Last data update: May 20, 2024. (Total: 46824 publications since 2009)
Records 1-11 (of 11 Records) |
Query Trace: Rota JS [original query] |
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Subacute sclerosing panencephalitis
Rota PA , Rota JS , Goodson JL . Clin Infect Dis 2017 65 (2) 233-234 Subacute sclerosing panencephalitis (SSPE) is a progressive neurologic disorder caused by measles virus that silently develops for several years after the primary measles virus infection and is inevitably fatal. The average latency period following primary infection is 6–10 years but can range from 2 to >30 years, and the time from early symptom onset to death is approximately 1–3 years. Though SSPE is the result of a persistent measles virus infection of neuronal and glial cells, much is unknown about the causes of SSPE and no specific immune deficiency has been identified. Early signs and symptoms that precede diagnosis, often confounding clinicians and parents, may include visual impairments, mental deterioration, behavioral changes, and weakness or impairment of motor function, such as difficulties in gait and frequent falls. Although clinical presentations can vary, severe neurologic symptoms such as monoclonic jerks, ataxia, tremors, and seizures are typical among patients with SSPE. Diagnosis is often delayed due to the initial nonspecific sequelae, and is based on clinical presentation and laboratory testing for detection of intrathecal production of antimeasles immunoglobulin G (IgG) antibody or measles RNA in brain tissue. If measles viral RNA is detected, sequence analysis is performed to identify the measles virus genotype, potentially providing insights into when and where the primary measles virus infection was likely to have occurred years earlier. Several studies that analyzed measles sequences from SSPE cases concluded that the live attenuated vaccine strains do not cause SSPE [1, 2]. The marked decline of SSPE, concurrent with the decline in measles after the introduction and widespread use of measles vaccine, demonstrates that the vaccine protects against SSPE. | The risk of developing SSPE cited in the older literature was 1–8.5 cases per 1000000 cases of measles [3]. In the early to mid-1970s, the risk for developing SSPE was calculated at a time when measles was endemic, and the denominator was based on a crude estimate for the annual number of measles cases [4]. Although an SSPE registry was established in the United States in 1969 [5], the completeness of the register was unknown, and it is likely that underdiagnosis of SSPE contributed to the lower estimates of risk for SSPE. |
High concentrations of measles neutralizing antibodies and high-avidity measles IgG accurately identify measles reinfection cases
Sowers SB , Rota JS , Hickman CJ , Mercader S , Redd S , McNall RJ , Williams N , McGrew M , Walls ML , Rota PA , Bellini WJ . Clin Vaccine Immunol 2016 23 (8) 707-16 In the United States, approximately 9% of the measles cases reported from 2012 to 2014 occurred in vaccinated individuals. Laboratory confirmation of measles in vaccinated individuals is challenging since IgM assays can give inconclusive results. Although a positive reverse transcription (RT)-PCR assay result from an appropriately timed specimen can provide confirmation, negative results may not rule out a highly suspicious case. Detection of high-avidity measles IgG in serum samples provides laboratory evidence of a past immunologic response to measles from natural infection or immunization. High concentrations of measles neutralizing antibody have been observed by plaque reduction neutralization (PRN) assays among confirmed measles cases with high-avidity IgG, referred to here as reinfection cases (RICs). In this study, we evaluated the utility of measuring levels of measles neutralizing antibody to distinguish RICs from noncases by receiver operating characteristic curve analysis. Single and paired serum samples with high-avidity measles IgG from suspected measles cases submitted to the CDC for routine surveillance were used for the analysis. The RICs were confirmed by a 4-fold rise in PRN titer or by RT-quantitative PCR (RT-qPCR) assay, while the noncases were negative by both assays. Discrimination accuracy was high with serum samples collected ≥3 days after rash onset (area under the curve, 0.953; 95% confidence interval [CI], 0.854 to 0.993). Measles neutralizing antibody concentrations of ≥40,000 mIU/ml identified RICs with 90% sensitivity (95% CI, 74 to 98%) and 100% specificity (95% CI, 82 to 100%). Therefore, when serological or RT-qPCR results are unavailable or inconclusive, suspected measles cases with high-avidity measles IgG can be confirmed as RICs by measles neutralizing antibody concentrations of ≥40,000 mIU/ml. |
