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. 2019 Jul;24(29):1900041.
doi: 10.2807/1560-7917.ES.2019.24.29.1900041.

Characterisation of measles after the introduction of the combined measles-mumps-rubella (MMR) vaccine in 2004 with focus on the laboratory data, 2016 to 2019 outbreak, Romania

Mihaela Lazar  1   2 , Aurora Stănescu  3 , Ana Raquel Penedos  4 , Adriana Pistol  3
Affiliations

Characterisation of measles after the introduction of the combined measles-mumps-rubella (MMR) vaccine in 2004 with focus on the laboratory data, 2016 to 2019 outbreak, Romania

Mihaela Lazar et al. Euro Surveill. 2019 Jul.

Abstract

BackgroundSince January 2016, a resurgence of measles in Romania has led to the third measles epidemic in the past 12 years; 64 deaths have been confirmed so far-the highest number of measles-related deaths since the measles-mumps-rubella (MMR) vaccine was introduced in 2004.AimTo provide an overview on the characterisation on measles in Romania after the introduction of the MMR vaccine with focus on the current outbreak, laboratory and molecular analysis.MethodsWe performed an analysis of measles incidence and mortality after the introduction of MMR vaccination and a retrospective study using serological and molecular data in three consecutive outbreaks with focus on the current outbreak.ResultsIn the current outbreak, 17,533 measles cases were notified to the national surveillance system, 93% were unvaccinated. Measles virus was isolated from 429 samples and 283 were genotyped. Genotype B3 was predominant (n = 269) and sporadic measles cases associated with D8 genotype (n = 9) were also observed; genotype D4 and D8 were identified in the previous two measles outbreaks. The detection of several distinct measles virus B3 genotypes suggests multiple virus importations to Romania.ConclusionThe current outbreak is a consequence of insufficient vaccine coverage. Control measures were implemented to improve uptake of MMR vaccine, including administering the first MMR dose at a younger age (9-11 months) and offering catch-up vaccination to children that have not followed the recommended dosing schedule. More measures are needed to improve the surveillance performance and to achieve high routine MMR vaccination coverage.

Keywords: MMR; Romania; air-borne infections; children; epidemiology; laboratory; laboratory surveillance; measles; measles-mumps-rubella (MMR) vaccine; molecular epidemiology; molecular methods; outbreak; vaccination; vaccine-preventable diseases; viral infections.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Incidence of measles in Romania,1960–2015
Figure 2
Figure 2
Measles cases by vaccination status, Romania, January 2016–July 2019 (n = 7,533)
Figure 3
Figure 3
Geographical distribution of serologically confirmed measles cases and virus genotype, Romania, January 2016–January 2019 (n = 9,673)
Figure 4
Figure 4
Quarterly distribution of confirmed measles cases and genotypes, Romania, 2004–2018 (n = 24,399)
Figure 5
Figure 5
Phylogenetic relationship between representative measles B3 strains, Romania
Figure 6
Figure 6
Phylogenetic tree of 18 cases infected with measles virus genotype D8, Romania, 2012–2019
See this image and copyright information in PMC

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