Genetic homogeneity of measles viruses associated with a measles outbreak, Sao Paulo, Brazil, 1997. (Research).During a resurgence of measles in Sao Paulo, Brazil, in 1997, >40,000 cases (peak incidence rate of 246/ 100,000 inhabitants
The game is based loosely on the concepts from SameGame. ) and 42 measles-related deaths were reported. Reverse transcriptase-polymerase chain reaction and nucleotide sequencing were used to analyze specimens from patients who had typical clinical measles infection during this outbreak and from six patients who had had measles in 1995 and 1996. Although wild-type measles viruses (genotypes D5 and D6) were present in Sao Paulo before this resurgence, we detected only D6 viruses. The genotype D6 viruses isolated during this outbreak had identical sequences to genotype D6 viruses isolated in other parts of Brazil and South America South America, fourth largest continent (1991 est. pop. 299,150,000), c.6,880,000 sq mi (17,819,000 sq km), the southern of the two continents of the Western Hemisphere. in 1997 and 1998, suggesting that a single chain of transmission was responsible. We also identified genotype A viruses in two vaccine-associated cases from 1995 and 1996. Our findings extend the knowledge of the circulation patterns of measles virus in South America, contributing to measles control efforts in the Americas.
The Pan American Health Organization The Pan American Health Organization (PAHO) is an international public health agency with 100 years of experience in working to improve health and living standards of the countries of the Americas. It serves as the specialized organization for health of the Inter-American System. (PAHO PAHO Pan American Health Organization (WHO) ) reported record low numbers of measles cases for 2000-2001, reflecting the success of measles control programs in the Western Hemisphere Western Hemisphere
Part of Earth comprising North and South America and the surrounding waters. Longitudes 20° W and 160° E are often considered its boundaries. (1). In the most populous country in the region, the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. , indigenous transmission of measles virus has been eliminated since 1993, and only 3 of 41 countries in the region reported indigenous measles transmission during 2001 (1,2). Despite this success, measles remains an endemic disease Endemic disease
An infectious disease that occurs frequently in a specific geographical locale. The disease often occurs in cycles. Influenza is an example of an endemic disease. in many areas of the world. The World Health Organization (WHO) estimates that approximately 45 million cases of measles and >800,000 measles-related deaths continue to occur annually (3,4). Sporadic measles outbreaks still occur in both developed and undeveloped countries that have failed to maintain adequate immunization immunization: see immunity; vaccination. levels. These outbreaks, such as the one that occurred in Sao Paulo, Brazil, in 1997, provide an opportunity to study the virologic and epidemiologic aspects of measles transmission in vaccinated populations.
Before the introduction of vaccine, measles was a substantial public health problem in Brazil, representing a major cause of death among young children. Even after the introduction of vaccine, measles epidemics continued to occur in Brazil. For example, the epidemics of 1984 and 1986 had incidence rates of 63/100,000 and 97/100,000, respectively. PAHO launched an aggressive measles control program for the Americas in 1991 that included one-time national catch-up campaigns for all children, routine "keep-up" vaccination of infants at 1 year of age, and follow-up campaigns at 3- to 5-year intervals. In Brazil, this strategy resulted in a 93% reduction in the incidence of measles in Brazil from 1991 through 1996. For the 4-year period 1993-1996, <1,000 cases were reported annually. However, during the resurgence of measles in 1997 in Sao Paulo, 42,055 confirmed cases of measles (23,907 laboratory confirmed), were reported, with a peak incidence rate of 246/ 100,000 inhabitants. Most of the cases were in adults living in metropolitan Sao Paulo. Forty-two deaths caused by measles were reported during this epidemic (5-7).
