Toward high-resolution and

timely diagnosis for measles

Ian Carter

Principal Hospital Scientist NSW Health Pathology

ICPMR Westmead Hospital

South Australian Chronicle and Weekly Mail (Adelaide SA

1868 - 1881) MEASLES IN PIGS

South Australian Chronicle and Weekly Mail (Adelaide SA

1868 - 1881) MEASLES IN PIGS

Pork measles is caused by tapeworm parasites that live

in the muscles of pigs (Cysticercus bovis)

The pig is not usually affected but can be in pain and

battle to move around When people eat undercooked

pork infected by tapeworm cysts tapeworms develop in

their intestines and make them very sick

Pigs cannot be treated for this disease but preventive

measures can be taken by practising good hygiene and

stopping them from wandering about where they eat

human faeces

Measles - Paramyxoviridae

Measles is an infection of the respiratory system caused

by a virus specifically a Paramyxovirus of the genus

Morbillivirus Morbilliviruses like other paramyxovirus are

enveloped single-stranded negative-sense RNA viruses

Measles is spread through contact with fluids from an

infected persons nose and mouth either directly or

through aerosol transmission and is highly infectious

The infection has an average incubation period of 14

days (range 6-19 days) and infectivity lasts from 2-4 days

prior to 2-5 days following the onset of the rash

The measles virus is a spherical non segmented single-stranded RNA virus in the Morbillivirus family closely related to the rinderpest and canine distemper viruses

It contains six structural proteins three that are complexed to the RNA and three that are associated with the viral membrane envelope

History

References to measles ndash as early as 7th century

Measles infection was distinguished from smallpox as

early as the 9th century by an Arab physician by the

name of Abu Becr Razi (the Doctor of Baghdad)

Described by the Persian physician Rhazes in the 10th

century as ldquomore dreaded than smallpoxrdquo

Measles was first mentioned as a childhood disease in

1224

The Danish physician Peter Panum is generally given credit

for illuminating the basic principles of measles infection and

epidemiology during his trip to the Faroe Islands in 1846

during a measles epidemic

1954 - Enders and Peebles first isolated the virus in human

and monkey kidney tissue culture

Estimated to have killed about 200 million worldwide in the

last 150 years

Diagnosis of Measles

Most cases of Measles are diagnosed clinically

usually in patientrsquos home or in General Practice

Direct Virological confirmation is difficult in most

of the Developing countries

How is measles diagnosedYour doctor will usually be able to diagnose measles from the

combination of your symptoms especially the characteristic rash

and the small Koplik spots inside your mouth

However a simple throat swab urine or blood test is usually done

to confirm the diagnosis

Diagnosis with Immunofluorescence

Direct and indirect immunofluorescence have

been used extensively to demonstrate MV

antigens in cells from NPS specimens Urine

was not as successful a specimen for IF

Diagnosis by Viral Isolation

Measles virus can be isolated form a variety of sources eg throat or conjunctival washings sputum urinary sediment cells and lymphocytes

Primary human kidney (HEK) cells are the best although primary monkey kidney can be used as well Continuous cell lines such as Vero cells can also be used

Diagnosis by Serology

Diagnosis of measles infection can be made if the antibody titres rise by 4 fold between the acute and the convalescent phase or if measles-specific IgM is found The methods that can be used include IF HAI CF EIA

Has been a great leap forward diagnostically

non-specific fluorescence issues-no problem

Rapid easy and is now multiplexed

The PCR and sequencing target is the

nucleoprotein gene

Molecular Detection of Measles

Started at ICPMR on the SmartCycler real-time platform

Graduated to the LC480 platform of Roche

Graduated to the BD Max platform ndash 247 in GMU core

Then graduated to the BD Max platform for simultaneous

detection of measles virus and if it is a vaccine related

strain as well as a human gene for sample adequacy

hence multiplexed with different probe labels

Molecular Detection- NAT or NAD

Measles - Paramyxoviridae

Measles is an infection of the respiratory system caused

by a virus specifically a Paramyxovirus of the genus

Morbillivirus Morbilliviruses like other paramyxovirus are

enveloped single-stranded negative-sense RNA viruses

Measles is spread through contact with fluids from an

infected persons nose and mouth either directly or

through aerosol transmission and is highly infectious

The infection has an average incubation period of 14

days (range 6-19 days) and infectivity lasts from 2-4 days

prior to 2-5 days following the onset of the rash

The measles virus is a spherical non segmented single-stranded RNA virus in the Morbillivirus family closely related to the rinderpest and canine distemper viruses

