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Contribution of virological surveillance to measles control and elimination programs

Paul A. Rota, Stephanie Liffick, Jennifer S. Rota, and William J. Bellini
Centers for Disease Control and Prevention, Atlanta, GA, USA

A key component of laboratory-based surveillance for measles is the genetic characterization of wild-type measles viruses. This molecular data, when analyzed in conjunction with standard epidemiological data, can help to monitor the transmission pathways of the virus. Observation of changes in temporal distribution of viral genotypes in a particular area can provide a means to measure the effectiveness of vaccination programs. For example, data collected in the US between 1989 and 1998 clearly indicated that interruption of viral transmission was achieved in 1993 and subsequently maintained (Figure). The genetic data was used to confirm epidemiological links or to suggest the viral source when standard epidemiological data was not available (1, 2, 3).

For virological surveillance to be most effective, appropriate specimens must be obtained from suspected measles cases as soon as possible after rash onset. Measles viruses was isolated from 25% of specimens collected from individuals with serologically confirmed cases of measles, while RT-PCR was able to detect measles RNA in 33% of these samples. However, no virus was isolated or viral RNA detected in any of the specimens taken more than 5 days after rash onset.

To facilitate expanded virological surveillance activities, the World Health Organization has recently proposed a standardized analysis protocol and nomenclature for the description of the genetic characteristics of wild type measles viruses. Comparison of the sequences from a large number of wild-type measles viruses leads to the recognition of 15 genotypes. To properly document transmission patterns, virological surveillance must be initiated or expanded in all areas of the world before accelerated control programs are enacted. This standardized nomenclature will allow for efficient acquisition and dissemination of this important information (4).

References:
1. Rota J.S., Heath, J.L., Rota P.A., King G.E., Celma M.L., Carabaña J., Fernandez-Muñoz R., Brown D., Jin L., and Bellini W.J. (1996) Molecular epidemiology of measles virus: Identification of pathways of transmission and the implications for measles elimination. J Infect Dis 173:32-37.

2. Rota, J.S., Rota, P.A., Redd, S.C.,Pattamadilok, S., and Bellini W.J. (1998) Phylogenetic analysis of measles viruses isolated in the United States 1995-1996. J. Inf. Dis. 177:204-208.

3. Bellini W.J. and Rota, P.A. (1998) Genetic diversity of wild-type measles viruses: Implications for global measles elimination programs. Emerging Inf. Dis. 4:1-7.

4. World Health Organization (1998) Standardisation of the nomenclature for describing the genetic characteristics of wild-type measles viruses. Weekly Epidemiologic Record, 73:265-272.

Abstract - Presented at the Virus Evolution Workshop
Ardmore, OK
October 21 - 24th, 1999

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Dr. Marilyn Roossinck
Plant Biology Division
The Noble Foundation
P.O. Box 2180
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phone: 580 224-6630