Virologic surveillance can help to identify the transmission pathways of measles virus and is an important component of measles surveillance activities (8-10). Sequence analysis of measles viruses has shown that distinct lineages of wild-type viruses exist and co-circulate, and WHO currently recognizes 20 measles genotypes (11-13). The epidemiologic aspects of the measles outbreak in Sao Paulo have been described (5-7). The purpose of this report is to present the genetic characteristics of the measles viruses responsible for the resurgence of measles in Sao Paulo, Brazil, during 1997. This outbreak provided an opportunity to study the transmission of viruses in an area that had previously had good measles control but then experienced a rapid resurgence in cases. Our study showed that a single genotype of virus, D6, was responsible for the outbreak and that viruses from this chain of transmission subsequently spread to other countries in South America.
Materials and Methods
Samples from patients with laboratory-confirmed measles were analyzed (Table). Six of the samples were serum specimens; the rest were heparinized, whole-blood specimens. Peripheral blood peripheral blood Cardiology Blood circulating in the system/body mononuclear mononuclear /mono·nu·cle·ar/ (-noo´kle-er)
1. having but one nucleus.
2. a cell having a single nucleus, especially a monocyte of the blood or tissues.
adj. cells (PBMC PBMC Peripheral Blood Mononuclear Cell ) were purified from whole blood by using Ficoll-Hypaque gradient centrifugation Centrifugation
A mechanical method of separating immiscible liquids or solids from liquids by the application of centrifugal force. This force can be very great, and separations which proceed slowly by gravity can be speeded up enormously in centrifugal . The PBMC were washed three times with phosphate-buffered saline before being resuspended in Dulbecco's minimal essential medium (DMEM DMEM Dulbecco's Modified Eagle's Medium (for cell culture growth)
DMEM Design Manufacture and Engineering Management Department ) containing 10% fetal calf serum (FCS FCS - Frame Check Sequence ). Aliquots of PBMC were cryopreserved by using standard procedures (14).
B95a cells (15) were injected with 0.2 mL of the clinical samples and maintained in DMEM, 0.2 mM L-glutamine/100 mL and gentamicin gentamicin /gen·ta·mi·cin/ (jen?tah-mi´sin) an aminoglycoside antibiotic complex isolated from bacteria of the genus Micromonospora, 40 mg/mL, in 2% FCS at 37[degrees]C. Samples with no apparent cytopathic effect Cytopathic effect (CPE) refers to degenerative changes in cells (especially in tissue culture) associated with the multiplication of certain viruses. When in tissue culture, the spread of virus is restricted by an overlay of agar (or other suitable substance) and thus the (CPE (Customer Premises Equipment) Communications equipment that resides on the customer's premises.
CPE - Customer Premises Equipment ) after 3 passages were discarded as negative for virus isolation. If CPE was observed, the cells were harvested by centrifugation when CPE was maximal, and RNA RNA: see nucleic acid.
in full ribonucleic acid
One of the two main types of nucleic acid (the other being DNA), which functions in cellular protein synthesis in all living cells and replaces DNA as the carrier of genetic was extracted from the cell pellet. Five measles viruses were isolated from PBMC collected during the epidemic.
RNA Extraction, Polymerase Chain Reaction polymerase chain reaction (pŏl`ĭmərās') (PCR), laboratory process in which a particular DNA segment from a mixture of DNA chains is rapidly replicated, producing a large, readily analyzed sample of a piece of DNA; the process is , and Sequencing
RNA was extracted from serum, PBMC, or infected cell pellets by the guanidinium acid-phenol method (16). cDNA corresponding to the nucleotides coding for the carboxyl carboxyl /car·box·yl/ (kahr-bok´sil) the monovalent radical —COOH, occurring in those organic acids termed carboxylic acids.
n. terminus of the nucleoprotein nucleoprotein
Macromolecular complex consisting of a protein linked to a nucleic acid, either DNA or RNA. The proteins that combine with DNA are generally of characteristic types called histones and protamines. (N) or the full-length open reading frame for the hemagglutinin hemagglutinin /he·mag·glu·ti·nin/ (-gloo´ti-nin) an antibody that causes agglutination of erythrocytes.
cold hemagglutinin one which acts only at temperatures near 4° C. (H) gene were synthesized by using avian myeloblastosis virus reverse transcriptase Reverse transcriptase
Any of the deoxyribonucleic acid (DNA) polymerases present in particles of retroviruses which are able to carry out DNA synthesis using an RNA template. (RT) and amplified by polymerase chain reaction (PCR PCR polymerase chain reaction.
