title: [Re-emergence of measles in the province of Guadalajara, Spain. Is it time to establish new strategies for its elimination?].
abstract: BACKGROUND
  Measles is a viral infection that was almost eradicated, but it is re-emerging in Spain and Europe in recent years. The aim of this study was to describe the microbiological, clinical and epidemiological characteristics of a measles outbreak that occurred in Guadalajara (Spain) from June to August 2012.
  
  
  METHODS
  A descriptive and retrospective study was conducted. A total of 117 samples (including serum, urine and pharyngeal swabs) from 52 patients were analyzed for measles.
  
  
  RESULTS
  Measles was diagnosed in 50 patients, 41 of them by microbiological diagnosis, and 9 by epidemiological link. The patients were grouped in four community outbreaks. No imported cases were observed. Positive IgM and positive CRP were detected in 25 patients, positive CRP only in 11 and positive IgM only in 5. The genotype D4 was identified in 13 patients and the genotype A in a post-vaccine case. The age groups most affected were adults between 20-34 years of age (38%) and younger than 15 months (26%). The large majority (86%) of patients were unvaccinated (44% Roma population, 27% younger than 15 months, 11% ideological reasons), 6% had one vaccine dose. The signs/symptoms were: rash and fever, 100%, cough, 82%, and conjunctivitis 50%. Almost one-third (32%) of patients were hospitalized, and 28% had complications.
  
  
  CONCLUSIONS
  It is very important to intensify the epidemiological surveillance of infections in the elimination phase. The increased incidence of measles was associated to unvaccinated pockets, presenting a challenge for Public Health Centers. These agencies should prepare strategies to obtain a higher vaccine coverage for the eradication of measles.
authors.affiliation: Sección de Microbiología, Hospital Universitario de Guadalajara, Guadalajara, España.
authors.forename: Mariela
authors.initials: M
authors.lastname: Martínez-Ramírez
authors.affiliation: Sección de Microbiología, Hospital Universitario de Guadalajara, Guadalajara, España. Electronic address: agonzalezp@sescam.jccm.es.
authors.forename: Alejandro
authors.initials: A
authors.lastname: González-Praetorius
authors.affiliation: Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España.
authors.forename: Fernando de
authors.initials: Fd
authors.lastname: Ory-Manchón
authors.affiliation: Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, España.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Martínez-Benito
authors.affiliation: Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, España.
authors.forename: M Victoria
authors.initials: MV
authors.lastname: García-Rivera
authors.affiliation: Laboratorio Europeo de Referencia de Sarampión de la OMS para el sur de Europa, Centre de Recherche Public de la Santé, Luxemburgo, Luxemburgo.
authors.forename: Judith
authors.initials: J
authors.lastname: Hübschen
authors.affiliation: Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España.
authors.forename: Juan Emilio
authors.initials: JE
authors.lastname: Echevarría-Mayo
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005838:Genotype; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008457:Measles / Q000453:epidemiology* / Q000517:prevention & control; D008458:Measles Vaccine; D008459:Measles virus / Q000145:classification / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D009017:Morbidity / Q000639:trends; D010614:Pharynx / Q000821:virology; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D014556:Urine / Q000821:virology; D014611:Vaccination / Q000706:statistics & numerical data; D014766:Viremia / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D008458:Measles Vaccine; D002097:C-Reactive Protein
keywords: Brote; Epidemiological surveillance; España; Measles; No vacunados; Outbreak; Sarampión; Spain; Unvaccinated; Vigilancia epidemiológica