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Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014–2020

The MMR vaccination program was introduced in Spain in 1981. Consistently high vaccination coverage has led to Spain being declared free of endemic measles transmission since 2014. A few imported and import-related cases were reported during the post-elimination phase (2014 to 2020), with very low i...

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Autores principales: López-Perea, Noemí, Fernández-García, Aurora, Echevarría, Juan Emilio, de Ory, Fernando, Pérez-Olmeda, Mayte, Masa-Calles, Josefa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537497/
https://www.ncbi.nlm.nih.gov/pubmed/34696412
http://dx.doi.org/10.3390/v13101982
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author López-Perea, Noemí
Fernández-García, Aurora
Echevarría, Juan Emilio
de Ory, Fernando
Pérez-Olmeda, Mayte
Masa-Calles, Josefa
author_facet López-Perea, Noemí
Fernández-García, Aurora
Echevarría, Juan Emilio
de Ory, Fernando
Pérez-Olmeda, Mayte
Masa-Calles, Josefa
author_sort López-Perea, Noemí
collection PubMed
description The MMR vaccination program was introduced in Spain in 1981. Consistently high vaccination coverage has led to Spain being declared free of endemic measles transmission since 2014. A few imported and import-related cases were reported during the post-elimination phase (2014 to 2020), with very low incidence: three cases per million of inhabitants a year, 70% in adults. In the post-elimination phase an increasing proportion of measles appeared in two-dose vaccinated individuals (up to 14%), posing a challenge to surveillance and laboratory investigations. Severity and clinical presentation were milder among the vaccinated. The IgM response varied and the viral load decreased, making the virus more difficult to detect. A valid set of samples (serum, urine and throat swab) is strongly recommended for accurate case classification. One third of measles in fully vaccinated people was contracted in healthcare settings, mainly in doctors and nurses, consistent with the important role of high intensity exposure in measles breakthrough cases. Surveillance protocols and laboratory algorithms should be adapted in advanced elimination settings. Reinforcing the immunity of people working in high exposure environments, such as healthcare settings, and implementing additional infection control measures, such as masking and social distancing, are becoming crucial for the global aim of measles eradication.
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spelling pubmed-85374972021-10-24 Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014–2020 López-Perea, Noemí Fernández-García, Aurora Echevarría, Juan Emilio de Ory, Fernando Pérez-Olmeda, Mayte Masa-Calles, Josefa Viruses Article The MMR vaccination program was introduced in Spain in 1981. Consistently high vaccination coverage has led to Spain being declared free of endemic measles transmission since 2014. A few imported and import-related cases were reported during the post-elimination phase (2014 to 2020), with very low incidence: three cases per million of inhabitants a year, 70% in adults. In the post-elimination phase an increasing proportion of measles appeared in two-dose vaccinated individuals (up to 14%), posing a challenge to surveillance and laboratory investigations. Severity and clinical presentation were milder among the vaccinated. The IgM response varied and the viral load decreased, making the virus more difficult to detect. A valid set of samples (serum, urine and throat swab) is strongly recommended for accurate case classification. One third of measles in fully vaccinated people was contracted in healthcare settings, mainly in doctors and nurses, consistent with the important role of high intensity exposure in measles breakthrough cases. Surveillance protocols and laboratory algorithms should be adapted in advanced elimination settings. Reinforcing the immunity of people working in high exposure environments, such as healthcare settings, and implementing additional infection control measures, such as masking and social distancing, are becoming crucial for the global aim of measles eradication. MDPI 2021-10-02 /pmc/articles/PMC8537497/ /pubmed/34696412 http://dx.doi.org/10.3390/v13101982 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
López-Perea, Noemí
Fernández-García, Aurora
Echevarría, Juan Emilio
de Ory, Fernando
Pérez-Olmeda, Mayte
Masa-Calles, Josefa
Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014–2020
title Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014–2020
title_full Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014–2020
title_fullStr Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014–2020
title_full_unstemmed Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014–2020
title_short Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014–2020
title_sort measles in vaccinated people: epidemiology and challenges in surveillance and diagnosis in the post-elimination phase. spain, 2014–2020
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537497/
https://www.ncbi.nlm.nih.gov/pubmed/34696412
http://dx.doi.org/10.3390/v13101982
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