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Abstract

We describe a rubella outbreak that occurred in Romania between September 2011 and December 2012. During this period 24,627 rubella cases, 41.1% (n=10,134) of which female, were notified based on clinical criteria, and a total of 6,182 individuals were found serologically positive for IgM-specific rubella antibody. The median age of notified cases was 18 years (range: <1–65) and the most affected age group 15 to 19 years (n=16,245 cases). Of all notified cases, 24,067 cases (97.7%) reported no history of vaccination. Phylogenetic analysis of 19 sequences (739 nucleotides each), from 10 districts of the country revealed that the outbreak was caused by two distinct rubella virus strains of genotype 2B, which co-circulated with both temporal and geographical overlap. In addition to the 6,182 IgM-positive rubella cases, 28 cases of congenital rubella syndrome (CRS) were identified, including 11 neonatal deaths and one stillbirth. The outbreak underscores the need to encourage higher vaccination uptake in the population, particularly in women of reproductive age, and to strengthen epidemiological and laboratory investigations of suspected rubella cases. Genetic characterisation of wild-type rubella virus is an essential component to enhance surveillance and here we report rubella virus sequences from Romania.

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2016-09-22
2024-09-07
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2016.21.38.30345
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References

  1. World Health Organization. Standardization of the nomenclature for genetic characteristics of wild-type rubella viruses. Wkly Epidemiol Rec. 2005;80(14):126-32. PMID: 15850226 
  2. Abernathy ES, Hübschen JM, Muller CP, Jin L, Brown D, Komase K, et al. Status of global virologic surveillance for rubella viruses. J Infect Dis. 2011;204(Suppl 1):S524-32.  https://doi.org/10.1093/infdis/jir099  PMID: 21666209 
  3. World Health Organization (WHO). Rubella Fact Sheet. Geneva: WHO; Mar 2016. Available from: http://www.who.int/mediacentre/factsheets/fs367/en/
  4. Miller E, Cradock-Watson JE, Pollock TM. Consequences of confirmed maternal rubella at successive stages of pregnancy. Lancet. 1982;320(8302):781-4.  https://doi.org/10.1016/S0140-6736(82)92677-0  PMID: 6126663 
  5. Toizumi M, Motomura H, Vo HM, Takahashi K, Pham E, Nguyen HA, et al. Mortality associated with pulmonary hypertension in congenital rubella syndrome. Pediatrics. 2014;134(2):e519-26.  https://doi.org/10.1542/peds.2013-4184  PMID: 25002666 
  6. Nardone A, Miller EESEN2 Group. Serological surveillance of rubella in Europe: European Sero-Epidemiology Network (ESEN2). Euro Surveill. 2004;9(4):456.  PMID: 15192256 
  7. Kurtz JB, Anderson MJ. Cross-reactions in rubella and parvovirus specific IgM tests. Lancet. 1985;326(8468):1356.  https://doi.org/10.1016/S0140-6736(85)92647-9  PMID: 2866403 
  8. Morgan-Capner P. False positive tests for rubella-specific IgM. Pediatr Infect Dis J. 1991;10(5):415-6. PMID: 1898481 
  9. Zuckerman AJ, Best JM, Icenogle JP, Brown DWG. Principles and practice of clinical virology. 6th ed. West Sussex, UK: Wiley-Blackwell; 2009. p. 561-92.
  10. Namuwulya P, Abernathy E, Bukenya H, Bwogi J, Tushabe P, Birungi M, et al. Phylogenetic analysis of rubella viruses identified in Uganda, 2003-2012. J Med Virol. 2014;86(12):2107-13.  https://doi.org/10.1002/jmv.23935  PMID: 24700073 
  11. World Health Organization (WHO). Surveillance Guidelines for Measles, Rubella and Congenital Rubella Syndrome in the WHO European Region Update December 2012. Geneva: WHO; 2012. Available from: http://www.euro.who.int/__data/assets/pdf_file/0018/79020/e93035-2013.pdf?ua=1
  12. Rafila A, Marin M, Pistol A, Nicolaiciuc D, Lupulescu E, Uzicanin A, et al. A large rubella outbreak, Romania--2003. Euro Surveill. 2004;9(4):457. PMID: 15192257 
  13. Janta D, Stanescu A, Lupulescu E, Molnar G, Pistol A. Ongoing rubella outbreak among adolescents in Salaj, Romania, September 2011-January 2012. Euro Surveill. 2012;17(7):20089. PMID: 22370012 
  14. Romanian National Institute of Public Health (INSP). Analiza rezultatelor evaluarii acoperirii vaccinale la varsta de 18 luni [Analysis of assessment results in vaccination coverage for children aged 18 months]. Bucharest: INSP. Romanian. Available from: http://www.insp.gov.ro/cnscbt/index.php?option=com_docman&amp;task=cat_view&amp;Itemid=31
  15. Janta D, Stanescu A, Pistol A. Evolutia epidemiei de rubeola, Septembrie 2011-Decembrie 2012 [The evolution of rubella outbreak September 2011-December 2012]. Bucharest: Romanian National Institute of Public Health. Romanian. Available from http://www.cnscbt.ro/index.php/analiza-date-supraveghere/rubeola/154-evolutia-epidemiei-de-rubeola/file
