Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
J Med Virol. 2023 Oct;95(10):e29141. doi: 10.1002/jmv.29141.
In the quest to eliminate measles virus (MV) and rubella virus (Ruv), every suspected case must be properly identified and diagnosed. Since 2017, in Milan (Italy), a total of 978 measles and rubella suspected cases (fever and rash) were investigated and 310 were not laboratory confirmed (discarded cases). To improve surveillance activities, we investigated the presence in discarded cases of 8 other viral pathogens commonly associated with rash: human herpesvirus 6 (HHV-6) and 7 (HHV-7), parvovirus B19 (B19V), enterovirus (EV), Epstein-Barr virus (EBV), human adenovirus (HAdV), cytomegalovirus (HCMV), and SARS-CoV-2. Differential diagnosis was carried out on 289 discarded cases by multiplex real-time PCR assays. At least one pathogen was detected in 188 cases (65.1%) with HHV-7 being the most frequently detected virus. No difference in the number of detected infections overtime was observed and infections were identified in all age groups. As expected, most HHV-6, EV, HAdV, and HCMV-positive cases were found in children aged 0-4 years and HHV-7 was most frequent in the 15-39 age group. In light of the World Health Organization measles elimination goal, the introduction of laboratory methods for differential diagnosis is required for the final classification of clinically compatible cases. The used screening panel allowed us to increase the percentage of virus-positive cases to 87.5%, allowing us to clarify viral involvement and epidemiology, improve diagnosis, and strengthen surveillance activities. As all investigated pathogens were detected, this diagnostic panel was a suitable tool to complement MV and RuV surveillance activities.
在消除麻疹病毒 (MV) 和风疹病毒 (Ruv) 的过程中，必须正确识别和诊断每一例疑似病例。自 2017 年以来，在意大利米兰共调查了 978 例麻疹和风疹疑似病例（发热和皮疹），其中 310 例未通过实验室确认（排除病例）。为了改进监测活动，我们调查了排除病例中 8 种其他常见的与皮疹相关的病毒病原体：人类疱疹病毒 6（HHV-6）和 7（HHV-7）、细小病毒 B19（B19V）、肠道病毒（EV）、EB 病毒（EBV）、人类腺病毒（HAdV）、巨细胞病毒（HCMV）和 SARS-CoV-2。我们通过多重实时 PCR 检测对 289 例排除病例进行了鉴别诊断。在 188 例病例（65.1%）中至少检测到一种病原体，其中 HHV-7 是最常检测到的病毒。未观察到随时间推移检测到的感染数量的差异，并且在所有年龄组中都发现了感染。正如预期的那样，大多数 HHV-6、EV、HAdV 和 HCMV 阳性病例出现在 0-4 岁的儿童中，而 HHV-7 则在 15-39 岁年龄组中最为常见。鉴于世界卫生组织消除麻疹的目标，需要引入实验室方法进行鉴别诊断，以便对临床符合病例进行最终分类。使用的筛选面板将病毒阳性病例的百分比提高到 87.5%，使我们能够阐明病毒的作用和流行病学，改善诊断，并加强监测活动。由于所有检测到的病原体，该诊断面板是补充 MV 和 RuV 监测活动的合适工具。