polymerase chain reaction
Polymerase chain reaction (PCR) ), and the sequences of the PCR products were obtained as described previously (17,18). Sequence data Were analyzed by using version 10.1 of the Genetics Computer Group Sequence Analysis Software Package (Accelrys Inc., Madison, WI) (18) and phylogenetic phy·lo·ge·net·ic
1. Of or relating to phylogeny or phylogenetics.
2. Relating to or based on evolutionary development or history. analyses were performed with PAUP PAUP Phylogenetic Analysis Using Parsimony version 4.0 (19). A reference N gene sequence was deposited in GenBank under accession number Accession number may mean:
We obtained genetic information from specimens that were collected in Sao Paulo from March 1995 to October 1997 (Table). During 1995 and 1996, relatively few measles cases were reported in Sao Paulo; six acute-phase serum samples were obtained from confirmed, sporadic cases that occurred as early as 2 years before the outbreak. In 1997, a resurgence of measles occurred in Sao Paulo, beginning in the fall and peaking in late winter (Figure 1). Twenty-three samples were obtained from cases that occurred during the first 42 weeks of 1997; 11 of these samples were obtained in August 1997 during the peak of the outbreak (Table). We obtained most of the outbreak specimens from young adults, which is consistent with the observation that most of the measles cases occurred in unvaccinated, young adults (6). Measles-specific immunoglobulin (Ig) M responses were detected in all the patients listed in the Table, except one. The serum sample from case number 802 was negative, probably because it was obtained <3 days after rash onset. However, this case was confirmed by a positive virus isolation (Table).
[FIGURE 1 OMITTED]
Virus isolation was not attempted for the serum samples, but five virus isolates were obtained from the PBMC specimens (Table) obtained during 1997. The sequences coding for the carboxyl terminus of the nucleoprotein (456 nucleotides) of these isolates were compared with the sequences of the WHO reference strains (12). The results indicated that these Brazilian viruses all had identical N gene sequences and were members of genotype D6 (Figure 2). The N gene sequence of MVi/SaoPaulo.BRA/42.97/35175 has been deposited in GenBank (accession no. AF495863) as a reference sequence for this outbreak. The complete sequence of the H gene was also obtained for MVi/SaoPaulo. BRA/42.97/35175. Comparison of this H gene sequence with the sequences of the H genes from the WHO reference strains confirmed the placement of these viruses in genotype D6 (data not shown).
[FIGURE 2 OMITTED]
For the rest of the specimens from 1997, nucleotide sequences were obtained from PCR products that were amplified directly from RNA extracted from the PBMC specimens. In most cases, we had to perform a nested PCR reaction to get sufficient material for sequencing. All specimens obtained in 1997, either just before or during the peak of the outbreak, were placed in genotype D6. Most of the N gene sequences obtained from these specimens were identical to each other and to the N gene sequences obtained from the five isolates from 1997. Only three of the specimens had sequences that differed from the majority sequence by a single nucleotide.
We were also able to amplify measles-specific PCR products from the serum samples obtained from sporadic measles cases that occurred in 1995 and 1996. Two of these specimens had nucleotide sequences in genotype A, which contains all vaccine viruses. Both specimens were obtained from 9-month-old infants who had received their measles vaccination 12-13 days before collection of the serum specimen. One of the samples obtained in 1995 had an N gene sequence in genotype D5, while the other three serum samples had sequences in genotype D6 identical to the D6 sequences obtained during the outbreak. These data showed that D6 viruses and wild-type viruses from genotypes other than D6 were present in Silo silo, watertight and airtight structure for making and storing silage. Silos vary in form from a covered pit, such as was used by the early Romans, to the modern storage tower, dating from the 19th cent. Paulo as early as 2 years before the peak of the outbreak in 1997.