A comparison of postelimination measles epidemiology in the United States, 2009-2014 versus 2001-2008
Fiebelkorn AP , Redd SB , Gastanaduy PA , Clemmons N , Rota PA , Rota JS , Bellini WJ , Wallace GS . J Pediatric Infect Dis Soc 2015 6 (1) 40-48 BACKGROUND: Measles, a vaccine-preventable disease that can cause severe complications, was declared eliminated from the United States in 2000. The last published summary of US measles epidemiology was during 2001-2008. We summarized US measles epidemiology during 2009-2014. METHODS: We compared demographic, vaccination, and virologic data on confirmed measles cases reported to the Centers for Disease Control and Prevention during January 1, 2009-December 31, 2014 and January 1, 2001-December 31, 2008. RESULTS: During 2009-2014, 1264 confirmed measles cases were reported in the United States, including 275 importations from 58 countries and 66 outbreaks. The annual median number of cases and outbreaks during this period was 130 (range, 55-667 cases) and 10 (range, 4-23 outbreaks), respectively, compared with an annual median of 56 cases (P = .08) and 4 outbreaks during 2001-2008 (P = .04). Among US-resident case-patients during 2009-2014, children aged 12-15 months had the highest measles incidence (65 cases; 8.3 cases/million person-years), and infants aged 6-11 months had the second highest incidence (86 cases; 7.3 cases/million person-years). During 2009-2014, 865 (74%) of 1173 US-resident case-patients were unvaccinated and 188 (16%) had unknown vaccination status; of 917 vaccine-eligible US-resident case-patients, 600 (65%) were reported as having philosophical or religious objections to vaccination. CONCLUSIONS: Although the United States has maintained measles elimination since 2000, measles outbreaks continue to occur globally, resulting in imported cases and potential spread. The annual median number of cases and outbreaks more than doubled during 2009-2014 compared with the earlier postelimination years. To maintain elimination, it will be necessary to maintain high 2-dose vaccination coverage, continue case-based surveillance, and monitor the patterns and rates of vaccine exemption. |
Measles - United States, January 1-May 23, 2014
Gastanaduy PA , Redd SB , Fiebelkorn AP , Rota JS , Rota PA , Bellini WJ , Seward JF , Wallace GS . MMWR Morb Mortal Wkly Rep 2014 63 (22) 496-9 Measles is a highly contagious, acute viral illness that can lead to serious complications and death. Although measles elimination (i.e., interruption of year-round endemic transmission) was declared in the United States in 2000, importations of measles cases from endemic areas of the world continue to occur, leading to secondary measles cases and outbreaks in the United States, primarily among unvaccinated persons. To update national measles data in the United States, CDC evaluated cases reported by states from January 1 through May 23, 2014. A total of 288 confirmed measles cases have been reported to CDC, surpassing the highest reported yearly total of measles cases since elimination (220 cases reported in 2011). Fifteen outbreaks accounted for 79% of cases reported, including the largest outbreak reported in the United States since elimination (138 cases and ongoing). The large number of cases this year emphasizes the need for health-care providers to have a heightened awareness of the potential for measles in their communities and the importance of vaccination to prevent measles. |
Outbreak of measles among persons with prior evidence of immunity, New York City, 2011
