Holzmann Heidemarie, Hengel Hartmut, Tenbusch Matthias, Doerr H W
Department of Virology, Medical University of Vienna, Vienna, Austria.
Institute of Virology, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany.
Med Microbiol Immunol. 2016 Jun;205(3):201-8. doi: 10.1007/s00430-016-0451-4. Epub 2016 Mar 2.
Measles virus (MeV) is an aerosol-borne and one of the most contagious pathogenic viruses known. Almost every MeV infection becomes clinically manifest and can lead to serious and even fatal complications, especially under conditions of malnutrition in developing countries, where still 115,000 to 160,000 patients die from measles every year. There is no specific antiviral treatment. In addition, MeV infections cause long-lasting memory B and T cell impairment, predisposing people susceptible to opportunistic infections for years. A rare, but fatal long-term consequence of measles is subacute sclerosing panencephalitis. Fifteen years ago (2001), WHO has launched a programme to eliminate measles by a worldwide vaccination strategy. This is promising, because MeV is a human-specific morbillivirus (i.e. without relevant animal reservoir), safe and potent vaccine viruses are sufficiently produced since decades for common application, and millions of vaccine doses have been used globally without any indications of safety and efficacy issues. Though the prevalence of wild-type MeV infection has decreased by >90 % in Europe, measles is still not eliminated and has even re-emerged with recurrent outbreaks in developed countries, in which effective vaccination programmes had been installed for decades. Here, we discuss the crucial factors for a worldwide elimination of MeV: (1) efficacy of current vaccines, (2) the extremely high contagiosity of MeV demanding a >95 % vaccination rate based on two doses to avoid primary vaccine failure as well as the installation of catch-up vaccination programmes to fill immunity gaps and to achieve herd immunity, (3) the implications of sporadic cases of secondary vaccine failure, (4) organisation, acceptance and drawbacks of modern vaccination campaigns, (5) waning public attention to measles, but increasing concerns from vaccine-associated adverse reactions in societies with high socio-economic standards and (6) clinical, epidemiological and virological surveillance by the use of modern laboratory diagnostics and reporting systems. By consequent implementation of carefully designed epidemiologic and prophylactic measures, it should be possible to eradicate MeV globally out of mankind, as the closely related morbillivirus of rinderpest could be successfully eliminated out of the cattle on a global scale.
麻疹病毒（MeV）通过气溶胶传播，是已知传染性最强的致病病毒之一。几乎每一例MeV感染都会出现临床症状，并可能导致严重甚至致命的并发症，尤其是在发展中国家营养不良的情况下，每年仍有11.5万至16万患者死于麻疹。目前尚无特效抗病毒治疗方法。此外，MeV感染会导致持久的记忆B细胞和T细胞损伤，使人们在数年内易患机会性感染。麻疹一种罕见但致命的长期后果是亚急性硬化性全脑炎。15年前（2001年），世界卫生组织发起了一项通过全球疫苗接种战略消除麻疹的计划。这是很有希望的，因为MeV是一种人类特有的麻疹病毒（即没有相关动物宿主），几十年来已经生产出足够安全有效的疫苗病毒用于普遍接种，并且全球已经使用了数百万剂疫苗，没有任何安全性和有效性问题的迹象。尽管欧洲野生型MeV感染的流行率已下降超过90%，但麻疹仍未消除，甚至在已实施数十年有效疫苗接种计划的发达国家再次出现反复暴发。在此，我们讨论在全球消除MeV的关键因素：（1）现有疫苗的效力；（2）MeV极高的传染性要求基于两剂接种的疫苗接种率>95%，以避免原发性疫苗失败，以及实施补种计划以填补免疫空白并实现群体免疫；（3）继发性疫苗失败散发病例的影响；（4）现代疫苗接种运动的组织、接受度和缺点；（5）公众对麻疹的关注度下降，但在社会经济水平较高的社会中对疫苗相关不良反应的担忧增加；（6）通过使用现代实验室诊断和报告系统进行临床、流行病学和病毒学监测。通过切实实施精心设计的流行病学和预防措施，应该有可能在全球范围内将MeV从人类中根除，就像与之密切相关的牛瘟病毒已在全球范围内成功地从牛群中消除一样。
