title: Epidemiologic and laboratory surveillance of the measles outbreak in the Federation of Bosnia and Herzegovina, February 2014-April 2015.
abstract: A measles outbreak with two epidemic waves involving 4649 probable and laboratory-confirmed cases was recorded in six out of ten cantons of the Federation of Bosnia and Herzegovina between February 2014 and April 2015. The majority of the patients had never received measles vaccination (3115/4649, 67.00%), and the vaccination status of another 23% was unknown (1066/4649). A total of 281 blood samples were tested serologically. Virus detection was performed using 44 nasopharyngeal swabs. About 57% (161/281) of the laboratory-investigated sera were immunoglobulin M positive, and 95% (42/44) of the swabs were reverse transcriptase-PCR positive. Phylogenetic analysis of sequences obtained from 30 swab samples showed circulation of two variants of genotype D8, but no genotype D4 strains as detected in 2007. Similar involvement of all age groups indicates a problem with vaccine refusal resulting from antivaccination activities in addition to gaps in immunization coverage during the war and postwar period (1992-1998). Differences in ethnicity, vaccine coverage, compliance with review policies of vaccination records and potentially also travel habits may partially explain why only six of ten cantons were affected by the outbreak. The second epidemic wave may in part be due to large-scale migrations due to catastrophic floods in 2014. As a result of the epidemic, 6- to 12-month-old children may now be vaccinated against measles during outbreaks, and public health recommendations for interventions have been strengthened. Additional efforts are required to implement the measures throughout the cantons.
authors.affiliation: Department of Clinical Microbiology, University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina. Electronic address: irma.salimovic_besic@yahoo.com.
authors.forename: I
authors.initials: I
authors.lastname: Salimović-Bešić
authors.affiliation: Department of Clinical Microbiology, University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors.forename: M
authors.initials: M
authors.lastname: Šeremet
authors.affiliation: Department of Infection and Immunity, WHO European Regional Reference Laboratory for Measles and Rubella, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
authors.forename: J M
authors.initials: JM
authors.lastname: Hübschen
authors.affiliation: Department of Genetics and Bioengineering, International Burch University, Ilidža, Sarajevo, Bosnia and Herzegovina; Department of Medical Sciences, Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina.
authors.forename: M
authors.initials: M
authors.lastname: Hukić
authors.affiliation: Department of Microbiology, Polyclinic of Laboratory Diagnostics, Tuzla, Bosnia and Herzegovina.
authors.forename: N
authors.initials: N
authors.lastname: Tihić
authors.affiliation: Department for Infectious Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
authors.forename: S
authors.initials: S
authors.lastname: Ahmetagić
authors.affiliation: Department of Microbiology, Polyclinic of Laboratory Diagnostics, Tuzla, Bosnia and Herzegovina.
authors.forename: Z
authors.initials: Z
authors.lastname: Delibegović
authors.affiliation: Department for Public Health, Monitoring and Evaluation, Federal Ministry of Health, Sarajevo, Bosnia and Herzegovina.
authors.forename: A
authors.initials: A
authors.lastname: Pilav
authors.affiliation: Department of Epidemiology, Institute for Public Health of Federation Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina.
authors.forename: M
authors.initials: M
authors.lastname: Mulaomerović
authors.affiliation: Department of Epidemiology, Institute for Public Health of Federation Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina.
authors.forename: J
authors.initials: J
authors.lastname: Ravlija
authors.affiliation: Department of Infection and Immunity, WHO European Regional Reference Laboratory for Measles and Rubella, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
authors.forename: C P
authors.initials: CP
authors.lastname: Muller
authors.affiliation: Department of Clinical Microbiology, University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina.
authors.forename: A
authors.initials: A
authors.lastname: Dedeić-Ljubović
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D017522:Bosnia and Herzegovina / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques; D004196:Disease Outbreaks; D062665:Epidemiological Monitoring; D005260:Female; D005838:Genotype; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D008297:Male; D008457:Measles / Q000175:diagnosis / Q000453:epidemiology*; D008459:Measles virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D008875:Middle Aged; D017720:Molecular Epidemiology; D009305:Nasopharynx / Q000821:virology; D010802:Phylogeny; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M; D012367:RNA, Viral
keywords: Bosnia and Herzegovina; measles; measles–mumps–rubella (MMR) vaccine; outbreaks; vaccine-preventable diseases; vaccines and immunization