Rosen JB , Rota JS , Hickman CJ , Sowers SB , Mercader S , Rota PA , Bellini WJ , Huang AJ , Doll MK , Zucker JR , Zimmerman CM . Clin Infect Dis 2014 58 (9) 1205-10 BACKGROUND: Measles was eliminated in the United States through high vaccination coverage and a public health system able to rapidly respond to measles. Measles may occur among vaccinated individuals, but secondary transmission from such individuals has not been documented. METHODS: Suspected patients and contacts exposed during a measles outbreak in New York City in 2011 were investigated. Medical histories and immunization records were obtained. Cases were confirmed by detection of measles-specific immunoglobulin M and/or RNA. Tests for measles immunoglobulin G (IgG), IgG avidity, measurement of measles neutralizing antibody titers, and genotyping were performed to characterize the cases. RESULTS: The index patient had 2 doses of measles-containing vaccine; of 88 contacts, 4 secondary patients were confirmed who had either 2 doses of measles-containing vaccine or a past positive measles IgG antibody. All patients had laboratory confirmation of measles infection, clinical symptoms consistent with measles, and high-avidity IgG antibody characteristic of a secondary immune response. Neutralizing antibody titers of secondary patients reached >80 000 mIU/mL 3-4 days after rash onset and that of the index was <500 mIU/mL 9 days after rash onset. No additional cases of measles occurred among 231 contacts of secondary patients. CONCLUSIONS: This is the first report of measles transmission from a twice-vaccinated individual with documented secondary vaccine failure. The clinical presentation and laboratory data of the index patient were typical of measles in a naive individual. Secondary patients had robust anamnestic antibody responses. No tertiary cases occurred despite numerous contacts. This outbreak underscores the need for thorough epidemiologic and laboratory investigation of suspected cases of measles regardless of vaccination status. |
Elimination of endemic measles, rubella, and congenital rubella syndrome from the Western hemisphere: the US experience.
Papania MJ , Wallace GS , Rota PA , Icenogle JP , Fiebelkorn AP , Armstrong GL , Reef SE , Redd SB , Abernathy ES , Barskey AE , Hao L , McLean HQ , Rota JS , Bellini WJ , Seward JF . JAMA Pediatr 2013 168 (2) 148-55 IMPORTANCE: To verify the elimination of endemic measles, rubella, and congenital rubella syndrome (CRS) from the Western hemisphere, the Pan American Health Organization requested each member country to compile a national elimination report. The United States documented the elimination of endemic measles in 2000 and of endemic rubella and CRS in 2004. In December 2011, the Centers for Disease Control and Prevention convened an external expert panel to review the evidence and determine whether elimination of endemic measles, rubella, and CRS had been sustained. OBJECTIVE: To review the evidence for sustained elimination of endemic measles, rubella, and CRS from the United States through 2011. DESIGN, SETTING, AND PARTICIPANTS: Review of data for measles from 2001 to 2011 and for rubella and CRS from 2004 to 2011 covering the US resident population and international visitors, including disease epidemiology, importation status of cases, molecular epidemiology, adequacy of surveillance, and population immunity as estimated by national vaccination coverage and serologic surveys. MAIN OUTCOMES AND MEASURES: Annual numbers of measles, rubella, and CRS cases, by importation status, outbreak size, and distribution; proportions of US population seropositive for measles and rubella; and measles-mumps-rubella vaccination coverage levels. RESULTS: Since 2001, US reported measles incidence has remained below 1 case per 1 000 000 population. Since 2004, rubella incidence has been below 1 case per 10 000 000 population, and CRS incidence has been below 1 case per 5 000 000 births. Eighty-eight percent of measles cases and 54% of rubella cases were internationally imported or epidemiologically or virologically linked to importation. The few cases not linked to importation were insufficient to represent endemic transmission. Molecular epidemiology indicated no endemic genotypes. The US surveillance system is adequate to detect endemic measles or rubella. Seroprevalence and vaccination coverage data indicate high levels of population immunity to measles and rubella. CONCLUSIONS AND RELEVANCE: The external expert panel concluded that the elimination of endemic measles, rubella, and CRS from the United States was sustained through 2011. However, international importation continues, and health care providers should suspect measles or rubella in patients with febrile rash illness, especially when associated with international travel or international visitors, and should report suspected cases to the local health department. |
Comparison of the sensitivity of laboratory diagnostic methods from a well-characterized outbreak of mumps in New York city in 2009.
