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. 2022 Oct 31;63(5):475-481.
doi: 10.3325/cmj.2022.63.475.

Detection of measles virus in Bulgaria from 2012 to 2018

Stefka Krumova  1 , Sabine Santibanez, Ivona Andonova, Radostina Stefanova, Annette Mankertz, Todor Kantardjiev
Affiliations

Detection of measles virus in Bulgaria from 2012 to 2018

Stefka Krumova et al. Croat Med J. .

Abstract

Aim: To determine the circulation patterns of measles virus in Bulgaria from 2012 to 2018 after a large measles outbreak in the country (2009-2011).

Methods: Three types of clinical material were collected: serum samples, urine samples, and nasal swabs. Enzyme-linked immunosorbent assay (ELISA) was used to detect specific viral immunoglobulin (Ig) M/IgG antibodies. Viral RNA was extracted from all urine and nasal swabs.

Results: In the investigated period, 102 patients were confirmed to have measles (age range: two months to 55 years). A total of 101 samples (99%) were measles-IgM positive. Most of them were detected in 2017 (73%, 74/101), when a measles outbreak in the country was reported. The majority of patients were unvaccinated children aged under 13 months. Out of 101 measles serum samples confirmed by ELISA, 18 (20.45%) were measles-IgG positive and 15 (17.05%) were borderline. Thirty-three positive PCR products were sequenced and genotyped. In 2013, 2016, 2017, and 2018, three different measles viral genotypes were detected: D8, H1, and B3. Most patients were unvaccinated or insufficiently vaccinated.

Conclusion: Preventive measures are indispensable to limit the infection in different regions of Bulgaria and its spread to other countries. As vaccination coverage against measles and other vaccine-preventable infections, including SARS-Co2, is low, it is necessary to perform molecular identification of viruses to monitor their circulation and pathogenicity.

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Figures

Figure 1
Figure 1
The number of patients confirmed with having measles-specific immunoglobulin M (IgM) and IgG according to age groups, 2012-2018 (n = 101).
Figure 2
Figure 2
Phylogenetic tree based on a 450-nt region of the N gene of measles virus created using the Kimura 2-parameter model and the neighbor-joining algorithm of MEGA 5.05. Only bootstrap values ≥70% (1000 replicates) are shown. Bulgarian sequences are named based on the location, epidemiological week, and year. The sequences obtained during the present study are marked with black dots, and reference sequences are defined by accession number, name, and genotype. Bulgarian sequences from the period 2013-2017 are noted according to the year (2013: black circle, 2016: black triangle, 2017: gray rhombus). In the GenBank, we found identical strains from other countries, and reference sequences were determined by accession number, name and genotype.
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