We compared the N gene sequences from the genotype D6 viruses in the Sao Paulo cases with N gene sequences from genotype D6 viruses isolated in other parts of South America (20-24) and the world (Figure 2). For simplicity, three representative sequences from the South American viruses are shown in the phylogenetic tree phylogenetic tree
Diagram showing the evolutionary interrelations of a group of organisms that usually originated from a shared ancestral form. The ancestor is in the tree trunk; organisms that have arisen from it are placed at the ends of tree branches. . The sequences from the Sao Paulo outbreak were identical to those obtained from viruses isolated in Brazil (i.e., Valenca, Rio de Janeiro Rio de Janeiro, city, Brazil
Rio de Janeiro (rē`ō də zhänā`rō, Port. rē` thĭ zhənĕē`r , Belo Horizonte Belo Horizonte (bəl'rēzôN`tĭ) [Port.,=beautiful horizon], city (1996 pop. 2,091,770), capital of Minas Gerais state, E Brazil. , Angra do Reis, and Curitiba) (20,21), Argentina (22,23), Uruguay (24), and Bolivia in 1997 and 1998. This homogenous homogenous - homogeneous group also included two viruses that were imported into the United States from Brazil in 1997 (25). The sequences from genotype D6 viruses imported into the United States (26, unpub. data) from European sources and genotype D6 viruses isolated in Europe (27,28) were slightly different from the South American D6 group. We found that the sequences from the South American viruses were most closely related to a genotype D6 virus isolated in Luxembourg in 1997, although no foreign source was identified for the outbreak in Brazil. Overall, the N genes sequences of D6 viruses within the South American group differed by no more than 0.4% but differed from other genotype D6 sequences by as much as 1.4%.
This report presents the virologic surveillance data from the measles outbreak that occurred in Sao Paulo, Brazil, during 1997. Sequence data from the specimens obtained during the outbreak indicated the presence of measles viruses belonging to genotype D6, which is one of the prevalent genotypes of measles virus in Europe. Frequently associated with imported measles cases from European countries (8,26), D6 viruses have been isolated in the United Kingdom, Spain, Germany, Russia, Poland, Denmark, and Luxembourg (27-31). During 1997-2000, these genotype D6 viruses were imported into the United States from Italy, Greece, Ukraine, Croatia, Cyprus, and the United Kingdom, and from the large measles outbreak that occurred in Sao Paulo (Rota, unpub. data). However, because neither conventional case nor virologic surveillance was conducted in Brazil before the start of the measles control program in 1991, it is not possible to determine if the D6 viruses were recently introduced into Brazil by importation or if they represent continued circulation of viruses indigenous to Brazil. Our data show that D6 viruses indistinguishable from the D6 viruses isolated during the Sao Paulo outbreak were responsible for sporadic measles cases in Sao Paulo for at least 2 years before the outbreak. In a large urban area such as Sao Paulo, the virus will likely be continually present either from low-level circulation or frequent importation. In late 1997, a change occurred in the epidemiologic circumstances, resulting in a large outbreak of the measles virus. Factors that contributed to the outbreak included the failure to conduct a timely follow-up vaccination campaign in 1995 and the low level of vaccination coverage among infants achieved by routine health services health services Managed care The benefits covered under a health contract . Additionally, a large number of unvaccinated young adults who had escaped measles infection had moved to Sao Paulo from rural areas. The high population density in Sao Paulo also facilitated rapid spread of the virus (7).
Laboratory-based surveillance for measles was established in Brazil in the early 1990s. Although virologic surveillance was certainly incomplete, some information is available about measles genotypes present in Brazil before the 1997 outbreak in Sao Paulo. Genotype D5 was detected in a sporadic case in Sao Paulo in 1995 and in sporadic cases that occurred in the state of Bahia in 1996 (21). Genotype D5 viruses that circulate in Japan have been associated with importation of viruses from Japan into other countries (26,32,33). The source of the genotype D5 viruses detected in Sao Paulo and Bahia was not identified. Genotype C2 viruses were detected in a small outbreak in the state of Santa Catarina Santa Catarina (sän`tə kətərē`nə), state (1996 pop. 4,865,090), 37,060 sq mi (95,985 sq km), S Brazil. The capital is Florianópolis. in 1996 (21). C2, another indigenous genotype in Europe, is often associated with imported cases in other parts of the world (27-31).