Rota JS , Rosen JB , Doll MK , McNall RJ , McGrew M , Williams N , Lopareva EN , Barskey AE , Punsalang A Jr , Rota PA , Oleszko WR , Hickman CJ , Zimmerman CM , Bellini WJ . Clin Vaccine Immunol 2013 20 (3) 391-6 A mumps outbreak in upstate New York in 2009 at a summer camp for Orthodox Jewish boys spread into Orthodox Jewish communities in the Northeast including New York City. The availability of epidemiologic information including vaccination records and parotitis onset dates allowed an enhanced analysis of laboratory methods for mumps testing. Serum and buccal swab samples were collected from 296 confirmed cases with onsets from September through December, 2009. All samples were tested using the CDC capture IgM EIA and a real-time RT-PCR (rRT-PCR) that targets the short hydrophobic gene. A subset of the samples (n=205) was used to evaluate 3 commercial mumps IgM assays and to assess the sensitivity of using an alternative target gene (nucleoprotein) in the rRT-PCR protocol. Among 115 cases of mumps with 2 documented doses of measles, mumps, and rubella (MMR) vaccine, the CDC capture IgM EIA detected IgM in 51% of serum samples compared to 9%-24% using three commercial IgM assays. The rRT-PCR that targeted the nucleoprotein gene increased RNA detection by 14% compared to that obtained with the original protocol. The ability to detect IgM improved when serum was collected 3 days or more after onset whereas sensitivity of RNA detection by rRT-PCR declined when buccal swabs were collected later than 2 days after onset. Selection of testing methods and timing of sample collection are important factors in the ability to confirm infection among vaccinated persons. These results reinforce the need to use virus detection assays in addition to serologic tests. |
Mumps outbreak in Orthodox Jewish communities in the United States
Barskey AE , Schulte C , Rosen JB , Handschur EF , Rausch-Phung E , Doll MK , Cummings KP , Alleyne EO , High P , Lawler J , Apostolou A , Blog D , Zimmerman CM , Montana B , Harpaz R , Hickman CJ , Rota PA , Rota JS , Bellini WJ , Gallagher KM . N Engl J Med 2012 367 (18) 1704-13 BACKGROUND: By 2005, vaccination had reduced the annual incidence of mumps in the United States by more than 99%, with few outbreaks reported. However, in 2006, a large outbreak occurred among highly vaccinated populations in the United States, and similar outbreaks have been reported worldwide. The outbreak described in this report occurred among U.S. Orthodox Jewish communities during 2009 and 2010. METHODS: Cases of salivary-gland swelling and other symptoms clinically compatible with mumps were investigated, and demographic, clinical, laboratory, and vaccination data were evaluated. RESULTS: From June 28, 2009, through June 27, 2010, a total of 3502 outbreak-related cases of mumps were reported in New York City, two upstate New York counties, and one New Jersey county. Of the 1648 cases for which clinical specimens were available, 50% were laboratory-confirmed. Orthodox Jewish persons accounted for 97% of case patients. Adolescents 13 to 17 years of age (27% of all patients) and males (78% of patients in that age group) were disproportionately affected. Among case patients 13 to 17 years of age with documented vaccination status, 89% had previously received two doses of a mumps-containing vaccine, and 8% had received one dose. Transmission was focused within Jewish schools for boys, where students spend many hours daily in intense, face-to-face interaction. Orchitis was the most common complication (120 cases, 7% of male patients ≥12 years of age), with rates significantly higher among unvaccinated persons than among persons who had received two doses of vaccine. CONCLUSIONS: The epidemiologic features of this outbreak suggest that intense exposures, particularly among boys in schools, facilitated transmission and overcame vaccine-induced protection in these patients. High rates of two-dose coverage reduced the severity of the disease and the transmission to persons in settings of less intense exposure. |
Two case studies of modified measles in vaccinated physicians exposed to primary measles cases: high risk of infection but low risk of transmission