It contains six structural proteins three that are complexed to the RNA and three that are associated with the viral membrane envelope

History

References to measles ndash as early as 7th century

Measles infection was distinguished from smallpox as

early as the 9th century by an Arab physician by the

name of Abu Becr Razi (the Doctor of Baghdad)

Described by the Persian physician Rhazes in the 10th

century as ldquomore dreaded than smallpoxrdquo

Measles was first mentioned as a childhood disease in

1224

The Danish physician Peter Panum is generally given credit

for illuminating the basic principles of measles infection and

epidemiology during his trip to the Faroe Islands in 1846

during a measles epidemic

1954 - Enders and Peebles first isolated the virus in human

and monkey kidney tissue culture

Estimated to have killed about 200 million worldwide in the

last 150 years

Diagnosis of Measles

Most cases of Measles are diagnosed clinically

usually in patientrsquos home or in General Practice

Direct Virological confirmation is difficult in most

of the Developing countries

How is measles diagnosedYour doctor will usually be able to diagnose measles from the

combination of your symptoms especially the characteristic rash

and the small Koplik spots inside your mouth

However a simple throat swab urine or blood test is usually done

to confirm the diagnosis

Diagnosis with Immunofluorescence

Direct and indirect immunofluorescence have

been used extensively to demonstrate MV

antigens in cells from NPS specimens Urine

was not as successful a specimen for IF

Diagnosis by Viral Isolation

Measles virus can be isolated form a variety of sources eg throat or conjunctival washings sputum urinary sediment cells and lymphocytes

Primary human kidney (HEK) cells are the best although primary monkey kidney can be used as well Continuous cell lines such as Vero cells can also be used

Diagnosis by Serology

Diagnosis of measles infection can be made if the antibody titres rise by 4 fold between the acute and the convalescent phase or if measles-specific IgM is found The methods that can be used include IF HAI CF EIA

Has been a great leap forward diagnostically

non-specific fluorescence issues-no problem

Rapid easy and is now multiplexed

The PCR and sequencing target is the

nucleoprotein gene

Molecular Detection of Measles

Started at ICPMR on the SmartCycler real-time platform

Graduated to the LC480 platform of Roche

Graduated to the BD Max platform ndash 247 in GMU core

Then graduated to the BD Max platform for simultaneous

detection of measles virus and if it is a vaccine related

strain as well as a human gene for sample adequacy

hence multiplexed with different probe labels

Molecular Detection- NAT or NAD

The measles virus is a spherical non segmented single-stranded RNA virus in the Morbillivirus family closely related to the rinderpest and canine distemper viruses

It contains six structural proteins three that are complexed to the RNA and three that are associated with the viral membrane envelope

History

References to measles ndash as early as 7th century

Measles infection was distinguished from smallpox as

early as the 9th century by an Arab physician by the

name of Abu Becr Razi (the Doctor of Baghdad)

Described by the Persian physician Rhazes in the 10th

century as ldquomore dreaded than smallpoxrdquo

Measles was first mentioned as a childhood disease in

1224

The Danish physician Peter Panum is generally given credit

for illuminating the basic principles of measles infection and

epidemiology during his trip to the Faroe Islands in 1846

during a measles epidemic

1954 - Enders and Peebles first isolated the virus in human

and monkey kidney tissue culture

Estimated to have killed about 200 million worldwide in the

last 150 years

Diagnosis of Measles

Most cases of Measles are diagnosed clinically

usually in patientrsquos home or in General Practice

Direct Virological confirmation is difficult in most

of the Developing countries

How is measles diagnosedYour doctor will usually be able to diagnose measles from the

combination of your symptoms especially the characteristic rash

and the small Koplik spots inside your mouth

However a simple throat swab urine or blood test is usually done

to confirm the diagnosis

Diagnosis with Immunofluorescence

Direct and indirect immunofluorescence have

been used extensively to demonstrate MV

antigens in cells from NPS specimens Urine

was not as successful a specimen for IF

Diagnosis by Viral Isolation

Measles virus can be isolated form a variety of sources eg throat or conjunctival washings sputum urinary sediment cells and lymphocytes