Fever and rash occur in approximately 5% of measles vaccine recipients (34). In areas where wild-type virus is circulating, vaccine reactions may be classified as measles cases. Distinguishing a vaccine reaction from a measles case is not possible with the currently available serologic se·rol·o·gy
n. pl. se·rol·o·gies
1. The science that deals with the properties and reactions of serums, especially blood serum.
2. methods. Only the genetic analysis of virus isolates can confirm the presence of either a vaccine or wild-type virus. In this study, two vaccine viruses were detected in persons who had received vaccine 12 and 13 days before collection of specimens. In vaccine reactions, rash and fever typically occur 7 to 12 days after vaccination; the virus can be detected in circulating lymphocytes Lymphocytes
Small white blood cells that bear the major responsibility for carrying out the activities of the immune system; they number about 1 trillion. even after the rash and fever have resolved.
The situation in Brazil is now very similar to that in the United States in the early 1990s. From 1989 to 1991, the United States experienced a resurgence of measles, with >50,000 reported cases. Virologic surveillance suggested that virus from a single genotype, D3, had seeded the entire country. As was the case with the D6 viruses from South America, the D3 viruses from many different areas in the United States had nearly identical sequences (8). Therefore, we conclude that when measles outbreaks occur in areas that have good measles control, genetic analysis of viruses will confirm the presence of a single chain of transmission. In contrast, in areas where measles control programs are less advanced, genetic studies have identified multiple chains of transmission within a genotype (17).
Initiation of a two-dose vaccination schedule, along with the success of the PAHO strategy in the Americas, resulted in historically low numbers of cases in the United States in the years following the resurgence there; both standard epidemiologic surveillance epidemiologic surveillance The ongoing, systematic collection, analysis, and interpretation of health data essential to planning, implementing, and evaluating public health practice, closely integrated with the timely dissemination of these data to those who need to know and molecular epidemiologic surveillance have documented the sustained interruption of transmission of the genotype D3 viruses (1,2,8,35-37). Similarly, the pattern of viral genotypes found in Brazil and other parts of South and Central America will help to assess the success of the PAHO measles control programs. Genotype D6 viruses were circulating in Haiti and the Dominican Republic during 2001 but have not been isolated from ongoing chains of transmission in any other countries in the region (36). During 2002, virologic surveillance showed that measles cases imported into El Salvador from Europe were genotype D7 (38). As the number of measles cases continues to decrease in the Americas, increasing virologic surveillance activities will be important. This virologic surveillance will document the interruption of indigenous transmission of the genotype D6 viruses in Brazil and in other parts of South America.
