Multinational Measles Outbreak in Post-Elimination Era, Involves Three Countries of North America and a European Country in a Short Transmission Chain

Read  full  paper  at:


Background: Four measles cases in Canada and one in the United States are linked to international importation of measles in Playa del Carmen, Quintana Roo, Mexico. Objective: To describe characteristics of transmission and not spillover to local population in Mexico. Material and Methods: The outbreak investigation was based on active search of cases and in the rapid monitoring of vaccination coverage in children aged 1 – 7 years old. Laboratory confirmation by Enzyme-Linked Immunosorbent Assay (ELISA) and molecular detection by Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) assay in throat swab and urine were done. Results: One transmission chain with three generations of cases was identified. The primary case was a 9-year-old boy who was infected in Wales, UK. His sisters aged 7 and 15 years old respectively, were the first generation of cases in Mexico. The second generation was related to the imported cases, and affected two Canadian tourists and an American woman aged 39 years old. A third generation occurred in Canada and affected an infant of 15 months of age and his sister aged 4 years old. The genotype D8 which was circulating in UK was identified in these patients. One probable case was detected in Quintana Roo, but was discarded by laboratory testing. The coverage with at least one dose of Measles-Mumps-Rubella (MMR) vaccine ranged from 95% to 99.5%. Conclusion: International travelers with no history of vaccination are at risk of acquiring measles even in countries that have interrupted endemic transmission. The high immunization coverage of measles containing vaccine could explain the absence of cases in Mexican population. Highlights: Multinational measles outbreak in a country without endemic transmission. The findings exhibit the importance of immunization in international travelers in the post-elimination era.

Cite this paper

Ruiz-Matus, C. , Suárez-Idueta, L. , Herbas-Rocha, I. , Diaz-Ortega, J. , Cruz-Ramírez, E. , Ramírez-Jurado, A. , López-Martínez, I. , Rodríguez-Martínez, J. and Díaz-Quiñonez, J. (2015) Multinational Measles Outbreak in Post-Elimination Era, Involves Three Countries of North America and a European Country in a Short Transmission Chain. World Journal of Vaccines, 5, 79-87. doi: 10.4236/wjv.2015.52010.


[1] Wolfson, L.J., Strebel, P.M., Gacic-Dobo, M., Hoekstra, E.J., McFarland, J.W. and Hersh, B.S. (2007) Has the 2005 Measles Mortality Reduction Global Been Achieved? A Natural History Modelling Study. The Lancet, 369,191-200.
[2] Perry, R.T., Gacic-Dobo, M., Dabbagh, A., Strebel, P.M., Okwo-Bele, J.M. and Goodson, J.I. (2013) Global Control and Regional Elimination of Measles, 2000-2011. Morbidity and Mortality Weekly Report, 62, 27-31.
[3] Velázquez-Monroy, O.J., Alavarez-Lucas, C.H., Lezana-Fernández, M.A. and Avila-Figueroa, C. (1990) Panorama epidemiológico del sarampión en México: Situación actual y perspectivas. Boletín Médico del Hospital Infantil de México, 47, 462-473.
[4] Díaz-Ortega, J.L. and Montesano-Castellano, R. (1998) Rompiendo la cadena: Eliminación del sarampión en México. In: Santos Preciado, J.I., Ed., Infectología, Interamericana-Mc-Graw-Hill, México, D.F., 258-272.
[5] Herbas Rocha, I.M.J. and Villanueva-Domínguez, J. (2010) Vacunación y panorama epidemiológico del sarampión en México 1989-2009. Revista de Enfermedades Infecciosas en Pediatría, 23, 36.
[6] OPS (2011) Plan de acción para la documentación y verificación de la eliminación de sarampión, rubéola y síndrome de rubéola congénita en la Región de las Américas. Organización Panamericana de la Salud, Washington DC.
[7] Comisión Nacional para la Documentación y Verificación de la Eliminación del Sarampión, Rubéola y Síndrome de Rubéola Congénita en México. Informe Final. Febrero de 2012.
[8] Díaz Ortega, J.L. (2013) Las estrategias de eliminación regional en la re-emergencia global del sarampión. Sensor. Boletín electrónico de Sociedad, género y políticas públicas. Información para el desarrollo del estado de Oaxaca, 12, 22-25.
[9] Martin, R., Deshevoi, S., Buddha, N. and Jankovic, D. (2009) Approaching Measles and Rubella Elimination in the European Region—Need to Sustain the Gains. Eurosurveillance, 14, pii=19449.
[10] WHO (2013) Progress in Global Control and Regional Elimination of Measles, 2000-2011. The Weekly Epidemiological Record, 88, 29-36.


Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  更改 )

Google+ photo

You are commenting using your Google+ account. Log Out /  更改 )

Twitter picture

You are commenting using your Twitter account. Log Out /  更改 )

Facebook photo

You are commenting using your Facebook account. Log Out /  更改 )


Connecting to %s