Epidemiological and laboratory surveillance of the measles outbreak in the Federation of Bosnia and Herzegovina February 2014- April 2015.

Tuesday, 15th of March 2016

Clin Microbiol Infect. 2016 Feb 26. pii: S1198-743X(16)00113-0. doi: 10.1016/j.cmi.2016.02.005. [Epub ahead of print]

Epidemiological and laboratory surveillance of the measles outbreak in the Federation of Bosnia and Herzegovina February 2014- April 2015.

Salimović-Bešić I¹ Šeremet M² Hübschen JM³ Hukić M⁴ Tihić N⁵ Ahmetagić S⁶ Delibegović Z⁵ Pilav A⁷ Mulaomerović M⁸ Ravlija J⁸ Muller CP³ Dedeić-Ljubović A².

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Abstract

A measles outbreak with two epidemic waves involving 4649 probable and laboratory-confirmed cases was recorded in six out of ten cantons of the Federation of Bosnia and Herzegovina between February 2014 and April 2015.The majority of the patients had never received measles vaccination (3115/4649 67.00%) and the vaccination status of another 23% was unknown (1066/4649). A total of 281 blood samples were tested serologically. Virus detection was performed using 44 nasopharyngeal swabs. About 57% (161/281) of the laboratory investigated serawere IgM positive and 95% (42/44) of the swabs were RT-PCR positive. Phylogenetic analysis of sequences obtained from 30 swab samples showed circulation of two variants of genotype D8 but no genotype D4 strains as detected in 2007. Similar involvement of all age groups indicates a problem with vaccine refusal due to anti-vaccination activities in addition to gaps in immunization coverage during the war and post-war period (1992-1998). Differences in ethnicity vaccine coverage compliance with review policies of vaccination records and potentially also travel habits may partially explain why only six of ten cantons were affected by the outbreak. The second epidemic wave may in part be due to large-scale migrations due to catastrophic floods in 2014. As a result of the epidemic 6-12 months old children may now be vaccinated against measles during outbreaks and public health recommendations for interventions have been strengthened. Additional efforts are required to implement the measures throughout the cantons.

Copyright © 2016. Published by Elsevier Ltd.