Primary human kidney (HEK) cells are the best although primary monkey kidney can be used as well Continuous cell lines such as Vero cells can also be used

Diagnosis by Serology

Diagnosis of measles infection can be made if the antibody titres rise by 4 fold between the acute and the convalescent phase or if measles-specific IgM is found The methods that can be used include IF HAI CF EIA

Has been a great leap forward diagnostically

non-specific fluorescence issues-no problem

Rapid easy and is now multiplexed

The PCR and sequencing target is the

nucleoprotein gene

Molecular Detection of Measles

Started at ICPMR on the SmartCycler real-time platform

Graduated to the LC480 platform of Roche

Graduated to the BD Max platform ndash 247 in GMU core

Then graduated to the BD Max platform for simultaneous

detection of measles virus and if it is a vaccine related

strain as well as a human gene for sample adequacy

hence multiplexed with different probe labels

Molecular Detection- NAT or NAD

History

References to measles ndash as early as 7th century

Measles infection was distinguished from smallpox as

early as the 9th century by an Arab physician by the

name of Abu Becr Razi (the Doctor of Baghdad)

Described by the Persian physician Rhazes in the 10th

century as ldquomore dreaded than smallpoxrdquo

Measles was first mentioned as a childhood disease in

1224

The Danish physician Peter Panum is generally given credit

for illuminating the basic principles of measles infection and

epidemiology during his trip to the Faroe Islands in 1846

during a measles epidemic

1954 - Enders and Peebles first isolated the virus in human

and monkey kidney tissue culture

Estimated to have killed about 200 million worldwide in the

last 150 years

Diagnosis of Measles

Most cases of Measles are diagnosed clinically

usually in patientrsquos home or in General Practice

Direct Virological confirmation is difficult in most

of the Developing countries

How is measles diagnosedYour doctor will usually be able to diagnose measles from the

combination of your symptoms especially the characteristic rash

and the small Koplik spots inside your mouth

However a simple throat swab urine or blood test is usually done

to confirm the diagnosis

Diagnosis with Immunofluorescence

Direct and indirect immunofluorescence have

been used extensively to demonstrate MV

antigens in cells from NPS specimens Urine

was not as successful a specimen for IF

Diagnosis by Viral Isolation

Measles virus can be isolated form a variety of sources eg throat or conjunctival washings sputum urinary sediment cells and lymphocytes

Primary human kidney (HEK) cells are the best although primary monkey kidney can be used as well Continuous cell lines such as Vero cells can also be used

Diagnosis by Serology

Diagnosis of measles infection can be made if the antibody titres rise by 4 fold between the acute and the convalescent phase or if measles-specific IgM is found The methods that can be used include IF HAI CF EIA

Has been a great leap forward diagnostically

non-specific fluorescence issues-no problem

Rapid easy and is now multiplexed

The PCR and sequencing target is the

nucleoprotein gene

Molecular Detection of Measles

Started at ICPMR on the SmartCycler real-time platform

Graduated to the LC480 platform of Roche

Graduated to the BD Max platform ndash 247 in GMU core

Then graduated to the BD Max platform for simultaneous

detection of measles virus and if it is a vaccine related

strain as well as a human gene for sample adequacy

hence multiplexed with different probe labels

Molecular Detection- NAT or NAD

The Danish physician Peter Panum is generally given credit

for illuminating the basic principles of measles infection and

epidemiology during his trip to the Faroe Islands in 1846

during a measles epidemic

1954 - Enders and Peebles first isolated the virus in human

and monkey kidney tissue culture

Estimated to have killed about 200 million worldwide in the

last 150 years

Diagnosis of Measles

Most cases of Measles are diagnosed clinically

usually in patientrsquos home or in General Practice

Direct Virological confirmation is difficult in most

of the Developing countries

How is measles diagnosedYour doctor will usually be able to diagnose measles from the

