• Stefka Krumova, Sabine Santibanez, Ivona Andonova, Radostina Stefanova, Annette Mankertz, and Todor Kantardjiev.
• Stefka Krumova, National Reference Laboratory "Measles, Mumps, Rubella", Department of Virology, National Centre of Infectious and Parasitic Diseases, 44A Stoletov Blvd., 1233 Sofia, Bulgaria, stefka.krumova@gmail.com.
• Croat. Med. J. 2022 Oct 31; 63 (5): 475481475-481.

AimTo determine the circulation patterns of measles virus in Bulgaria from 2012 to 2018 after a large measles outbreak in the country (2009-2011).MethodsThree types of clinical material were collected: serum samples, urine samples, and nasal swabs. Enzyme-linked immunosorbent assay (ELISA) was used to detect specific viral immunoglobulin (Ig) M/IgG antibodies. Viral RNA was extracted from all urine and nasal swabs.ResultsIn the investigated period, 102 patients were confirmed to have measles (age range: two months to 55 years). A total of 101 samples (99%) were measles-IgM positive. Most of them were detected in 2017 (73%, 74/101), when a measles outbreak in the country was reported. The majority of patients were unvaccinated children aged under 13 months. Out of 101 measles serum samples confirmed by ELISA, 18 (20.45%) were measles-IgG positive and 15 (17.05%) were borderline. Thirty-three positive PCR products were sequenced and genotyped. In 2013, 2016, 2017, and 2018, three different measles viral genotypes were detected: D8, H1, and B3. Most patients were unvaccinated or insufficiently vaccinated.ConclusionPreventive measures are indispensable to limit the infection in different regions of Bulgaria and its spread to other countries. As vaccination coverage against measles and other vaccine-preventable infections, including SARS-Co2, is low, it is necessary to perform molecular identification of viruses to monitor their circulation and pathogenicity.

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