rubéola, dengue e eritema infeccioso entre casos suspeitos de sarampo e rubéola, no estado de Pernambuco, Brasil. Foram testadas 1.161 amostras de soro coletadas no período de 2001 a 2004, para as quatro viroses, utilizando-se ensaios imunoenzimáticos para detecção de anticorpos IgM. Desse total, 276 (23,8 por cento) amostras foram positivas para uma das quatro viroses analisadas. Foram detectados 196 (16,9 por cento) casos positivos para dengue, 38 (3,3 por cento) para eritema infeccioso (parvovírus B19), 32 (2,8 por cento) para rubéola e 10 (0,9 por cento) para sarampo. Entre os casos suspeitos de sarampo e rubéola, a infecção pelo vírus dengue foi a mais freqüente, seguida pelo parvovírus B19. A semelhança de manifestações clínicas entre as doenças exantemáticas contribui para dificultar o diagnóstico de sarampo, rubéola, dengue e eritema infeccioso, quando observados apenas os critérios clínicos. Deve-se salientar que os quatro testes utilizados foram insuficientes para diagnosticar 76,2 por cento das doenças febris exantemáticas notificadas. Este é o primeiro estudo que evidencia a circulação de parvovírus B19 humano em Pernambuco.

This study had the aim of investigating the frequency of measles, rubella, dengue and erythema infectiosum among suspected cases of measles and/or rubella in the state of Pernambuco, Brazil. A total of 1,161 serum samples collected between 2001 and 2004 were tested for these four viral diseases, using enzyme immunoassays to detect IgM antibodies. Out of this total, 276 (23.8 percent) samples were positive for one of the four viral diseases analyzed. There were 196 positive cases (16.9 percent) for dengue, 38 (3.3 percent) for erythema infectiosum (parvovirus B19), 32 (2.8 percent) for rubella and 10 (0.9 percent) for measles. Among the suspected cases of measles and rubella, dengue infection was the most frequent, followed by parvovirus B19. The similarity of the clinical manifestations among rash diseases contributes towards making it difficult to diagnose measles, rubella, dengue and erythema infectiosum on clinical grounds alone. It must be emphasized that the four tests used were insufficient for diagnosing 76.2 percent of the febrile and rash diseases notified. This is the first study bringing evidence of human parvovirus B19 circulation in Pernambuco.