combination of your symptoms especially the characteristic rash

and the small Koplik spots inside your mouth

However a simple throat swab urine or blood test is usually done

to confirm the diagnosis

Diagnosis with Immunofluorescence

Direct and indirect immunofluorescence have

been used extensively to demonstrate MV

antigens in cells from NPS specimens Urine

was not as successful a specimen for IF

Diagnosis by Viral Isolation

Measles virus can be isolated form a variety of sources eg throat or conjunctival washings sputum urinary sediment cells and lymphocytes

Primary human kidney (HEK) cells are the best although primary monkey kidney can be used as well Continuous cell lines such as Vero cells can also be used

Diagnosis by Serology

Diagnosis of measles infection can be made if the antibody titres rise by 4 fold between the acute and the convalescent phase or if measles-specific IgM is found The methods that can be used include IF HAI CF EIA

Has been a great leap forward diagnostically

non-specific fluorescence issues-no problem

Rapid easy and is now multiplexed

The PCR and sequencing target is the

nucleoprotein gene

Molecular Detection of Measles

Started at ICPMR on the SmartCycler real-time platform

Graduated to the LC480 platform of Roche

Graduated to the BD Max platform ndash 247 in GMU core

Then graduated to the BD Max platform for simultaneous

detection of measles virus and if it is a vaccine related

strain as well as a human gene for sample adequacy

hence multiplexed with different probe labels

Molecular Detection- NAT or NAD

Diagnosis of Measles

Most cases of Measles are diagnosed clinically

usually in patientrsquos home or in General Practice

Direct Virological confirmation is difficult in most

of the Developing countries

How is measles diagnosedYour doctor will usually be able to diagnose measles from the

combination of your symptoms especially the characteristic rash

and the small Koplik spots inside your mouth

However a simple throat swab urine or blood test is usually done

to confirm the diagnosis

Diagnosis with Immunofluorescence

Direct and indirect immunofluorescence have

been used extensively to demonstrate MV

antigens in cells from NPS specimens Urine

was not as successful a specimen for IF

Diagnosis by Viral Isolation

Measles virus can be isolated form a variety of sources eg throat or conjunctival washings sputum urinary sediment cells and lymphocytes

Primary human kidney (HEK) cells are the best although primary monkey kidney can be used as well Continuous cell lines such as Vero cells can also be used

Diagnosis by Serology

Diagnosis of measles infection can be made if the antibody titres rise by 4 fold between the acute and the convalescent phase or if measles-specific IgM is found The methods that can be used include IF HAI CF EIA

Has been a great leap forward diagnostically

non-specific fluorescence issues-no problem

Rapid easy and is now multiplexed

The PCR and sequencing target is the

nucleoprotein gene

Molecular Detection of Measles

Started at ICPMR on the SmartCycler real-time platform

Graduated to the LC480 platform of Roche

Graduated to the BD Max platform ndash 247 in GMU core

Then graduated to the BD Max platform for simultaneous

detection of measles virus and if it is a vaccine related

strain as well as a human gene for sample adequacy

hence multiplexed with different probe labels

Molecular Detection- NAT or NAD

How is measles diagnosedYour doctor will usually be able to diagnose measles from the

combination of your symptoms especially the characteristic rash

and the small Koplik spots inside your mouth

However a simple throat swab urine or blood test is usually done

to confirm the diagnosis

Diagnosis with Immunofluorescence

Direct and indirect immunofluorescence have

been used extensively to demonstrate MV

antigens in cells from NPS specimens Urine

was not as successful a specimen for IF

Diagnosis by Viral Isolation

Measles virus can be isolated form a variety of sources eg throat or conjunctival washings sputum urinary sediment cells and lymphocytes

Primary human kidney (HEK) cells are the best although primary monkey kidney can be used as well Continuous cell lines such as Vero cells can also be used

Diagnosis by Serology

Diagnosis of measles infection can be made if the antibody titres rise by 4 fold between the acute and the convalescent phase or if measles-specific IgM is found The methods that can be used include IF HAI CF EIA

