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. 2018 Feb 15;13(2):e0188957.
doi: 10.1371/journal.pone.0188957. eCollection 2018.

Occurrence of measles in a country with elimination status: Amplifying measles infection in hospitalized children due to imported virus

HyeEun Eom  1 , YoungJoon Park  1 , JooWhee Kim  1 , Jeong-Sun Yang  2 , HaeJi Kang  2 , Kisoon Kim  2 , Byung Chul Chun  3 , Ok Park  1 , Jeong Ik Hong  1
Affiliations

Occurrence of measles in a country with elimination status: Amplifying measles infection in hospitalized children due to imported virus

HyeEun Eom et al. PLoS One. .

Abstract

The Republic of Korea declared measles elimination in 2006. However, a measles outbreak occurred in 2013. This study aimed to identify the epidemiological characteristics of the sources of infection and the pattern of measles transmission in 2013 in South Korea. We utilized surveillance data, epidemiological data, immunization registry data, and genetic information. We describe the epidemiological characteristics of all measles case patients (sex, age distribution, vaccination status, sources of infection) as well as details of the outbreak (the pattern of transmission, duration, mean age of patients, and generation time). In 2013, a total of 107 measles cases were notified. Most patients were infants (43.0%) and unvaccinated individuals (60.7%). We identified 4 imported and 103 import-related cases. A total of 105 cases were related to four outbreaks that occurred in Gyeongnam, northern Gyeonggi, southern Gyeonggi, and Seoul. The predominant circulating genotype was B3 type, which was identified in the Gyeongnam, northern Gyeonggi, and southern Gyeonggi outbreaks. The B3 type had not been in circulation in South Korea in the previous 3 years; virologic evidence suggests that these outbreaks were import-related. Most measles cases in South Korea have been associated with imported measles virus. Although Korea has maintained a high level of herd immunity, clustering of susceptible people can cause such measles outbreaks.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Sporadic cases and four outbreaks by week, according to sources of infection, in South Korea, 2013.
*Reference: date of rash onset *Sporadic cases detected in weeks 5 and 18 lived in Gyeongnam and Southern Gyeonggi provinces, respectively. No sporadic cases were related to the four outbreaks.
Fig 2
Fig 2. Geographical distribution of measles cases in South Korea, 2013.
*A foreigner (n = 2) is displayed in notification area. Black dot on the map indicates a sporadic case. Measles outbreaks occurred in four regions of South Korea (Gyeongnam, northern and southern Gyeonggi, and Seoul).
Fig 3
Fig 3. Phylogenetic tree of measles virus isolated in South Korea, 2006–2013.
Fig 4
Fig 4. Transmission patterns of measles outbreaks in four regions of South Korea, 2013.
See this image and copyright information in PMC

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