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Many infectious diseases are thought to have emerged in humans after the Neolithic revolution. Although it is broadly accepted that this also applies to measles, the exact date of emergence for this disease is controversial. We sequenced the genome of a 1912 measles virus and used selection-aware molecular clock modeling to determine the divergence date of measles virus and rinderpest virus. This divergence date represents the earliest possible date for the establishment of measles in human populations. Our analyses show that the measles virus potentially arose as early as the sixth century BCE, possibly coinciding with the rise of large cities.

The 53 member states of the World Health Organization (WHO) European Region (EUR) have set a goal to eliminate measles and rubella virus transmission by 2015 in Europe (1). Elimination [...]

Objective To determine morbidity and costs related to a large measles outbreak in Germany and to identify ways to improve the country&apos;s national measles elimination strategy. Methods We investigated a large outbreak of measles in the federal state of North Rhine-Westphalia (NRW) that occurred in 2006 after 2 years of low measles incidence (< 1 case per 100 000). WHO&apos;s clinical case definition was used, and surveillance data from 2006 and 2001 were compared. AII cases notified in Duisburg, the most severely affected city, were contacted and interviewed or sent a questionnaire. Health-care provider costs were calculated using information on complications, hospitalization and physician consultations. Findings In NRW, 1749 cases were notified over a 48-week period. Compared with 2001, the distribution of cases shifted to older age groups (especially the 10-14 year group). Most cases (n = 614) occurred in Duisburg. Of these, 81% were interviewed; 15% were hospitalized and two died. Of the 464 for whom information was available, 80% were reported as unvaccinated. Common reasons for non-vaccination were parents either forgetting (36%) or rejecting (28%) vaccination. The average cost per measles case was estimated at 373 [euro]. Conclusion An accumulation of non-immune individuals led to this outbreak. The shift in age distribution has implications for the effectiveness of measles control and the elimination strategy in place. Immediate nationwide school-based catch-up vaccination campaigns targeting older age groups ate needed to close critical immunity gaps. Otherwise, the elimination of measles in Germany and thus in Europe by 2010 will not be feasible. Objectif Determiner la morbidite et les couts lies a une vaste flambee de rougeole en Allemagne et identifier les moyens permettant d&apos;ameliorer la strategie nationale allemande d&apos;elimination de la rougeole. Methodes Nous avons enquete sur une vaste flambee de rougeole dans I&apos;Etat federal de Rhenanie-Du-Nord-Westphalie (NRW), survenue en 2006 apres 2 annees de faible incidence de cette maladie (< 1 cas pour 100 000 habitants). On a utilise la definition du cas clinique de I&apos;OMS et compare les donnees de surveillance de 2006 et 2001. Tous les cas notifies a Duisbourg, la ville la plus severement touchee, ont ete contactes et soumis a un entretien ou a. un questionnaire. Les couts lies aux prestateurs de soins ont ete calcules & partir d&apos;informations sur les complications, les hospitalisations et les consultations medicales. Resultats En Rhenanie-Du-Nord-Westphalie, 1749 cas ont ete notifies sur une periode de 48 semaines. Par comparaison avec 2001, la distribution de cas s&apos;est deplacee vers les tranches d&apos;ages superieures (en particulier la tranche 10-14 ans). La majorite des cas (n = 614) se sont produits a Duisbourg. Parmi les cas apparus a Duisbourg, 81% ont subi un entretien, 15 % ont ete hospitalises et deux sont decedes. Sur les 464 cas pour lesquels on disposait d&apos;informations, 80 % ont ete signales comme non vaccines. Les motifs courants de I&apos;absence de vaccination etaient I&apos;oubli (36 %) ou le refus (28 %) de cette vaccination par les parents. Le cout moyen par cas de rougeole a ete estime a 373 euros. Conclusion Cette flambee etait due a un regroupement d&apos;individus non immuns. Le decalage de la distribution par ages a des implications pour I&apos;efficacite de la lutte antirougeoleuse et pour la strategie d&apos;elimination en place. Pour combler des lacunes immunitaires critiques, il faudrait lancer immediatement, a I&apos;echelle nationale, des campagnes de vaccination de rattrapage en milieu scolaire visant les classes d&apos;ages superieures. Faute de quoi, I&apos;elimination de la rougeole en Allemagne, et par consequent en Europe, ne serait pas realisable d&apos;ici 2010. Objetivo Determinar la morbilidad y los costos asociados a un extenso brote de sarampion declarado en Alemania e identificar la manera de mejorar la estrategia nacional aplicada en ese pais para eliminar dicha enfermedad. Metodos Investigamos un extenso brote de sarampion que se produjo en el estado federal de Renania del Norte-Westfalia (RNW) en 2006 tras dos anos de baja incidencia de sarampion (< 1 caso por 100 000 habitantes). Usando la definicion de caso clinico de la OMS, se compararon los datos de vigilancia de 2006 y 2001. Se establecio contacto con todos los casos notificados en Duisburgo, la ciudad mas gravemente afectada, a los que se entrevisto o se envio un cuestionario. Los costos de la dispensacion de salud se calcularon a partir de diversos datos sobre las complicaciones, las hospitalizaciones y las consultas al medico. Resultados En RNW se notificaron 1749 casos a lo largo de un periodo de 48 semanas. En comparacion con 2001, la distribucion de los casos se desplazo hacia los grupos de mas edad (especialmente hacia el grupo de 10-14 anos). La mayoria de los casos (n = 614) se dieron en Duisburgo. De ellos, un 81% fueron entrevistados, un 15% fueron hospitalizados y dos fallecieron. De los 464 respecto a los que se disponia de informacion, el 80% no habian sido vacunados. Las razones mas frecuentes de que no se hubiera vacunado a los ninos es que los padres habian olvidado hacerlo (36%) orechazaban la vacunacion (28%). El costo medio por caso de sarampion se estimo en 373 euros. Conclusion La acumulacion de individuos no inmunizados es lo que provoco la aparicion de este brote. El desplazamiento de la distribucion de edades tiene implicaciones en lo tocante a la eficacia del control del sarampion y la estrategia de eliminacion aplicada. A fin de cerrar la critica brecha de inmunidad aparecida, es preciso emprender de inmediato en todo el pais campanas de vacunacion escolar de puesta al dia centradas en los grupos de mas edad. De lo contrario, no sera posible eliminar el sarampion en Alemania, y por tanto en Europa, para 2010., Background Germany, with 82 million inhabitants, is committed to the WHO goal of eliminating indigenous measles transmission in the European Region by 2010. (1,2) WHO recommends that at least 95% [...]