Has been a great leap forward diagnostically

non-specific fluorescence issues-no problem

Rapid easy and is now multiplexed

The PCR and sequencing target is the

nucleoprotein gene

Molecular Detection of Measles

Started at ICPMR on the SmartCycler real-time platform

Graduated to the LC480 platform of Roche

Graduated to the BD Max platform ndash 247 in GMU core

Then graduated to the BD Max platform for simultaneous

detection of measles virus and if it is a vaccine related

strain as well as a human gene for sample adequacy

hence multiplexed with different probe labels

Molecular Detection- NAT or NAD

Diagnosis with Immunofluorescence

Direct and indirect immunofluorescence have

been used extensively to demonstrate MV

antigens in cells from NPS specimens Urine

was not as successful a specimen for IF

Diagnosis by Viral Isolation

Measles virus can be isolated form a variety of sources eg throat or conjunctival washings sputum urinary sediment cells and lymphocytes

Primary human kidney (HEK) cells are the best although primary monkey kidney can be used as well Continuous cell lines such as Vero cells can also be used

Diagnosis by Serology

Diagnosis of measles infection can be made if the antibody titres rise by 4 fold between the acute and the convalescent phase or if measles-specific IgM is found The methods that can be used include IF HAI CF EIA

Has been a great leap forward diagnostically

non-specific fluorescence issues-no problem

Rapid easy and is now multiplexed

The PCR and sequencing target is the

nucleoprotein gene

Molecular Detection of Measles

Started at ICPMR on the SmartCycler real-time platform

Graduated to the LC480 platform of Roche

Graduated to the BD Max platform ndash 247 in GMU core

Then graduated to the BD Max platform for simultaneous

detection of measles virus and if it is a vaccine related

strain as well as a human gene for sample adequacy

hence multiplexed with different probe labels

Molecular Detection- NAT or NAD

Diagnosis by Viral Isolation

Measles virus can be isolated form a variety of sources eg throat or conjunctival washings sputum urinary sediment cells and lymphocytes

Primary human kidney (HEK) cells are the best although primary monkey kidney can be used as well Continuous cell lines such as Vero cells can also be used

Diagnosis by Serology

Diagnosis of measles infection can be made if the antibody titres rise by 4 fold between the acute and the convalescent phase or if measles-specific IgM is found The methods that can be used include IF HAI CF EIA

Has been a great leap forward diagnostically

non-specific fluorescence issues-no problem

Rapid easy and is now multiplexed

The PCR and sequencing target is the

nucleoprotein gene

Molecular Detection of Measles

Started at ICPMR on the SmartCycler real-time platform

Graduated to the LC480 platform of Roche

Graduated to the BD Max platform ndash 247 in GMU core

Then graduated to the BD Max platform for simultaneous

detection of measles virus and if it is a vaccine related

strain as well as a human gene for sample adequacy

hence multiplexed with different probe labels

Molecular Detection- NAT or NAD

Diagnosis by Serology

Diagnosis of measles infection can be made if the antibody titres rise by 4 fold between the acute and the convalescent phase or if measles-specific IgM is found The methods that can be used include IF HAI CF EIA

