title: Measles re-emergence in Northern Italy: Pathways of measles virus genotype D8, 2013-2014.
abstract: Molecular surveillance and advanced phylogenetic methods are important tools to track the pathways of Measles virus (MV) genotypes, provide evidence for the interruption of endemic transmission and verify the elimination of the disease. The aims of this study were to describe the genetic profile of MV genotype D8 (D8-MV) strains circulating in Northern Italy (Lombardy Region) during the 2013-2014 period and to analyze the transmission chains and estimate the introduction time points using a phylogenetic approach. Forty-four strains of D8-MV identified from 12 outbreaks and 28 cases reported as sporadic were analyzed. Molecular analysis was performed by sequencing the highly variable 450nt region of the N gene of MV genome (N-450), as recommended by the WHO. Phylogenetic analyses and tree time-scaled reconstruction were performed with BEAST software. We could trace back the transmission pathways that resulted in three chains of transmission, two introductions with limited spread (two familiar outbreaks), and two single introductions (true sporadic cases). The D8-Taunton transmission chain, which was involved in 7 outbreaks and 13 sporadic cases, was endemic during the studied period. Furthermore, two novel local variants emerged independently in March 2014 and caused two transmission chains linked to at least 3 outbreaks. Overall, viral diversity was high and strains belonging to 5 different variants were identified. The results of this study clearly demonstrate that multiple lineages of D8-MV co-circulated in Northern Italy. Measles can be considered a re-emerging disease in Italy and additional efforts are necessary to achieve measles elimination goal.
authors.affiliation: Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy; Coordinated Research Center "EpiSoMI", University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy. Electronic address: antonella.amendola@unimi.it.
authors.forename: Antonella
authors.initials: A
authors.lastname: Amendola
authors.affiliation: Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy. Electronic address: silvia.bianchi@unimi.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bianchi
authors.affiliation: Department of Biomedical and Clinical Sciences "Luigi Sacco", Section of Infectious Diseases, University of Milan, Via Gian Battista Grassi, 74, 20157 Milan, Italy. Electronic address: alessia.lai@unimi.it.
authors.forename: Alessia
authors.initials: A
authors.lastname: Lai
authors.affiliation: Department of Biology, Memorial University of Newfoundland, 232 Elizabeth Ave., St John's, NL A1B 3X9, Canada. Electronic address: marta.canuti@gmail.com.
authors.forename: Marta
authors.initials: M
authors.lastname: Canuti
authors.affiliation: Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, via Taramelli, 5, 27100 Pavia, Italy. Electronic address: A.Piralla@smatteo.pv.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Piralla
authors.affiliation: Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy. Electronic address: melissa.baggieri@guest.iss.it.
authors.forename: Melissa
authors.initials: M
authors.lastname: Baggieri
authors.affiliation: Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy. Electronic address: alberto_ranghiero@hotmail.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ranghiero
authors.affiliation: Directorate General for Health, Regione Lombardia, Piazza Città di Lombardia, 1, 20124 Milan, Italy. Electronic address: Alessandra_Piatti@regione.lombardia.it.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Piatti
authors.affiliation: Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy; Coordinated Research Center "EpiSoMI", University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy. Electronic address: elisabetta.tanzi@unimi.it.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Tanzi
authors.affiliation: Coordinated Research Center "EpiSoMI", University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Section of Infectious Diseases, University of Milan, Via Gian Battista Grassi, 74, 20157 Milan, Italy. Electronic address: gianguglielmo.zehender@unimi.it.
authors.forename: Gianguglielmo
authors.initials: G
authors.lastname: Zehender
authors.affiliation: Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy. Electronic address: fabio.magurano@iss.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Magurano
authors.affiliation: Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, via Taramelli, 5, 27100 Pavia, Italy; Section of Microbiology, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Brambilla, 74, 27100 Pavia, Italy. Electronic address: f.baldanti@smatteo.pv.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Baldanti
mesh_terms: D021821:Communicable Diseases, Emerging; D004196:Disease Outbreaks; D019143:Evolution, Molecular; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008457:Measles / Q000453:epidemiology / Q000821:virology*; D008459:Measles virus / Q000235:genetics*; D017720:Molecular Epidemiology; D010802:Phylogeny; D012367:RNA, Viral / Q000235:genetics; D017422:Sequence Analysis, DNA; D014764:Viral Proteins / Q000235:genetics
chemical_list: D012367:RNA, Viral; D014764:Viral Proteins
keywords: Epidemiology; Measles; Phylogeny; Surveillance