Measles elimination in Italy: data from laboratory activity, 2011-2013.

BACKGROUND: The European Regional Office of the World Health Organization developed a strategic approach to halt the indigenous transmission of measles in its 53 Member States by 2015, World Health Organization [1]. Many European countries, including Italy began the implementation of national programs to reach this goal. OBJECTIVES: To describe and discuss the results of laboratory activity in measles surveillance, performed from January 2011 to December 2013 by the Italian National Reference Laboratory for Measles and Rubella. STUDY DESIGN: Samples of suspected measles cases were collected from different Italian regions to confirm clinical diagnosis. Anti-measles IgM antibodies detection by Enzyme-Linked Immunosorbent Assay and/or molecular detection by Reverse Transcriptase-Polymerase Chain Reaction assay were performed. Positive samples were sequenced for viral characterization. RESULTS AND CONCLUSIONS: According to results from the National Reference Laboratory's activity urine and blood seem to be the best specimens for measles laboratory surveillance. Phylogenetic analysis revealed a co-circulation of the genotypes D4 and D8 during the reviewed period, a cluster of B3 and sporadic cases of D9 and H1.

Spotlight on measles 2010: excretion of vaccine strain measles virus in urine and pharyngeal secretions of a child with vaccine associated febrile rash illness, Croatia, March 2010.

We describe excretion of measles vaccine strain Schwarz in a child who developed a febrile rash illness eight days after primary immunisation against measles, mumps and rubella. Throat swabs and urine specimens were collected on the fifth and sixth day of illness, respectively. Genotyping demonstrated measles vaccine strain Schwarz (genotype A). If measles and rubella were not under enhanced surveillance in Croatia, the case would have been either misreported as rubella or not recognised at all.

[Measles outbreak in Barcelona. Clinical and epidemiological characteristics]. / Brote de sarampión en Barcelona. Características clínicas y epidemiológicas.

INTRODUCTION: Measles is an acute, highly contagious illness that affects humans, the only natural host. Although effective attenuated virus vaccines exist for this disease, outbreaks continue to occur in susceptible subgroups. From August 2006 to July 2007, an outbreak of measles occurred in the Barcelona (Spain) area, resulting from an imported case. The aim of this study was to describe the clinical and epidemiological characteristics of children with microbiologically confirmed measles diagnosed at our hospital. METHODS: Retrospective, descriptive study. The clinical histories and emergency records of children diagnosed with measles and evaluated at our hospital during the outbreak were analyzed. RESULTS: Of the 130 children with suspected measles evaluated, 99 cases were confirmed by laboratory tests. Median age at diagnosis was 12.4 months (25th-75th percentile: 9.6-14.4 months; 74.6% 6-15 months of age) and 51.4% were boys. Among the total, 23.6% of patients had been vaccinated against measles and 55.3% reported previous contact with a confirmed measles case. The most frequent symptoms/signs were fever (100%; mean evolution 4.3 days (standard deviation [SD]: 2.2 days), rash (82.7%), Koplik's spots (60.2%), and red eyes (59.2%). Complementary tests were performed in 35.7% of children. Most common complications were acute otitis media (20.4%) and pneumonia (15.3%). Among the total, 23.5% of patients were hospitalized for a mean duration of 6.6 days (SD: 3.6 days). CONCLUSION: Geographical mobility facilitates the reappearance of diseases having a low incidence. Infants 6-15 months of age were the patient group most highly affected by the measles outbreak. Most cases were diagnosed with typical signs and symptoms of the infection, but as the outbreak advanced, patients were diagnosed based on less specific symptoms because of the epidemiological context.

Genomic characterization of wild-type measles viruses that circulated in different states in Brazil during the 1997 measles epidemic.

Despite the marked reduction in the incidence of measles in Brazil, a measles epidemic occurred in this country in 1997. The measles cases observed during this epidemic began to reappear in large numbers in São Paulo, and spread to Rio de Janeiro and other Brazilian states. In the present study molecular biology techniques were used for the detection and genomic characterization of measles viruses from clinical samples such as urine and nasopharyngeal secretions collected in the states of Rio de Janeiro, Minas Gerais and Paraná, during the 1997 epidemic. RT-PCR and nucleotide sequence analysis of part of the carboxyl-terminal region of the nucleoprotein gene of measles viruses obtained directly from clinical samples or from infected cell cultures during this epidemic classified all as wild-type of genotype D6. As the genotype D6 was identified in different Brazilian states, this study demonstrated that this genotype was circulating in Brazil during the 1997 epidemic.

A rapid culture assay for examining measles virus infections from urine specimens.