Has been a great leap forward diagnostically

non-specific fluorescence issues-no problem

Rapid easy and is now multiplexed

The PCR and sequencing target is the

nucleoprotein gene

Molecular Detection of Measles

Started at ICPMR on the SmartCycler real-time platform

Graduated to the LC480 platform of Roche

Graduated to the BD Max platform ndash 247 in GMU core

Then graduated to the BD Max platform for simultaneous

detection of measles virus and if it is a vaccine related

strain as well as a human gene for sample adequacy

hence multiplexed with different probe labels

Molecular Detection- NAT or NAD

Has been a great leap forward diagnostically

non-specific fluorescence issues-no problem

Rapid easy and is now multiplexed

The PCR and sequencing target is the

nucleoprotein gene

Molecular Detection of Measles

Started at ICPMR on the SmartCycler real-time platform

Graduated to the LC480 platform of Roche

Graduated to the BD Max platform ndash 247 in GMU core

Then graduated to the BD Max platform for simultaneous

detection of measles virus and if it is a vaccine related

strain as well as a human gene for sample adequacy

hence multiplexed with different probe labels

Molecular Detection- NAT or NAD

Started at ICPMR on the SmartCycler real-time platform

Graduated to the LC480 platform of Roche

Graduated to the BD Max platform ndash 247 in GMU core

Then graduated to the BD Max platform for simultaneous

detection of measles virus and if it is a vaccine related

strain as well as a human gene for sample adequacy

hence multiplexed with different probe labels

Molecular Detection- NAT or NAD

bull Incorporating locked nucleic acid LNA into the PCR

probe increases thermal duplex stability and

improves the specificity of probe hybridization to its

target sequence This reduces background

fluorescence from spurious binding which increases

the signal-to-noise ratio

bull This increase in hybridization creates a significant

broadening in the scope of assay conditions and

allows for more successful multiplexing

Target - Nucleoprotein gene

Negative sample

QAP

Pathology 2018 Jun50(4)450-454 doi

101016jpathol201711093 Epub 2018 May 8

Simultaneous co-detection of wild-type

and vaccine strain measles virus using

the BD MAX system

Thapa K1 Ellem JA1 Basile K2 Carter I1 Olma T1 Chen

SC3 Dwyer DE3 Kok J3

Target - Nucleoprotein gene

Negative sample

QAP

Pathology 2018 Jun50(4)450-454 doi

101016jpathol201711093 Epub 2018 May 8

Simultaneous co-detection of wild-type

and vaccine strain measles virus using

the BD MAX system

Thapa K1 Ellem JA1 Basile K2 Carter I1 Olma T1 Chen

SC3 Dwyer DE3 Kok J3

Negative sample

QAP

Pathology 2018 Jun50(4)450-454 doi

101016jpathol201711093 Epub 2018 May 8

Simultaneous co-detection of wild-type

and vaccine strain measles virus using

the BD MAX system

Thapa K1 Ellem JA1 Basile K2 Carter I1 Olma T1 Chen

SC3 Dwyer DE3 Kok J3

QAP

Pathology 2018 Jun50(4)450-454 doi

101016jpathol201711093 Epub 2018 May 8

Simultaneous co-detection of wild-type

and vaccine strain measles virus using

the BD MAX system

Thapa K1 Ellem JA1 Basile K2 Carter I1 Olma T1 Chen

SC3 Dwyer DE3 Kok J3

Pathology 2018 Jun50(4)450-454 doi

101016jpathol201711093 Epub 2018 May 8

Simultaneous co-detection of wild-type

and vaccine strain measles virus using

the BD MAX system

Thapa K1 Ellem JA1 Basile K2 Carter I1 Olma T1 Chen

SC3 Dwyer DE3 Kok J3

The WHO Measles and Rubella Laboratory Network

(LabNet) supports genetic characterization of circulating

wild-type viruses throughout the world

Genetic characterization of MeVs is based on sequence

analysis of the 450 nucleotides coding for the 150 amino

acids at the carboxyl terminus of the nucleoprotein (N-450)

The entire N-450 sequence is required for determination of

the genotype and there is up to 12 nucleotide variation

between genotypes

Based on these sequences 24 genotypes have been

identified

2017-2018 Number

Genotype A = vaccine 29

Genotype D8 19

Genotype B3 2

Genotype D9 2

WESTMEAD RESULTS

10 DETECTED A Measles vaccine strain (genotype A) Throat no hx

10 DETECTED A Measles virus genotype A Comb NoseThroat morbilliform rash

09 DETECTED A Measles virus genotype A (vaccine strain) Throat rash on face and body

15 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Nasal conjunctivitis face rash

12 DETECTED A Throat vaccination 257

409 DETECTED A Throat recent immunisations

409 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Urine recent immunisations

10 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Urine post mmr with blotchy rash

12 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Comb NoseThroat no hx

12 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Comb NoseThroat no hx

12 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Source NOT spec maculopapular rash face and torso

12 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Source NOT spec maculopapular rash face and torso

