title: Description of two measles outbreaks in the Lazio Region, Italy (2006-2007). Importance of pockets of low vaccine coverage in sustaining the infection.
abstract: BACKGROUND
  Despite the launch of the national plan for measles elimination, in Italy, immunization coverage remains suboptimal and outbreaks continue to occur. Two measles outbreaks, occurred in Lazio region during 2006-2007, were investigated to identify sources of infection, transmission routes, and assess operational implications for elimination of the disease.
  
  
  METHODS
  Data were obtained from several sources, the routine infectious diseases surveillance system, field epidemiological investigations, and molecular genotyping of virus by the national reference laboratory.
  
  
  RESULTS
  Overall 449 cases were reported, sustained by two different stereotypes overlapping for few months. Serotype D4 was likely imported from Romania by a Roma/Sinti family and subsequently spread to the rest of the population. Serotype B3 was responsible for the second outbreak which started in a secondary school. Pockets of low vaccine coverage individuals (Roma/Sinti communities, high school students) facilitated the reintroduction of serotypes not endemic in Italy and facilitated the measles infection to spread.
  
  
  CONCLUSIONS
  Communities with low vaccine coverage represent a more serious public health threat than do sporadic susceptible individuals. The successful elimination of measles will require additional efforts to immunize low vaccine coverage population groups, including hard-to-reach individuals, adolescents, and young adults. An enhanced surveillance systems, which includes viral genotyping to document chains of transmission, is an essential tool for evaluating strategy to control and eliminate measles.
authors.affiliation: Unit of Infecious Diseases and Vaccination, Department of Health Prevention and Promotion, Laziosanita' Agenzia di Sanita' Pubblica, Via Santa Costanza 53, 00198 Roma, Italy. f.curtale@ickamp.org
authors.forename: Filippo
authors.initials: F
authors.lastname: Curtale
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Perrelli
authors.forename: Jessica
authors.initials: J
authors.lastname: Mantovani
authors.forename: Marta
authors.initials: M
authors.lastname: Ciofi degli Atti
authors.forename: Antonietta
authors.initials: A
authors.lastname: Filia
authors.forename: Loredana
authors.initials: L
authors.lastname: Nicoletti
authors.forename: Fabio
authors.initials: F
authors.lastname: Magurano
authors.forename: Piero
authors.initials: P
authors.lastname: Borgia
authors.forename: Domenico
authors.initials: D
authors.lastname: Di Lallo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D008457:Measles / Q000453:epidemiology*; D008458:Measles Vaccine / Q000008:administration & dosage* / Q000276:immunology*; D008459:Measles virus / Q000145:classification / Q000302:isolation & purification; D012703:Serotyping; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D008458:Measles Vaccine