Eradication of measles: remaining challenges.
Eradication of measles: remaining challenges.
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DOI：
10.1007/s00430-016-0451-4
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发表时间：
2016-06
影响因子：
5.4
通讯作者：
Doerr HW
中科院分区：
文献类型：
--
作者：
Holzmann H;Hengel H;Tenbusch M;Doerr HW
麻疹病毒（MeV）是一种气溶胶传播的已知最具传染性的致病性病毒之一。几乎每一种麻疹病毒感染都会出现临床表现，并可能导致严重甚至致命的并发症，特别是在发展中国家营养不良的情况下，那里每年仍有11.5万至16万患者死于麻疹。没有特定的抗病毒治疗。此外，MeV感染会导致长期记忆B细胞和T细胞损伤，使人们易受机会性感染多年。麻疹的一种罕见但致命的长期后果是亚急性硬化性全脑炎。15年前（2001年），世卫组织启动了一项通过全球疫苗接种战略消除麻疹的规划。这是有希望的，因为MeV是一种人类特有的麻疹病毒（即没有相关的动物宿主），几十年来生产了足够的安全和有效的疫苗病毒以供普遍应用，并且在全球使用了数百万剂疫苗，没有任何安全性和有效性问题的迹象。尽管野生型麻疹病毒感染的流行率在欧洲已经下降了90%，但麻疹仍然没有消除，甚至在发达国家再次出现，并反复暴发，这些国家几十年来已经建立了有效的疫苗接种规划。在这里，我们讨论了在世界范围内消除MeV的关键因素：(1)现有疫苗的有效性；(2)麻疹病毒的极高传染性，需要在两次接种的基础上达到95%以上的接种率，以避免一次疫苗失败，并建立补充疫苗接种计划，以填补免疫空白，实现群体免疫；(3)偶发的二次疫苗失败病例的影响；(4)现代疫苗接种运动的组织、接受和缺点；(5)公众对麻疹的关注减弱；但是，在具有较高社会经济标准和(6)使用现代实验室诊断和报告系统进行临床、流行病学和病毒学监测的社会中，与疫苗相关的不良反应日益引起关注。通过随后实施精心设计的流行病学和预防措施，应该有可能在全球范围内从人类中根除MeV，因为密切相关的牛瘟麻疹病毒可以在全球范围内成功地从牛中消灭。
Measles virus (MeV) is an aerosol-borne and one of the most contagious pathogenic viruses known. Almost every MeV infection becomes clinically manifest and can lead to serious and even fatal complications, especially under conditions of malnutrition in developing countries, where still 115,000 to 160,000 patients die from measles every year. There is no specific antiviral treatment. In addition, MeV infections cause long-lasting memory B and T cell impairment, predisposing people susceptible to opportunistic infections for years. A rare, but fatal long-term consequence of measles is subacute sclerosing panencephalitis. Fifteen years ago (2001), WHO has launched a programme to eliminate measles by a worldwide vaccination strategy. This is promising, because MeV is a human-specific morbillivirus (i.e. without relevant animal reservoir), safe and potent vaccine viruses are sufficiently produced since decades for common application, and millions of vaccine doses have been used globally without any indications of safety and efficacy issues. Though the prevalence of wild-type MeV infection has decreased by >90 % in Europe, measles is still not eliminated and has even re-emerged with recurrent outbreaks in developed countries, in which effective vaccination programmes had been installed for decades. Here, we discuss the crucial factors for a worldwide elimination of MeV: (1) efficacy of current vaccines, (2) the extremely high contagiosity of MeV demanding a >95 % vaccination rate based on two doses to avoid primary vaccine failure as well as the installation of catch-up vaccination programmes to fill immunity gaps and to achieve herd immunity, (3) the implications of sporadic cases of secondary vaccine failure, (4) organisation, acceptance and drawbacks of modern vaccination campaigns, (5) waning public attention to measles, but increasing concerns from vaccine-associated adverse reactions in societies with high socio-economic standards and (6) clinical, epidemiological and virological surveillance by the use of modern laboratory diagnostics and reporting systems. By consequent implementation of carefully designed epidemiologic and prophylactic measures, it should be possible to eradicate MeV globally out of mankind, as the closely related morbillivirus of rinderpest could be successfully eliminated out of the cattle on a global scale.