Laboratory investigations are indispensable to monitor the progress of measles elimination--results of the German Measles Sentinel 1999-2003.
BACKGROUND
The elimination of measles is a goal set by the World Health Organisation to be reached by 2010 in the European region.


OBJECTIVE
To enhance the measles surveillance in Germany, a country-wide laboratory supported a sentinel was established.


METHODS
A network of >1200 representatively distributed practitioners reported detailed data on all clinically diagnosed cases and provided specimens for laboratory diagnosis.


RESULTS
A total of 3225 suspected cases were reported between October 1999 and December 2003. The incidence in Western Germany decreased from >15 cases per 100,000 population to one case in 2003, while in Eastern Germany <1 case per 100,000 population was observed during these years. Laboratory investigations were undertaken in 40% of cases in 2000/2001. This rate increased to 79% in 2003. Simultaneously, the rate of confirmed cases dropped from 60% in the former years to 23% in 2003. Measles virus (MV) detection by serology and by PCR revealed concordant results in 92%. Most suspected cases (85%) were unvaccinated with 66% being laboratory confirmed. Only 10% of suspected cases occurred in vaccinated individuals and very few (22%) could be confirmed. Analyses of confirmed measles in vaccinated patients (n = 49) revealed 24.5% primary vaccine failures, 24.5% reinfections after successful vaccination and 31% MV infection before or shortly after vaccination. The genetic characterisation of 389 MV isolates identified eight genotypes: B3, C2, D4, D5, D6, D7, G2 and H1. Only the C2, D6 and D7 MV genotypes circulated endemically in Western Germany. The newly emerged MV D7 almost completely replaced the pre-existing C2 and D6 MVs in 2001. The few measles cases detected in Eastern Germany were mostly caused by imported MVs.


CONCLUSIONS
The data demonstrate that laboratory investigations including molecular methods are an indispensable tool for surveillance in all countries advanced in measles elimination.
Division of Viral Infections, Robert Koch Institute, Nordufer 20, D-13353 Berlin, Germany. tischera@rki.de
Annedore
A
Tischer
Sabine
S
Santibanez
Anette
A
Siedler
Alla
A
Heider
Hartmut
H
Hengel
D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques; D005838:Genotype; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008457:Measles / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D008458:Measles Vaccine / Q000008:administration & dosage; D008459:Measles virus / Q000145:classification / Q000235:genetics / Q000276:immunology* / Q000302:isolation & purification*; D018571:Sentinel Surveillance
D000914:Antibodies, Viral; D008458:Measles Vaccine