Table. Summary of 41 measles specimens analyzed, Sao Paulo, Brazil, March 1995--October 1997 Date of specimen Name (a) ID (b) Age collection MVs/Sao Paulo.BRA/10.95 205 * 9 m 03/09/95 MVs/Sao Paulo.BRA/35.95/2 258 * 9 m 08/30/95 MVs/Sao Paulo.BRA/35.95/1 2793 * 9 m 08/29/95 MVs/Sao Paulo.BRA/3.96 141 * 9 m 01/15/96 MVs/Sao Paulo.BRA/5.96 431 * 9 m 02/26/96 MVs/Sao Paulo.BRA/27.96 1490 * 9 m 07/03/96 MVs/Sao Paulo.BRA/4.27 106 25 yr 01/20/97 MVs/Sao Paulo.BRA/6.97 267 20 yr 02/04/97 MVs/Sao Paulo.BRA/9.97 503 30 yr 03/01/97 MVs/Sao Paulo.BRA/10.97 561 24 yr 03/06/97 MVs/Sao Paulo.BRA/11.97 661 20 yr 03/11/97 MVs/Sao Paulo.BRA/12.97/3 760 27 yr 03/18/97 MVs/Sao Paulo.BRA/12.97/1 764 23 yr 03/17/97 MVs/Sao Paulo.BRA/12.97/2 765 31 yr 03/17/97 MVi/Sao Paulo.BRA/12.97/4 802 29 yr 03/18/97 MVs/Sao Paulo.BRA/12.97/5 862 26 yr 03/18/97 MVs/Sao Paulo.BRA/14.97/2 1045 6 m 04/02/97 MVs/Sao Paulo.BRA/14.97/3 1048 27 yr 04/02/97 MVs/Sao Paulo.BRA/14.97/1 1084 3 m 04/01/97 MVs/Sao Paulo.BRA/15.97/1 1225 4 m 04/07/97 MVi/Sao Paulo.BRA/14.97/4 1139 22 yr 04/03/97 MVs/Sao Paulo.BRA/15.97/2 1202 2 yr 04/10/97 MVs/Sao Paulo.BRA/17.97/1 1398 15 yr 04/23/97 MVi/Sao Paulo.BRA/17.97/3 1494 33 yr 04/27/97 MVs/Sao Paulo.BRA/17.97/2 8954 3 yr 04/25/97 MVs/Sao Paulo.BRA/32.97 9462 20 yr 08/21/97 MVi/Sao Paulo.BRA/33.97/1 9463 25 yr 08/12/97 MVs/Sao Paulo.BRA/33.97/2 9778 24 yr 08/13/97 MVs/Sao Paulo.BRA/30.97 9786 -- 07/22/97 MVs/Sao Paulo.BRA/34.97/4 10085 3 m 08/21/97 MVs/Sao Paulo.BRA/33.97/5 10171 30 yr 08/15/97 MVs/Sao Paulo.BRA/33.97/6 10172 26 yr 08/15/97 MVs/Sao Paulo.BRA/33.97/3 10173 5 m 08/14/97 MVs/Sao Paulo.BRA/33.97/4 10175 24 yr 08/14/97 MVs/Sao Paulo.BRA/33.97/8 10179 28 yr 08/16/97 MVs/Sao Paulo.BRA/33.97/9 10181 22 yr 08/17/97 MVs/Sao Paulo.BRA/34.97/1 10242 25 yr 08/19/97 MVs/Sao Paulo.BRA/33.97/7 10660 20 yr 08/15/97 MVs/Sao Paulo.BRA/34.97/2 10661 3 yr 08/19/97 MVs/Sao Paulo.BRA/34.97/3 10705 31 yr 08/21/97 MVi/Sao Paulo.BRA/42.97 35175 4 m 10/14/97 Name (a) Vaccination status (c) Genotype (a) MVs/Sao Paulo.BRA/10.95 02/24/95 A MVs/Sao Paulo.BRA/35.95/2 Yes D5 MVs/Sao Paulo.BRA/35.95/1 08/19/95 D6 MVs/Sao Paulo.BRA/3.96 01/03/96 A MVs/Sao Paulo.BRA/5.96 02/08/96 D6 MVs/Sao Paulo.BRA/27.96 06/15/96 D6 MVs/Sao Paulo.BRA/4.27 No D6 MVs/Sao Paulo.BRA/6.97 Yes D6 MVs/Sao Paulo.BRA/9.97 Unknown D6 MVs/Sao Paulo.BRA/10.97 Unknown D6 MVs/Sao Paulo.BRA/11.97 No D6 MVs/Sao Paulo.BRA/12.97/3 No D6 MVs/Sao Paulo.BRA/12.97/1 Unknown D6 MVs/Sao Paulo.BRA/12.97/2 No D6 MVi/Sao Paulo.BRA/12.97/4 No D6 MVs/Sao Paulo.BRA/12.97/5 Unknown D6 MVs/Sao Paulo.BRA/14.97/2 No D6 MVs/Sao Paulo.BRA/14.97/3 No D6 MVs/Sao Paulo.BRA/14.97/1 No D6 MVs/Sao Paulo.BRA/15.97/1 No D6 MVi/Sao Paulo.BRA/14.97/4 No D6 MVs/Sao Paulo.BRA/15.97/2 Unknown D6 MVs/Sao Paulo.BRA/17.97/1 No D6 MVi/Sao Paulo.BRA/17.97/3 No D6 MVs/Sao Paulo.BRA/17.97/2 Yes D6 MVs/Sao Paulo.BRA/32.97 Unknown D6 MVi/Sao Paulo.BRA/33.97/1 No D6 MVs/Sao Paulo.BRA/33.97/2 Unknown D6 MVs/Sao Paulo.BRA/30.97 Yes D6 MVs/Sao Paulo.BRA/34.97/4 No D6 MVs/Sao