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Volume 17, Number 8—August 2011

Research

Spread of Measles Virus D4-Hamburg, Europe, 2008–2011

Annette MankertzComments to Author , Zefira Mihneva, Hermann Gold, Sigrid Baumgarte, Armin Baillot, Rudolph Helble, Hedwig Roggendorf, Golubinka Bosevska, Jasminka Nedeljkovic, Agata Makowka, Veronik Hutse, Heidemarie Holzmann, Stefan W. Aberle, Samuel Cordey, Gheorghe Necula, Andreas Mentis, Gulay Korukluoğlu, Michael Carr, Kevin E. Brown, Judith M. Hübschen, Claude P. Muller, Mick N. Mulders, and Sabine Santibanez
Author affiliations: Author affiliations: Robert Koch Institute, Berlin, Germany (A. Mankertz, S. Santibanez); National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria (Z. Mihneva); Department of Health and Environment, München, Germany (H. Gold); Institute of Hygiene and the Environment, Hamburg, Germany (S. Baumgarte); Governmental Institute of Public Health of Lower Saxony, Hannover, Germany (A. Baillot); Health Office City of Mannheim, Mannheim, Germany (R. Helble); Public Health Office, Essen, Germany (H. Roggendorf); Institute for Public Health, Skopje, Republic of Macedonia (G. Bosevska); Institute of Virology, Belgrade, Serbia (J. Nedeljkovic); National Institute of Public Health, Warsaw, Poland (A. Makowka); Scientific Institute of Public Health, Brussels, Belgium (V. Hutse); Medical University of Vienna, Vienna, Austria (H. Holzmann, S.W. Aberle); University of Geneva Hospitals, Geneva, Switzerland (S. Cordey); Cantacuzino National Institute of Research and Development for Microbiology and Immunology, Bucharest, Romania (G. Necula); Hellenic Pasteur Institute, Athens, Greece (A. Mentis); Refik Saydam National Public Health Agency, Ankara, Turkey (G. Korukluoğlu); Virus Reference Laboratory, Dublin, Ireland (M. Carr); Health Protection Agency, London, UK (K.E. Brown); Laboratoire National de Santé/CRP-Santé, Luxembourg (J.M. Hübschen, C.P. Muller); World Health Organization Regional Office for Europe, Copenhagen, Denmark (M.N. Mulders)

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Table A1

Data for 20 patients and results of laboratory investigation of measles virus specimens, Bulgaria, April 2009–March 2011*

