Tischer Annedore, Santibanez Sabine, Siedler Anette, Heider Alla, Hengel Hartmut
Division of Viral Infections, Robert Koch Institute, Nordufer 20, D-13353 Berlin, Germany.
J Clin Virol. 2004 Nov;31(3):165-78. doi: 10.1016/j.jcv.2004.05.007.
The elimination of measles is a goal set by the World Health Organisation to be reached by 2010 in the European region.
To enhance the measles surveillance in Germany, a country-wide laboratory supported a sentinel was established.
A network of >1200 representatively distributed practitioners reported detailed data on all clinically diagnosed cases and provided specimens for laboratory diagnosis.
A total of 3225 suspected cases were reported between October 1999 and December 2003. The incidence in Western Germany decreased from >15 cases per 100,000 population to one case in 2003, while in Eastern Germany <1 case per 100,000 population was observed during these years. Laboratory investigations were undertaken in 40% of cases in 2000/2001. This rate increased to 79% in 2003. Simultaneously, the rate of confirmed cases dropped from 60% in the former years to 23% in 2003. Measles virus (MV) detection by serology and by PCR revealed concordant results in 92%. Most suspected cases (85%) were unvaccinated with 66% being laboratory confirmed. Only 10% of suspected cases occurred in vaccinated individuals and very few (22%) could be confirmed. Analyses of confirmed measles in vaccinated patients (n = 49) revealed 24.5% primary vaccine failures, 24.5% reinfections after successful vaccination and 31% MV infection before or shortly after vaccination. The genetic characterisation of 389 MV isolates identified eight genotypes: B3, C2, D4, D5, D6, D7, G2 and H1. Only the C2, D6 and D7 MV genotypes circulated endemically in Western Germany. The newly emerged MV D7 almost completely replaced the pre-existing C2 and D6 MVs in 2001. The few measles cases detected in Eastern Germany were mostly caused by imported MVs.
The data demonstrate that laboratory investigations including molecular methods are an indispensable tool for surveillance in all countries advanced in measles elimination.
消除麻疹是世界卫生组织设定的目标，欧洲区域要在2010年实现这一目标。
为加强德国的麻疹监测，建立了一个由全国实验室支持的哨点。
一个由1200多名分布具有代表性的从业者组成的网络报告了所有临床诊断病例的详细数据，并提供了用于实验室诊断的标本。
1999年10月至2003年12月期间共报告了3225例疑似病例。西德的发病率从每10万人中超过15例降至2003年的1例，而在东德，这些年中每10万人中观察到的病例数不到1例。2000/2001年40%的病例进行了实验室检查。这一比例在2003年增至79%。同时，确诊病例的比例从前几年的60%降至2003年的23%。通过血清学和聚合酶链反应检测麻疹病毒（MV）的结果在92%的情况下是一致的。大多数疑似病例（85%）未接种疫苗，其中66%经实验室确诊。只有10%的疑似病例发生在接种疫苗的个体中，且很少（22%）能够确诊。对接种疫苗患者中的确诊麻疹病例（n = 49）进行分析发现，24.5%为原发性疫苗失败，24.5%为成功接种疫苗后再次感染，31%为接种疫苗前或接种后不久感染MV。对389株MV分离株的基因特征分析确定了8种基因型：B3、C2、D4、D5、D6、D7、G2和H1。只有C2、D6和D7基因型的MV在西德呈地方性流行。新出现的MV D7在2001年几乎完全取代了先前存在的C2和D6 MV。在东德检测到的少数麻疹病例大多由输入性MV引起。
数据表明，包括分子方法在内的实验室检查是所有在消除麻疹方面取得进展的国家进行监测的不可或缺的工具。