BACKGROUND: Large numbers of measles virus (MV) specimens are processed in our laboratory each year as part of a molecular epidemiological study of MV in South Africa. The development of a sensitive, rapid virus isolation system is needed to cope with the number of specimens processed. OBJECTIVES: A comparison was made of centrifugation-enhanced shell vial culture and standard tissue culture using B95a cells for the isolation of MV from throat swabs and urine. STUDY DESIGN: The rapid method was initially evaluated using Schwarz vaccine virus and then compared to standard culture using throat swab specimens. RESULTS: The shell via assay proved to be ten times more sensitive than standard culture in the initial evaluation. Of 43 throat swab specimens, 37 (86%) were positive and 6 (14%) negative in standard culture using B95a cells. The specimens were removed after adsorption in standard culture, frozen and then used in the shell vial assay. It was found that 16/27 were positive in the shell vial assay (24 of these 27 being positive in standard culture,) and 8 negative and 8 specimens gave an indeterminate result. For the 45 urine specimens used in the shell vial assay, 71% were positive, 11% negative and 18% gave an indeterminate result, due to too few cells being present for antigen determination by indirect fluorescent antibody assay. Results were obtained in 4 days, as opposed to the average of 14 days for confirmed isolation in standard culture. CONCLUSION: Rapid culture substantially reduced total test time, was less labour-intensive and was as sensitive as standard culture for the isolation of measles virus from clinical specimens.

Detection of measles virus RNA in urine specimens from vaccine recipients.

Analysis of urine specimens by using reverse transcriptase-PCR was evaluated as a rapid assay to identify individuals infected with measles virus. For the study, daily urine samples were obtained from either 15-month-old children or young adults following measles immunization. Overall, measles virus RNA was detected in 10 of 12 children during the 2-week sampling period. In some cases, measles virus RNA was detected as early as 1 day or as late as 14 days after vaccination. Measles virus RNA was also detected in the urine samples from all four of the young adults between 1 and 13 days after vaccination. This assay will enable continued studies of the shedding and transmission of measles virus and, it is hoped, will provide a rapid means to identify measles infection, especially in mild or asymptomatic cases.

Urinary excretion of 3-methylhistidine, creatinine and total nitrogen by Kenyan children during acute measles and after recovery.

The urinary excretion of 3-methylhistidine (3MH), creatinine and total nitrogen was measured during the course of energy balance studies on 20 black Kenyan children. Studies were carried out over 24 h during an acute attack of measles with a second (control) study after recovery, and complete urinary collections were obtained on 14 ill and 18 recovered children. The nutritional status was assessed by anthropometry, and energy intake was determined by duplicate diet analysis. Twelve out of 13 acutely ill and 6 out of 17 recovered children were in negative energy balance. No effect on the rate of excretion of 3MH or of creatinine attributable to differences in nutritional status, of energy intake or to infection was observed. The linear relationship between the excretion rate of all three metabolites and body weight which was observed in recovered children was absent during acute infection. Nitrogen excretion was correlated (P less than 0.05) with the level of energy intake. The linear relationship between the rate of excretion of 3MH and creatinine and of 3MH and nitrogen was significantly closer in recovered than in ill children. The simultaneous effects of infection, underfeeding (and oliguria) on the rate of excretion of protein metabolites may be complex and contradictory. Our results suggest that the excretion of 3MH, creatinine and nitrogen is sustained during infection accompanied by negative energy balance. Disruption during infection of the relationship between the excretion of all three metabolites and body weight, and between 3MH and the other two metabolites suggests perturbation in protein metabolism at this time.

Cellular elements in the urine in health and in acute infectious diseases, especially with respect to the presence of haematuria. A study with application of millipore procedure and Papanicolaou staining.

The excretion of cellular per litre of urine amounted in healthy persons to, in round figures, one million epithelial cells (2.5 cells per visual field) in both sexes, one million leukocytes in males, one million erythrocytes in females and 0.5 million in males. The maximal excretion was calculated to be 5-6 million per litre. In acute infections the number of epithelial cells and leukocytes in the urine rose to more than the double. Pathological microscopic haematuria, judged by exceeding of the maximal value for normal excretion during the acute phase (24 or more erythrocytes per visual field), occurred in no case of mycoplasma infection, in about 4% of measles, mononucleosis, serous meningitis and hepatitis cases, in about 8% of mumps and streptococcal infections, and in more than 20% of influenza A2 cases. Statistical significance or probable significant existed between influenza and other diseases. The haematuria was unrelated either to the general degenerative or to the specific inclusion-provocative reaction within the renal and urinary tract epithelium. The cause is sought in an involvement of glomeruli with increased diapedesis. The special position of influenza may be explained by the marked haemorrhagic reactions produced by this infection. In one case persistent haematuria combined with increased content of inclusion-bearing cells occurred after influenza. Immunoglobulin deposition in glomerular mesangium may perhaps be one explanation of this haematuria.

Further observations on inclusion-bearing cells in urinary sediment in infectious diseases.

A study of the cytology of the urinary sediment in 43 patients with known viral diseases has revealed a variety of inclusion-bearing cells in 28.The morphology of the cells suggest that the changes recorded may be due to the viral infections, at least in some instances, bearing in mind the findings of workers quoted in our 1964 report that cellular changes very similar to those induced by virus infections can be initiated by non-viral stimuli. Multinucleate giant cells are occasionally found in chickenpox, measles, herpes simplex infection, and in mumps.