Importation of viruses from other continents caused prolonged circulation and large outbreaks in the WHO European Region.

Mumps is a highly transmissible but usually benign disease consisting of bilateral swelling of the salivary glands. In some instances, though, clinical complications can arise. Bilateral orchitis and clinical self-limited meningitis or more serious complications, such as encephalitis, deafness, male sexual sterility, and pancreatitis, may occur in rare cases (9).Mumps virus (MV), a virus belonging to the genus Rubulavirus of the subfamily Paramyxovirinae, is considered monotypic regarding its antigenicity. Thus, mumps vaccination is part of the regular immunization schedule of many countries, usually along with the measles and rubella vaccination (i.e., the MMR vaccine) in a single formulation. However, in contrast to rubella and measles, secondary vaccine failure frequently allows MV circulation within highly immunized populations (1,5,8,24,36). The use of a poorly immunogenic genotype A strain called Rubini has been proposed as a cause of these major failures, although the occurrence of mumps in patients immunized with other vaccine strains has also been described (26).Genetic variation in the small hydrophobic (SH) gene has led to the characterization of 12 genotypes, which are recognized by the WHO (13, 14, 23). Differential efficiency on cross neutralization among different genotypes has been suggested (20, 21), as have the differential capacities of certain strains to invade the neural system (25, 32). Finally, previous experience with the elimination programs for other preventable viral diseases, such as measles, rubella, and polio, suggest that genotyping would facilitate mumps surveillance (38), since the pattern of viral circulation can be traced. Consequently, molecular epidemiology studies have been performed around the world (2,7,10,11,12,15,17,18,23,31,32,33,34,35,41).Mumps vaccination was introduced in the Spanish national vaccination repertoire in 1981 as part of the triple viral vaccine (the MMR vaccine). As a result, the number of mumps cases fell from 286,887 in 1984 to 1,527 in 2004. However, the general descendant trend was interrupted by some peaks: in 1989 (from 48,393 in 1987 to 83,527 in 1989), 1996 (from 7,002 in 1995 to 14,411 in 1996), 2000 (from 2,857 in 1998 to 9,391 in 2000), and 2007 (from 1,527 in 2004 to 10,219 in 2007). Surprisingly, these peaks occurred despite a national vaccine coverage rate of over 95% of the population by 1999. As has been previously reported (29,30), the occurrence of vaccinated individuals with MV RNA present in their saliva and/or urine with viral IgG but not IgM in acute-phase serum was frequent, suggesting secondary vaccine failure. Although most secondary vaccine failures were associated with the use of at least one dose of the Rubini strain, cases of mumps in patients vaccinated with two doses of the Jerryl Lynn strain were also observed (29,30).In this report, we describe the MV genotypes circulating in Spain over the past 8 years. This represents the first series of data obtained for the national level. Interestingly, this series comprises three...

Molecular characterization of measles virus is important for disease surveillance and for monitoring elimination of the virus throughout the world. Furthermore, knowledge of genotype distribution in as many countries as possible, is useful for tracing the origin of a strain, especially in countries without endemic measles disease, where most cases are imported. Data on genotypes circulating in Spain from 1970 to 1997 showed the prevalence of genotypes C1, C2, and D6, with subsequent replacement of each other. After the establishment of the Spanish Measles Elimination Plan, genotyping with a new retrotranscriptase polymerase chain reaction (RT-PCR) was undertaken directly on 92 specimens, corresponding to 90 patients, which were positive for measles by a different diagnostic RT-PCR. Genotypes B3, D4, D8, A, C2, H1, and D7 were found in different autonomous communities (Madrid, Balearic Islands, Valencia Community, Extremadura, Andalusia, Canary Islands and Murcia) between 2001 and 2003 with none of these genotypes being prevalent. After the introduction of the vaccine in 1978, the incidence of the disease decreased from 150,000 cases in 1977 to 64 in 2002. This could be the reason for the change observed in the pattern of measles genotype circulation, since this pattern was reported in countries at an advanced stage of eradication of measles. This report considers that Spain is on the way to eradicating measles.