title: Laboratory diagnosis, molecular characteristics, epidemiological and clinical features of an outbreak of measles in a low incidence population in Australia.
abstract: BACKGROUND
  Prompt and accurate laboratory diagnosis of measles is essential for case detection, outbreak management and ongoing surveillance in low incidence countries. Several disease markers are employed for diagnosis and are important to determine epidemiological and molecular characteristics for future control measures.
  
  
  OBJECTIVE
  To report different disease markers, genotypes and epidemiology of a measles outbreak in Australia, a low incidence country.
  
  
  METHODS
  A retrospective descriptive study of the clinical and epidemiological features and laboratory diagnosis in 16 confirmed measles cases using measles serum IgM/IgG, antigen detection (IFA), viral RNA detection by real-time PCR and genotyping results for respiratory and urine specimens processed in one reference laboratory.
  
  
  RESULTS
  Of the 16 confirmed measles cases, 11 were young adults aged between 20-35 years and 15 were not age-appropriately vaccinated. The most common genotype detected was D9 (11/16), followed by D4 (1/16) and D8 (1/16). Two imported cases were from the Philippines (D4) and Italy (D9). Of six disease markers, respiratory swab PCR and serum IgM gave the highest percentage (100%) of positive samples for confirmed cases followed by urine PCR (90.9%), serum PCR (66.6%), urine IFA (54.5%) and respiratory IFA (46.2%).
  
  
  CONCLUSIONS
  Measles should be considered in the differential diagnosis of a presentation with fever and rash, even in countries in the elimination phase of measles control. Genotyping is a powerful molecular-epidemiological tool to assist low incidence countries towards eradication goals. Improving vaccination coverage remains essential, particularly in young adults and travellers.
authors.affiliation: Virology Division, Department of Microbiology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, Australia.
authors.forename: Jude
authors.initials: J
authors.lastname: Jayamaha
authors.forename: Philippa L
authors.initials: PL
authors.lastname: Binns
authors.forename: Michael
authors.initials: M
authors.lastname: Fennell
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Ferson
authors.forename: Peter
authors.initials: P
authors.lastname: Newton
authors.forename: Thomas
authors.initials: T
authors.lastname: Tran
authors.forename: Michael
authors.initials: M
authors.lastname: Catton
authors.forename: Peter
authors.initials: P
authors.lastname: Robertson
authors.forename: William
authors.initials: W
authors.lastname: Rawlinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000379:methods*; D004196:Disease Outbreaks; D005260:Female; D005838:Genotype; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D015994:Incidence; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D008459:Measles virus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D017720:Molecular Epidemiology; D008969:Molecular Sequence Data; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M