title: Measles outbreak in Macedonia: epidemiological, clinical and laboratory findings and identification of susceptible cohorts.
abstract: OBJECTIVE
  Despite a 92-99% national vaccination coverage since 2000, the former Yugoslav Republic of Macedonia experienced a large measles outbreak between 2010 and 2011. Here we investigate the characteristics of patients hospitalized during this outbreak at the Clinic of Infectious Diseases in Skopje.
  
  
  METHODS
  Epidemiological, clinical and laboratory data of 284 measles patients, including 251 from Skopje (43.80% of the 573 reported cases) and 33 from elsewhere in Macedonia were collected.
  
  
  RESULTS
  The most affected age groups were children up to 4 years of age and adolescents/adults of 15 years and older. Most patients were unvaccinated (n=263, 92.61%) and many had non-Macedonian nationalities (n=156, 54.93%) or belonged to the Roma ethnicity (n=73, 25.70%). Bronchopneumonia and diarrhea were the most common complications. Eighty-two out of 86 tested patients (95.35%) had measles-specific IgM antibodies. The outbreak was caused by the measles variant D4-Hamburg.
  
  
  CONCLUSIONS
  The epidemic identified pockets of susceptibles in Skopje and indicated that additional vaccination opportunities in particular for people with non-Macedonian nationality and traveler communities are warranted to ensure efficient measles control in Macedonia. The high attack rate among children of less than 1 year suggests that vaccination before 12 months of age should be considered in high risk settings.
authors.affiliation: University Clinic of Infectious Diseases and Febrile Conditions, Clinical Centre, Medical Faculty, Skopje, R. Macedonia.
authors.forename: Irena T
authors.initials: IT
authors.lastname: Kondova
authors.forename: Zvonko
authors.initials: Z
authors.lastname: Milenkovic
authors.forename: Sanja P
authors.initials: SP
authors.lastname: Marinkovic
authors.forename: Golubinka
authors.initials: G
authors.lastname: Bosevska
authors.forename: Gordana
authors.initials: G
authors.lastname: Kuzmanovska
authors.forename: Goran
authors.initials: G
authors.lastname: Kondov
authors.forename: Sonja
authors.initials: S
authors.lastname: Alabakovska
authors.forename: Claude P
authors.initials: CP
authors.lastname: Muller
authors.forename: Judith M
authors.initials: JM
authors.lastname: Hübschen
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D005838:Genotype; D006760:Hospitalization; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D015994:Incidence; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology*; D008458:Measles Vaccine / Q000627:therapeutic use; D008875:Middle Aged; D018843:Republic of North Macedonia / Q000453:epidemiology; D014611:Vaccination; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M; D008458:Measles Vaccine
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