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In this study we aimed to assess the etiological diagnosis of discarded measles cases in the context of an outbreak among a highly immunized population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective observational study of discarded measles cases from an outbreak that occurred from October 2006 to July 2007 in Catalonia. A confirmed case was defined as having a positive measles serum IgM result and\/or a positive result by RT\u2010PCR in urine and\/or nasopharyngeal swab; or an epidemiological link to a confirmed case. Serum specimens were tested by a commercially available indirect\u2010format and by an in\u2010house capture\u2010format measles IgM enzyme immunoassays.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Testing of 89 samples discarded for measles determined the etiologies for 10 (11.2%), including one rubella, three human herpes virus 6, and six measles infections. Of 381 confirmed cases in the outbreak, 10% had received at least one dose of the measles\u2010mumps\u2010rubella vaccine versus 54% of the discarded for measles (OR: 0.09; 95% CI: 0.06, 0.14; <jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Highly sensitive surveillance systems are critical to identifying cases, responding to outbreaks and verifying progress towards measles elimination. Molecular tools for measles detection and differential diagnosis, and collection of appropriate specimens for molecular and serological testing are essential to correctly diagnose suspected measles infection.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ped.15430","type":"journal-article","created":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T08:13:17Z","timestamp":1670055197000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Etiological analysis of discarded measles in the context of a measles outbreak among a highly immunized population"],"prefix":"10.1111","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0143-5295","authenticated-orcid":false,"given":"Nuria","family":"Torner","sequence":"first","affiliation":[{"name":"CIBER Epidemiology and Public Health CIBERESP Institute Carlos III  Madrid Spain"},{"name":"Department of Medicine University of Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Mercader","sequence":"additional","affiliation":[{"name":"Division of Viral Diseases, Centers for Disease Control and Prevention National Center for Immunization and Respiratory Diseases  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Dominguez","sequence":"additional","affiliation":[{"name":"CIBER Epidemiology and Public Health CIBERESP Institute Carlos III  Madrid Spain"},{"name":"Department of Medicine University of Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Martinez","sequence":"additional","affiliation":[{"name":"CIBER Epidemiology and Public Health CIBERESP Institute Carlos III  Madrid Spain"},{"name":"Public Health Agency of Catalonia  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josep","family":"Costa","sequence":"additional","affiliation":[{"name":"Virology Unit, Centre de Diagn\u00f2stic Biom\u00e8dic Hospital Cl\u00ednic  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sun B.","family":"Sowers","sequence":"additional","affiliation":[{"name":"Division of Viral Diseases, Centers for Disease Control and Prevention National Center for Immunization and Respiratory Diseases  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily S.","family":"Abernathy","sequence":"additional","affiliation":[{"name":"Division of Viral Diseases, Centers for Disease Control and Prevention National Center for Immunization and Respiratory Diseases  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William J.","family":"Bellini","sequence":"additional","affiliation":[{"name":"Division of Viral Diseases, Centers for Disease Control and Prevention National Center for Immunization and Respiratory Diseases  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carol J.","family":"Hickman","sequence":"additional","affiliation":[{"name":"Division of Viral Diseases, Centers for Disease Control and Prevention National Center for Immunization and Respiratory Diseases  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,1,29]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Strategic Advisory Group of Experts on Immunization.The global vaccine action plan 2011\u20132020. 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