10 DETECTED A Throat 13 days post vaccination Fever for 2 days

10 Positive A Measles vaccine genotype NoseThroat high temp generalised rash irritability

11 Positive A Measles vaccine genotype Throat rash appearing 5 days after rash and temp

10 Positive A Measles vaccine genotype Nasalrash to torso and face Blanches with pressuremeasles

21 Positive A Measles vaccine genotype NoseThroat viral rash measles

10 Positive A Measles vaccine genotype NoseThroat no hx

11 Positive A Measles vaccine genotype NoseThroatcoryzal symptoms and rash since yesterday measles

AGE SYMPTOMS

Subacute sclerosing panencephalitis (SSPE) is a

rare and chronic form of progressive brain inflammation

caused by a persistent infection with measles virus

Although SSPE is a rare condition there is still a

relatively high incidence in Asia and the Middle East

However the number of reported cases is declining

since the introduction of the measles vaccine -

eradication of the measles virus prevents the SSPE

mutation and therefore the progression of the disease

or even the initial infection itself

Diagnosis of SSPE

The presence of measles specific antibodies in the CSF is the most reliable means of laboratory diagnosis of SSPE

SSPE is not as common as 30 years ago where at every conference there was a specific session just for this ndash the result of vaccination

Is measles infectious

Yes - it is very infectious It is passed on by coughing

and sneezing the virus into the air It takes between 7

and 18 days (most commonly 10-12 days) to develop

symptoms after being infected (This is the incubation

period) You are infectious and can pass it on to

others from four days before to four days after the

onset of the rash Therefore children with measles

should not mix with others and should stay off school

2017-2018 Number

Genotype A = vaccine 29

Genotype D8 19

Genotype B3 2

Genotype D9 2

WESTMEAD RESULTS

10 DETECTED A Measles vaccine strain (genotype A) Throat no hx

10 DETECTED A Measles virus genotype A Comb NoseThroat morbilliform rash

09 DETECTED A Measles virus genotype A (vaccine strain) Throat rash on face and body

15 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Nasal conjunctivitis face rash

12 DETECTED A Throat vaccination 257

409 DETECTED A Throat recent immunisations

409 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Urine recent immunisations

10 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Urine post mmr with blotchy rash

12 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Comb NoseThroat no hx

12 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Comb NoseThroat no hx

12 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Source NOT spec maculopapular rash face and torso

12 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Source NOT spec maculopapular rash face and torso

10 DETECTED A Throat 13 days post vaccination Fever for 2 days

10 Positive A Measles vaccine genotype NoseThroat high temp generalised rash irritability

11 Positive A Measles vaccine genotype Throat rash appearing 5 days after rash and temp

10 Positive A Measles vaccine genotype Nasalrash to torso and face Blanches with pressuremeasles

21 Positive A Measles vaccine genotype NoseThroat viral rash measles

10 Positive A Measles vaccine genotype NoseThroat no hx

11 Positive A Measles vaccine genotype NoseThroatcoryzal symptoms and rash since yesterday measles

AGE SYMPTOMS

Subacute sclerosing panencephalitis (SSPE) is a

rare and chronic form of progressive brain inflammation

caused by a persistent infection with measles virus

Although SSPE is a rare condition there is still a

relatively high incidence in Asia and the Middle East

However the number of reported cases is declining

since the introduction of the measles vaccine -

eradication of the measles virus prevents the SSPE

mutation and therefore the progression of the disease

or even the initial infection itself

Diagnosis of SSPE

The presence of measles specific antibodies in the CSF is the most reliable means of laboratory diagnosis of SSPE

SSPE is not as common as 30 years ago where at every conference there was a specific session just for this ndash the result of vaccination

Is measles infectious

Yes - it is very infectious It is passed on by coughing

and sneezing the virus into the air It takes between 7

and 18 days (most commonly 10-12 days) to develop

symptoms after being infected (This is the incubation

period) You are infectious and can pass it on to

others from four days before to four days after the

onset of the rash Therefore children with measles

should not mix with others and should stay off school

10 DETECTED A Measles vaccine strain (genotype A) Throat no hx

10 DETECTED A Measles virus genotype A Comb NoseThroat morbilliform rash

09 DETECTED A Measles virus genotype A (vaccine strain) Throat rash on face and body

15 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Nasal conjunctivitis face rash