Paulo.BRA/33.97/5 No D6 MVs/Sao Paulo.BRA/33.97/6 Unknown D6 MVs/Sao Paulo.BRA/33.97/3 No D6 MVs/Sao Paulo.BRA/33.97/4 Unknown D6 MVs/Sao Paulo.BRA/33.97/8 Unknown D6 MVs/Sao Paulo.BRA/33.97/9 Yes D6 MVs/Sao Paulo.BRA/34.97/1 No D6 MVs/Sao Paulo.BRA/33.97/7 Yes D6 MVs/Sao Paulo.BRA/34.97/2 No D6 MVs/Sao Paulo.BRA/34.97/3 Unknown D6 MVi/Sao Paulo.BRA/42.97 No D6 (a) Sequence name and genotype designation based on nomenclature established by World Health Organization (11). (b) ID, specimen identification number. All samples were from purified peripheral blood mononuclear lymphocytes except for serum samples, designated by an asterisk. (c) Date of last measles vaccination, if known.
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n. Offensive Slang
Used as a disparaging term for a person of Japanese birth or descent.
Noun 1. Jap - (offensive slang) offensive term for a person of Japanese descent
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(31.) Jin L, Brown DWG (filename extension) dwg - The filename extension for Autodesk drawing files.
http://faqs.org/faqs/graphics/fileformats-faq/part3/. , Ramsay MEB MEB Marine Expeditionary Brigade
MEB Medical Evaluation Board (also abbreviated as MEBD)
MEB Milli Egitim Bakanligi
MEB Muscle-Eye-Brain Disease
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exocrine pancreatic insufficiency. Newsletter 2001;23:1-3.
Dr. Oliviera is a research scientist at the Adolfo Lutz Institute, Sao Paulo, Brazil. Her research interests include diagnosis of exantematic viral diseases and molecular epidemiology of exantematic viral diseases, including measles, rubella rubella or German measles, acute infectious disease of children and young adults. It is caused by a filterable virus that is spread by droplet spray from the respiratory tract of an infected individual. , parvovirus parvovirus (pär'vōvī`rəs), any of several small DNA viruses that cause several diseases in animals, including humans. In humans, parvoviruses cause fifth disease, or erythema infectiosum, an acute disease usually affecting young B19 and herpevirus 6.
Address for correspondence: Paul A. Rota, Measles Virus Section, MS C22, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, USA; fax: 404-639-4187; e-mail: email@example.com
Maria I. Oliveira, * Paul A. Rota, ([dagger]) Suely P. Curti, * Cristina A. Figueiredo, * Ana M. S. Afonso, * Marcia Theobaldo, * Luiza T.M. Souza, * Stephanie L. Liffick, ([dagger]) William J. Bellini, ([dagger]) Jose C. Moraes, ([double dagger]) Klaus E. Stevien, ([section]) and Edison L. Durigon ([section])
* Adolfo Lutz Institute, Sao Paulo; Brazil; ([dagger]) Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ([double dagger]) Center for Epidemiological Surveillance, Sao Paulo, Brazil; and ([section]) Institute of Biomedical Science The Institute of Biomedical Science (IBMS) is the professional body for biomedical scientists in the United Kingdom. It aims to promote and develop biomedical science and its practitioners. , Sao Paulo, Brazil