Patient no. Age Vaccination status, year Rash onset/date specimens obtained IgM IgG Avidity PCR results Genotype Diagnosis
1 6 y MMR1, 2004 2009 Apr 16/Apr 23 Pos Equivocal ND U pos MVs/Shumen.BGR/15.09/1[D4] Acute measles, vaccination failure
2 29 y Unknown 2009 Apr 16/Apr 23 Pos Pos ND U pos MVs/Shumen.BGR/15.09/2[D4] Acute measles
3 33 y Unknown 2009 Apr 16/Apr 23 Pos Pos ND U pos MVs/Shumen.BGR/15.09/3[D4] Acute measles
4 13 y Unknown 2009 May 25/May 30 Pos Pos ND U pos MVs/Silistra.BGR/21.09/1[D4] Acute measles
5 23 y Unknown 2009 May 25/May 30 Pos Neg ND U pos MVs/Silistra.BGR/21.09/2[D4] Acute measles
6 11 y Unknown 2009 May 25/May 30 Pos Pos ND U pos MVs/Silistra.BGR/21.09/3[D4] Acute measles
7 11 y MMR1, 1998 2009 May 25/May 30 Pos Pos Low (8%) U pos MVs/Silistra.BGR/21.09/4[D4] Acute measles, vaccination failure
8 18 y Unknown 2010 Jan 4/Jan 14 No serum U pos Sequence neg Acute measles
9 11 y Unknown 2010 Jan 12/Jan 21 Pos Neg ND U pos MVs/Blagoevgrad.BGR/02.10/1[D4] Acute measles
10 22 y Unknown 2010 Jan 14/Jan 21 Pos Neg ND U pos MVs/Plovdiv.BGR/03.10/1[D4] Acute measles
11 7 mo Not vaccinated 2010 Jan 18/Jan 21 No serum U pos MVs/Plovdiv.BGR/03.10/2[D4] Acute measles
12 15 y MMR2 2010 Jan 13/Jan 21 Pos Neg ND U pos MVs/Plovdiv.BGR/03.10/3[D4] Acute measles, vaccination failure
13 35 y Unknown 2010 Jun 2/Jun 7 Pos Pos Low (27%) U pos, TS pos MVs/Plovdiv.BGR/23.10/1[D4] Acute measles
14 19 y MMR1, 1991/ MMR2, 2002 2010 Jun 3/Jun 7 Equivocal Pos Equivocal (46%) U pos, TS pos MVs/Plovdiv.BGR/23.10/2[D4] Secondary vaccination failure?
15 11 y MMR1, 2001/
MMR2 2010 May 27 2010 Jun 2/Jun 7 Pos Neg ND U pos, TS pos MVs/Plovdiv.BGR/23.10/3[D4] Acute measles, vaccination failure
16 9 y Unknown 2010 Jun 4/Jun 7 Pos Neg ND U neg, TS pos MVs/Plovdiv.BGR/23.10/4[D4] Acute measles
17 14 y MMR1, 1998 2010 Jun 4/Jun 7 Pos Neg ND U pos, TS pos MVs/Plovdiv.BGR/23.10/5[D4] Acute measles, vaccination failure
18 6 y MMR1, 2004 2010 Jun 3/Jun 7 Pos Neg ND U pos, TS pos MVs/Plovdiv.BGR/23.10/6[D4] Acute measles, vaccination failure
19 22 y Unknown 2011 Mar 6/Mar 11 Pos Pos 93% U pos MVs/VelikoTarnovo.BGR/10.11/1[D4] Secondary vaccination failure
20 32 y Unknown 2011 Mar 8/Mar 11 Pos Pos 86% U pos MVs/VelikoTarnovo.BGR/10.11/2[D4] Secondary vaccination failure

*Ig, immunoglobulin; MMR, measles, mumps, rubella vaccine; MMR1, 1 dose of MMR vaccine; MMR2, two doses of MMR vaccine; pos, positive; ND, not determined; U, urine; neg, negative;–, not investigated (serum sample not available); TS, throat swab. Patients were hospitalized in distinct districts of Bulgaria; specimens were investigated in the World Health Organization Regional Reference Laboratory, Berlin, Germany.

*Ig, immunoglobulin; MMR, measles, mumps, rubella vaccine; MMR1, 1 dose of MMR vaccine; MMR2, two doses of MMR vaccine; pos, positive; ND, not determined; U, urine; neg, negative;–, not investigated (serum sample not available); TS, throat swab. Patients were hospitalized in distinct districts of Bulgaria; specimens were investigated in the World Health Organization Regional Reference Laboratory, Berlin, Germany.

*Ig, immunoglobulin; MMR, measles, mumps, rubella vaccine; MMR1, 1 dose of MMR vaccine; MMR2, two doses of MMR vaccine; pos, positive; ND, not determined; U, urine; neg, negative;–, not investigated (serum sample not available); TS, throat swab. Patients were hospitalized in distinct districts of Bulgaria; specimens were investigated in the World Health Organization Regional Reference Laboratory, Berlin, Germany.

*Ig, immunoglobulin; MMR, measles, mumps, rubella vaccine; MMR1, 1 dose of MMR vaccine; MMR2, two doses of MMR vaccine; pos, positive; ND, not determined; U, urine; neg, negative;–, not investigated (serum sample not available); TS, throat swab. Patients were hospitalized in distinct districts of Bulgaria; specimens were investigated in the World Health Organization Regional Reference Laboratory, Berlin, Germany.

*Ig, immunoglobulin; MMR, measles, mumps, rubella vaccine; MMR1, 1 dose of MMR vaccine; MMR2, two doses of MMR vaccine; pos, positive; ND, not determined; U, urine; neg, negative;–, not investigated (serum sample not available); TS, throat swab. Patients were hospitalized in distinct districts of Bulgaria; specimens were investigated in the World Health Organization Regional Reference Laboratory, Berlin, Germany.

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