Rota JS , Hickman CJ , Sowers SB , Rota PA , Mercader S , Bellini WJ . J Infect Dis 2011 204 Suppl 1 S559-63 In 2009, measles outbreaks in Pennsylvania and Virginia resulted in the exposure and apparent infection of 2 physicians, both of whom had a documented history of vaccination with >2 doses of measles-mumps-rubella vaccine. These physicians were suspected of having been infected with measles after treating patients who subsequently received a diagnosis of measles. The clinical presentation was nonclassical in regard to progression, duration, and severity. It is hypothesized that the 2 physicians mounted vigorous secondary immune responses typified by high avidity measles immunoglobulin G antibody and remarkably high neutralizing titers in response to intense and prolonged exposure to a primary measles case patient. Both of the physicians continued to see patients, because neither considered that they could have measles. Despite surveillance for cases among contacts, including unvaccinated persons, no additional cases were identified. |
Measles outbreak associated with an international youth sporting event in the United States, 2007
Chen TH , Kutty P , Lowe LE , Hunt EA , Blostein J , Espinoza R , Dykewicz CA , Redd S , Rota JS , Rota PA , Lute JR , Lurie P , Nguyen MD , Moll M , Reef SE , Sinclair JR , Bellini WJ , Seward JF , Ostroff SM . Pediatr Infect Dis J 2010 29 (9) 794-800 BACKGROUND: Despite elimination of endemic measles in the United States (US), outbreaks associated with imported measles continue to occur. In 2007, the initiation of a multistate measles outbreak was associated with an imported case occurring in a participant at an international youth sporting event held in Pennsylvania. METHODS: Case finding and contact tracing were conducted. Control measures included isolating ill persons and administering postexposure prophylaxis to exposed persons without documented measles immunity. Laboratory evaluation of suspected cases and contacts included measles serologic testing, viral culture, detection of viral RNA by reverse-transcription polymerase chain reaction, and viral genotyping. RESULTS: The index case occurred in a child from Japan aged 12 years. Contact tracing among 1250 persons in 8 states identified 7 measles cases; 5 (71%) cases occurred among persons without documented measles vaccination. Epidemiologic and laboratory investigation supported a single chain of transmission, linking the outbreak to contemporaneous measles virus genotype D5 transmission in Japan. Of the 471 event participants, 193 (41%) lacked documentation of presumed measles immunity, 94 (49%) of 193 were US-resident adults, 19 (10%) were non-US-resident adults (aged >18 years), and 80 (41%) were non-US-resident children. DISCUSSION: Measles outbreaks associated with imported disease are likely to continue in the US. Participants in international events, international travelers, and persons with routine exposure to such travelers might be at greater risk of measles. To reduce the impact of imported cases, high measles, mumps, and rubella vaccine coverage rates should be maintained throughout the US, and support should continue for global measles control and elimination. |
Investigation of a mumps outbreak among university students with two measles-mumps-rubella (MMR) vaccinations, Virginia, September-December 2006
Rota JS , Turner JC , Yost-Daljev MK , Freeman M , Toney DM , Meisel E , Williams N , Sowers SB , Lowe L , Rota PA , Nicolai LA , Peake L , Bellini WJ . J Med Virol 2009 81 (10) 1819-1825 Following the clinical diagnosis of the first case of mumps on September 22, 2006 at the University of Virginia (UVA), 52 suspected cases were identified through active surveillance for mumps by the end of December 2006. Samples were collected from 47 students who presented with parotitis despite a documented history of two doses of measles, mumps, and rubella (MMR) vaccine. Six of 47 serum samples (13%) were positive for mumps IgM, and 46/47 specimens were positive for mumps IgG. Endpoint titration of acute phase serum samples from laboratory-confirmed cases did not provide evidence that elevated serum IgG is a consistent marker for infection among cases due to secondary vaccine failure. Buccal swab samples from 39 of the 47 students were tested by real-time reverse transcription-polymerase chain reaction (RT-PCR) and/or viral culture. Mumps virus or mumps RNA was detected in 12 of 39 buccal samples (31%). Genetic analysis of the virus from the outbreak at UVA indicated that the outbreak was not linked to the large mumps outbreak in the Midwestern US that occurred earlier in 2006. Our findings support the use of viral detection to improve laboratory diagnosis of mumps among persons who have received two doses of MMR. J. Med. Virol. 81:1819-1825, 2009. (c) 2009 Wiley-Liss, Inc. |
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