title: Differentiating the wild from the attenuated during a measles outbreak.
abstract: In the midst of a local measles outbreak, a recently immunized child was investigated for a new-onset measles-type rash. Nucleic acid testing identified that a vaccine-type measles virus was being shed in the urine. Clinically differentiating measles from a nonmeasles rash is challenging, but can be supported by a thorough medical history evaluation. Rashes are expected to occur after immunization; nucleic acid testing can be used when it is difficult to differentiate between wild and attenuated strains.
authors.affiliation: Communicable Disease Control, Alberta Health Services;
authors.forename: Lindsay
authors.initials: L
authors.lastname: Nestibo
authors.forename: Bonita E
authors.initials: BE
authors.lastname: Lee
authors.forename: Kevin
authors.initials: K
authors.lastname: Fonseca
authors.forename: Jennifer
authors.initials: J
authors.lastname: Beirnes
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Johnson
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Sikora
keywords: Measles; PCR; Secondary transmission; Vaccine
references.citation: Can J Infect Dis Med Microbiol. 2009 Winter;20(4):e157-62
references.pmid: 21119794
references.citation: Can Commun Dis Rep. 1999 Mar 1;25(5):45-7
references.pmid: 10095293
references.citation: J Clin Microbiol. 1995 Sep;33(9):2485-8
references.pmid: 7494055
references.citation: J Infect Dis. 1998 Dec;178(6):1567-70
references.pmid: 9815205
references.citation: J Infect Dis. 2001 Feb 15;183(4):532-8
references.pmid: 11170977
references.citation: Methods Mol Biol. 2011;665:183-93
references.pmid: 21116802
references.citation: Ann Intern Med. 1998 Jul 15;129(2):104-6
references.pmid: 9669968
references.citation: Jpn J Infect Dis. 2010 Jul;63(4):225-8
references.pmid: 20657059
references.citation: CMAJ. 1993 Dec 1;149(11):1669-74
references.pmid: 8242506
references.citation: J Clin Microbiol. 2001 Jan;39(1):375-6
references.pmid: 11136805
references.citation: J Virol Methods. 2006 Mar;132(1-2):166-73
references.pmid: 16274752
references.citation: Lancet. 1989 Feb 4;1(8632):271
references.pmid: 2563426
references.citation: N Engl J Med. 1960 Jul 28;263:159-61
references.pmid: 14404829
references.citation: Bull World Health Organ. 2009 Feb;87(2):93-8
references.pmid: 19274360
references.citation: J Infect Dis. 2004 May 1;189 Suppl 1:S171-6
references.pmid: 15106107
references.citation: N Engl J Med. 1960 Jul 28;263:180-4
references.pmid: 14404830
references.citation: MMWR Morb Mortal Wkly Rep. 2011 Apr 8;60(13):397-400
references.pmid: 21471945