12 DETECTED A Throat vaccination 257

409 DETECTED A Throat recent immunisations

409 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Urine recent immunisations

10 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Urine post mmr with blotchy rash

12 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Comb NoseThroat no hx

12 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Comb NoseThroat no hx

12 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Source NOT spec maculopapular rash face and torso

12 DETECTED AMeasles virus vaccine strain (genotype A) detected by PCR Further genotyping by sequencing not required Source NOT spec maculopapular rash face and torso

10 DETECTED A Throat 13 days post vaccination Fever for 2 days

10 Positive A Measles vaccine genotype NoseThroat high temp generalised rash irritability

11 Positive A Measles vaccine genotype Throat rash appearing 5 days after rash and temp

10 Positive A Measles vaccine genotype Nasalrash to torso and face Blanches with pressuremeasles

21 Positive A Measles vaccine genotype NoseThroat viral rash measles

10 Positive A Measles vaccine genotype NoseThroat no hx

11 Positive A Measles vaccine genotype NoseThroatcoryzal symptoms and rash since yesterday measles

AGE SYMPTOMS

Subacute sclerosing panencephalitis (SSPE) is a

rare and chronic form of progressive brain inflammation

caused by a persistent infection with measles virus

Although SSPE is a rare condition there is still a

relatively high incidence in Asia and the Middle East

However the number of reported cases is declining

since the introduction of the measles vaccine -

eradication of the measles virus prevents the SSPE

mutation and therefore the progression of the disease

or even the initial infection itself

Diagnosis of SSPE

The presence of measles specific antibodies in the CSF is the most reliable means of laboratory diagnosis of SSPE

SSPE is not as common as 30 years ago where at every conference there was a specific session just for this ndash the result of vaccination

Is measles infectious

Yes - it is very infectious It is passed on by coughing

and sneezing the virus into the air It takes between 7

and 18 days (most commonly 10-12 days) to develop

symptoms after being infected (This is the incubation

period) You are infectious and can pass it on to

others from four days before to four days after the

onset of the rash Therefore children with measles

should not mix with others and should stay off school

Subacute sclerosing panencephalitis (SSPE) is a

rare and chronic form of progressive brain inflammation

caused by a persistent infection with measles virus

Although SSPE is a rare condition there is still a

relatively high incidence in Asia and the Middle East

However the number of reported cases is declining

since the introduction of the measles vaccine -

eradication of the measles virus prevents the SSPE

mutation and therefore the progression of the disease

or even the initial infection itself

Diagnosis of SSPE

The presence of measles specific antibodies in the CSF is the most reliable means of laboratory diagnosis of SSPE

SSPE is not as common as 30 years ago where at every conference there was a specific session just for this ndash the result of vaccination

Is measles infectious

Yes - it is very infectious It is passed on by coughing

and sneezing the virus into the air It takes between 7

and 18 days (most commonly 10-12 days) to develop

symptoms after being infected (This is the incubation

period) You are infectious and can pass it on to

others from four days before to four days after the

onset of the rash Therefore children with measles

should not mix with others and should stay off school

Diagnosis of SSPE

The presence of measles specific antibodies in the CSF is the most reliable means of laboratory diagnosis of SSPE

SSPE is not as common as 30 years ago where at every conference there was a specific session just for this ndash the result of vaccination

Is measles infectious

Yes - it is very infectious It is passed on by coughing

and sneezing the virus into the air It takes between 7

and 18 days (most commonly 10-12 days) to develop

symptoms after being infected (This is the incubation

period) You are infectious and can pass it on to

others from four days before to four days after the

onset of the rash Therefore children with measles

should not mix with others and should stay off school

Is measles infectious

Yes - it is very infectious It is passed on by coughing

and sneezing the virus into the air It takes between 7

and 18 days (most commonly 10-12 days) to develop

symptoms after being infected (This is the incubation

period) You are infectious and can pass it on to

others from four days before to four days after the

onset of the rash Therefore children with measles

should not mix with others and should stay off school