Etiology of Maculopapular Rash in Measles and Rubella Suspected Patients from Belarus

Abstract

As a result of successful implementation of the measles/rubella elimination program, the etiology of more and more double negative cases remains elusive. The present study determined the role of different viruses as causative agents in measles or rubella suspected cases in Belarus. A total of 856 sera sent to the WHO National Laboratory between 2009 and 2011 were tested for specific IgM antibodies to measles virus (MV), rubella virus (RV) and human parvovirus B19 (B19V). The negatives were further investigated for antibodies to enterovirus (EV) and adenovirus (AdV). Children of up to 3 years were tested for IgM antibodies to human herpesvirus 6 (HHV6). A viral etiology was identified in 451 (52.7%) cases, with 6.1% of the samples being positive for MV; 2.6% for RV; 26.2% for B19V; 9.7% for EV; 4.6% for AdV; and 3.6% for HHV6. Almost all measles and rubella cases occurred during limited outbreaks in 2011 and nearly all patients were at least 15 years old. B19V, EV and AdV infections were prevalent both in children and adults and were found throughout the 3 years. B19V occurred mainly in 3–10 years old children and 20–29 years old adults. EV infection was most common in children up to 6 years of age and AdV was confirmed mainly in 3–6 years old children. HHV6 infection was mostly detected in 6–11 months old infants. Laboratory investigation of measles/rubella suspected cases also for B19V, EV, AdV and HHV6 allows diagnosing more than half of all cases, thus strengthening rash/fever disease surveillance in Belarus.

A method for detecting rash and fever illness‐associated viruses using multiplex reverse transcription polymerase chain reaction

“…Thus, many viruses are associated with RFIs . However, many patients with RFIs do not show the typical symptoms associated with certain diagnoses; thus, confirmation of pathogens may be important .…”

An evaluation of the clinical features of measles virus infection for diagnosis in children within a limited resources setting

“…Because the signs and symptoms of measles are nonspecific and patients with fevers and rashes can try to access any level of medical services, the relevant cases are easily missed [11,13,14,30,35,41,42]. Moreover, several patients showed some less typical features.…”

“…Indonesia has been suffering from many outbreaks of vaccine preventable diseases included poliomyelitis, diphtheria, and measles [23][24][25]. Every year, some measles outbreak cases are found in many places across Indonesia, just like other underdeveloped and developing countries [20][21][22][26][27][28][29][30][31]. .…”

A sensitive one-step TaqMan amplification approach for detection of rubella virus clade I and II genotypes in clinical samples

“…Despite the existence of an effective vaccine and a high overall RV immunization coverage in many European countries, susceptible cohorts with low vaccine-acquired immunity might represent a continuous risk for importation of RV from its endemic areas [18,24]. Additionally, RV needs to be discriminated from other skin rash-associated diseases such as allergies and infections caused by viral pathogens, including parvovirus B19, measles virus and Zika virus [8,26,[28][29][30]. In this regard, it needs to be considered that both RV and Zika virus cause a notable rate of asymptomatic infections.…”

“…In this regard, it needs to be considered that both RV and Zika virus cause a notable rate of asymptomatic infections. A clear verification of clinical cases is also the basis for assessment of the goals set by the WHO to control RV, as rash/fever outbreaks continue to occur [4,15,30].…”