No 3 - 2019

Novel primary vaccine in the childhood vaccination programme

As from the beginning of March 2019, the vaccine Pentavac must be used as a new primary vaccine in the childhood vaccination programme. Pentavac is equivalent to the previously used primary vaccine DiTeKiPol/Hib (DTaP-IPV/Hib) from AJ Vaccines A/S (previously SSI Vaccine). The vaccine’s five antigens are identical to those of the Hexyon from the same manufacturer (Sanofi Pasteur), which were used for a limited period of time in Denmark in 2016-2017, EPI-NEWS 5/16 and 13/17. Pentavac was administered in more than 160 million doses worldwide and is, among others, used in Sweden. 

Children who have initiated vaccination using the DiTeKiPol/Hib (DTaP-IPV/Hib) vaccine from AJ Vaccines A/S should conclude their vaccination series with the same vaccine, if possible. The vaccinating doctor should keep this shift in mind for vaccine orders made until the beginning of March. 

After the Summer holidays, the booster vaccine given at five years will also shift from the DiTeKiPolBooster (dTaP-IPV booster) vaccine from AJ vaccines A/S to the Tetravac vaccine, which is made by the same manufacturer as Pentavac.

The background for this is the statutory vaccine tender, and, initially, the change will remain in force for 4 years. Before vaccination is initiated, in-depth medical information will be provided in EPI-NEWS and on the SSI’s website.

(P.H. Andersen, Department of Infectious Disease Epidemiology and Prevention)

New cases of measles in the Herning area, with transmission to air passengers

This week saw the detection of a new case of measles in a young child from the Herning area (Jutland, Denmark). It is very likely that the child became infected with measles during a journey to Romania. Therefore, there is no apparent association with the measles case from the same area that was described before Christmas (in Danish language). Statens Serum Institut will be genotyping the virus to establish this firmly.

The child fell ill on 7 January. The child developed a measles-like rash on the day of its arrival to Denmark, 12 January. The child was examined by an emergency service physician on 13 January and then admitted to the Paediatric Ward at Regional Hospital Herning. A sample from the child tested positive to measles virus on 14 January at the Department of Clinical Microbiology, Aarhus University Hospital. 

The Danish Patient Safety Authority, Unit for Supervision and Guidance North was informed of the strong suspicion of measles already on 13 January and has informed any susceptible persons who had come into contact with the child and offered them treatment as relevant following exposure to infection.

Even so, doctors in the area are encouraged to be extra attentive to patients with measles symptoms and to ensure that any such patients are examined without exposing other patients, e.g. in waiting rooms, etc., to infection.

For all practical purposes, it is safe to assume that people born before 1974 have had measles.
Measles have been eradicated from Denmark since 2017, but imported cases and limited further transmission may nevertheless occur. We strive to inform rapidly of any detected measles cases in order to limit the spreading of infection as much as possible.

In this case, the patient was infectious during a plane travel counting more than 200 passengers. Measles virus is extremely infectious, and all non-immune passengers are therefore considered to have been exposed to infection. As a considerable share of the passengers are of Romanian nationality, and because the available information is insufficient to determine if they are staying permanently in Denmark, in many cases it was not possible to contact the passengers directly. 

Therefore, a press statement was released yesterday encouraging all passengers who had travelled on Wizz Air W63211 from Bucharest to Billund on Saturday 12 January 2019 to contact their GP if they are susceptible to measles. Additionally, anyone else who has been to the Airport of Billund in the period from 9.30 p.m. to approx. 10.30 p.m. may also have been exposed to measles, and they should therefore contact their GP if they think they are not immune.  

As prevention against illness after having been exposed to the infection, the MMR vaccine may be used for up to three days after exposure, and human immunoglobulin for up to six days after exposure. Detailed guidelines for the ordering and use of these products are provided on the SSI website.

For health staff about sampling

On suspicion of measles, the following samples should be taken:

A blood sample for measles virus IgM/IgG antibody determination. IgM antibodies may be confirmed by rash.

Pharyngeal swab and urine for detection of measles virus RNA (by PCR). The best possibility for detecting measles virus is in the early phases of the disease course, but the virus is frequently detectable in urine for several weeks after the acute disease occurs. A negative finding does not exclude measles.

On suspicion of measles, it is important that diagnostics and work-up are performed as rapidly as practically possible with a view to isolation and treatment of the patient as well as tracking and vaccination, if relevant, of anyone who has become exposed to infection. Serological detection is insufficient for measles diagnostics. Virus detection by PCR is a WHO requirement. The National WHO Reference Laboratory for Measles and Rubella at the SSI handles the characterisation (typing and sequencing) of all measles virus-PCR-positive samples in Denmark.

As rapid characterisation of the measles virus is important in relation to infection tracing, all suspected as well as all measles virus PCR positive samples should be forwarded hereto as quickly as is practically possible. We recommend contact by phone to the virologist in charge at the SSI (in the daytime pho.: 4033 6379, after 15.30 to the epidemiologist on call pho.: 4131 7404) to inform the laboratory that samples are underway to avoid any unnecessary delay of the diagnosis and/or typing.

(P.H. Andersen, L.K. Knudsen, Department of Infectious Disease Epidemiology and Prevention, L.D. Rasmussen, Virology Surveillance and Research, N. Ank, the Danish Patient Safety Authority, Supervision and Guidance North, M.K. Thomsen, Clinical Microbiology, Aarhus University Hospital)