  16. Necula G, Lazar M, Stanescu A, Pistol A, Santibanez S, Mankertz A, et al. Transmission and molecular characterisation of wild measles virus in Romania, 2008 to 2012. Euro Surveill. 2013;18(50):20658.  https://doi.org/10.2807/1560-7917.ES2013.18.50.20658  PMID: 24342518 
  17. European Commission. Commission Implementing Decision of 8 August 2012 (2012/506/EU) amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council. Official Journal of the European Union. Luxembourg: Publications Office of the European Union. 27.9.2012;L 262. Available from: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2012:262:0001:0057:EN:PDF[REMOVED IF= FIELD]
  18. National Centre for Communicable Diseases Surveillance and Control (CNSCBT). Metodologia de supraveghere a rujeolei si rubeolei [Surveillance methodology for measles and rubella]. Bucharest: CNSCBT. Romanian. [Accessed 26 Jan 2014]. Available from: http://www.cnscbt.ro/index.php/metodologii/rujeola-si-rubeola/486-metodologia-de-suraveghere-a-rujeolei-si-rubeolei-2016/file
  19. World Health Organization (WHO). WHO-recommended surveillance standard of rubella and congenital rubella syndrome. Geneva: WHO; 2012. Available from: http://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/rubella_standards/en/
  20. National Centre for Communicable Diseases Surveillance and Control (CNSCBT). Metodologia de supraveghere a infectiei rubeolice congenitale (inclusiv sindromul rubeolic congenital). [Methodology of surveillance for congenital rubella infection (including congenital rubella syndrome)]. Bucharest: CNSCBT. Romanian. [Accessed 26 Jan 2014]. Available from: http://www.cnscbt.ro/index.php/metodologii/irc-src/487-metodologia-de-supraveghere-irc-src-2016
  21. Bosma TJ, Corbett KM, O’Shea S, Banatvala JE, Best JM. PCR for detection of rubella virus RNA in clinical samples. J Clin Microbiol. 1995;33(5):1075-9. PMID: 7615708 
  22. Abernathy E, Cabezas C, Sun H, Zheng Q, Chen MH, Castillo-Solorzano C, et al. Confirmation of rubella within 4 days of rash onset: comparison of rubella virus RNA detection in oral fluid with immunoglobulin M detection in serum or oral fluid. J Clin Microbiol. 2009;47(1):182-8.  https://doi.org/10.1128/JCM.01231-08  PMID: 19005151 
  23. Altschul SF, Gish W, Miller W, Myers EW, Lipman DJ. Basic local alignment search tool. J Mol Biol. 1990;215(3):403-10.  https://doi.org/10.1016/S0022-2836(05)80360-2  PMID: 2231712 
  24. Stamatakis A. RAxML version 8: a tool for phylogenetic analysis and post-analysis of large phylogenies. Bioinformatics. 2014;30(9):1312-3.  https://doi.org/10.1093/bioinformatics/btu033  PMID: 24451623 
  25. Rambaut A. (2009) FigTree v1.4: Tree Figure Drawing Tool. [Accessed 25 Apr 2014]. Available from: http://tree.bio.ed.ac.uk/software/figtree/
  26. Inkscape. Available from: http://www.inkscape.org
  27. Lazar M, Perelygina L, Martines R, Greer P, Paddock CD, Peltecu G, et al. Immunolocalization and distribution of rubella antigen in fatal congenital rubella syndrome. EBioMedicine. 2016;3:86-92.  https://doi.org/10.1016/j.ebiom.2015.11.050  PMID: 26870820 
  28. World Health Organization (WHO). Status Report on Progress towards Measles and Rubella Elimination SAGE Working Group on Measles and Rubella (22 October 2012). Geneva: WHO; 2012. Available from: http://www.who.int/immunization/sage/meetings/2012/november/1_Status_Report_Measles_Rubella_22_Oct.pdf
  29. Reef SE, Redd SB, Abernathy E, Kutty P, Icenogle JP. Evidence used to support the achievement and maintenance of elimination of rubella and congenital rubella syndrome in the United States. J Infect Dis. 2011;204(Suppl 2):S593-7.  https://doi.org/10.1093/infdis/jir420  PMID: 21954252 
  30. European Centre for Disease Prevention and Control (ECDC). Annual Epidemiological Report 2013. Reporting on 2011 surveillance data and 2012 epidemic intelligence data. Stockholm: ECDC; 2013 Pg 191. Available from: http://ecdc.europa.eu/en/publications/Publications/annual-epidemiological-report-2013.pdf
  31. Icenogle JP, Frey TK, Abernathy E, Reef SE, Schnurr D, Stewart JA. Genetic analysis of rubella viruses found in the United States between 1966 and 2004: evidence that indigenous rubella viruses have been eliminated. Clin Infect Dis. 2006;43(Suppl 3):S133-40.  https://doi.org/10.1086/505945  PMID: 16998772 
  32. European Centre for Disease Prevention and Control (ECDC). ECDC measles and rubella monitoring (EMMO). Stockholm: ECDC; June 2012. Issue 12: Pg 9. Available from: http://ecdc.europa.eu/en/publications/Publications/2012June13_SUR_measles_rubella_report.pdf
  33. Paradowska-Stankiewicz I, Czarkowski MP, Derrough T, Stefanoff P. Ongoing outbreak of rubella among young male adults in Poland: increased risk of congenital rubella infections. Euro Surveill. 2013;18(21):20485. PMID: 23725976 
  34. Bellini W, Icenogle J. Measles and Rubella Viruses. In: Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (Editors), Manual of Clinical Microbiology. 10th Edition. Washington DC: ASM Press; 2011. Pgs: 1372-1387.