During 2005-2006, nine measles virus (MV) genotypes were identified throughout the World Health Organization European Region. All major epidemics were associated with genotypes D4, D6, and B3. Other genotypes (B2, [...]

Abstract Background In Germany, measles vaccination coverage with two doses is not yet sufficient to prevent regional outbreaks. Among the 16 German federal states, vaccination coverage was lowest in Bavaria with 85% in 2008. From March to mid-April 2008, four neighbouring Bavarian counties reported 55 measles-cases mostly linked to an ongoing measles outbreak in an anthroposophic school in Austria. We investigated this outbreak to guide future public health action. Methods We applied the German national case-definition for measles and collected data using the national surveillance system and a questionnaire. Measles cases with disease onset a maximum of 18 days apart and spatial contact (e.g. same household, same school) were summed up in clusters. Two different interventions, which were implemented in schools and kindergartens in Bavaria, were compared by their impact on the size and duration of measles clusters. Susceptible persons were excluded from schools or kindergartens either with the first (intervention A) or second (intervention B) measles case occurring in the respective institution. Results Among the 217 Bavarian measles cases identified from March-July 2008, 28 (13%) cases were attendees of the anthroposophic school in Austria. In total, vaccination status was known in 161 (74%) cases and 156 (97%) of them were not vaccinated. The main factor for non-vaccination was "fear of vaccine-related adverse events" (33%). Twenty-nine (18%) of 161 cases suffered complications. Exclusively genotype D5 was detected. Overall, 184 cases could be epidemiologically grouped into 59 clusters. Of those, 41 clusters could be linked to households and 13 to schools or kindergartens. The effect of intervention A and B was analysed in 10 school or kindergarten clusters. Depending on the respective intervention A or B, the median number of cases per cluster was 3 versus 13 (p = 0.05), and the median duration of a cluster was 3 versus 26 days (p = 0.13). Conclusions Introduction of measles virus into a pocket of susceptible persons (e.g. vaccination opponents or sceptics) may lead to large outbreaks in the general population, if the general population's vaccination coverage is below the WHO recommended level. Education on the safety of measles vaccine needs to be strengthened to increase measles vaccination coverage. Early intervention may limit spread in schools or kindergartens. Suspected measles has to be reported immediately to the local health authorities in order to allow intervention as early as possible.