  35. Zheng Q, Abernathy ES, Sun H, Zhu Z, de Filippis A, Akoua-Koffi C, et al. Genotyping of rubella virus RNA in sera and dried blood spots collected during routine surveillance and in archival sera. J Virol Methods. 2013;187(2):284-7.  https://doi.org/10.1016/j.jviromet.2012.11.023  PMID: 23201287 
  36. Tran DN, Pham NTK, Tran TTT, Khamrin P, Thongprachum A, Komase K, et al. Phylogenetic analysis of rubella viruses in Vietnam during 2009-2010. J Med Virol. 2012;84(4):705-10.  https://doi.org/10.1002/jmv.23199  PMID: 22337313 
  37. Zhu Z, Rivailler P, Abernathy E, Cui A, Zhang Y, Mao N, et al. Rubella Virology Surveillance Working Group. Evolutionary analysis of rubella viruses in mainland China during 2010-2012: endemic circulation of genotype 1E and introductions of genotype 2B. Sci Rep. 2015;5:7999.  https://doi.org/10.1038/srep07999  PMID: 25613734 
  38. Figueiredo CA, Oliveira MI, Curti SP, Afonso AMS, Frugi Yu AL, Gualberto F, et al. Phylogenetic analysis of rubella virus strains during an outbreak in São Paulo, 2007-2008. J Med Virol. 2012;84(10):1666-71.  https://doi.org/10.1002/jmv.23382  PMID: 22930516 
  39. World Health Organization (WHO). Framework for the verification process in the WHO European Region, 2014. Geneva: WHO; 2014. Available from: http://www.euro.who.int/__data/assets/pdf_file/0009/247356/Eliminating-measles-and-rubella-Framework-for-the-verification-process-in-the-WHO-European-Region.pdf?ua=1
Epidemiological and molecular investigation of a rubella outbreak, Romania, 2011 to 2012
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Mihaela+Lazar&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lazar Mihaela</a>, <a href="/search?value1=Emily+Abernathy&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Abernathy Emily</a>, <a href="/search?value1=Min-hsin+Chen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Chen Min-hsin</a>, <a href="/search?value1=Joseph+Icenogle&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Icenogle Joseph</a>, <a href="/search?value1=Denisa+Janta&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Janta Denisa</a>, <a href="/search?value1=Aurora+Stanescu&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Stanescu Aurora</a>, <a href="/search?value1=Adriana+Pistol&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pistol Adriana</a>, <a href="/search?value1=Sabine+Santibanez&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Santibanez Sabine</a>, <a href="/search?value1=Annette+Mankertz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mankertz Annette</a>, <a href="/search?value1=Judith+M+H%C3%BCbschen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hübschen Judith M</a>, <a href="/search?value1=Grigore+Mihaescu&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mihaescu Grigore</a>, <a href="/search?value1=Gheorghe+Necula&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Necula Gheorghe</a>, <a href="/search?value1=Emilia+Lupulescu&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lupulescu Emilia</a></span>. Epidemiological and molecular investigation of a rubella outbreak, Romania, 2011 to 2012. <a href="/content/ecdc">Euro Surveill.</a> 2016;21(38):pii=30345. <a href="https://doi.org/10.2807/1560-7917.ES.2016.21.38.30345" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2016.21.38.30345</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 02 Jun 2015;&nbsp;&nbsp; <span class="generated">Accepted</span>: 16 Jun 2016 </span> </p>
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