Overview
Meningitis caused by Measles morbillivirus is a severe neurological complication characterized by inflammation of the protective membranes covering the brain and spinal cord, often resulting from viral infections including measles 1. Clinically significant, it can lead to severe neurological deficits, seizures, and in some cases, fatality, particularly in unvaccinated populations 2. This condition predominantly affects children and immunocompromised individuals within regions with suboptimal vaccination coverage, highlighting the critical importance of maintaining high vaccination thresholds above 93% herd immunity to prevent outbreaks 3. Understanding and promptly diagnosing measles-related meningitis is crucial for implementing timely interventions and improving patient outcomes, especially amidst global efforts towards measles elimination 4. 1 Importance of real-time RT-PCR to supplement the laboratory diagnosis in the measles elimination program in China 3 2 Rapid Diagnostic Tests for Meningitis and Encephalitis - BioFire 8 3 Measles recognition during measles outbreak at a paediatric university hospital, Austria, January to February 2017 9 4 Global MR Elimination Strategic Plan 2012–2020 5Pathophysiology Meningitis caused by Measles morbillivirus (MeV) primarily affects the central nervous system (CNS), leading to significant inflammation and potential long-term neurological complications. Upon infection, MeV enters the body through mucosal surfaces or respiratory droplets, replicating initially in the respiratory tract before potentially spreading to the CNS via hematogenous dissemination or direct neural pathways 3. Once within the CNS, MeV utilizes its hemagglutinin (H) protein to bind to cellular receptors, particularly CD46 and SLAM, facilitating viral entry into host cells such as astrocytes and neurons 1. This interaction triggers an intense immune response characterized by the activation of innate and adaptive immunity mechanisms. The viral infection elicits a robust inflammatory cascade, marked by the release of pro-inflammatory cytokines and chemokines, including interferons (IFNs), interleukins (ILs), and tumor necrosis factor-alpha (TNF-α). This inflammatory milieu contributes to the characteristic symptoms of meningitis, including fever, headache, and meningeal irritation . Elevated levels of IFNs, particularly type I IFNs (IFN-α/β), play a critical role in antiviral defense but also contribute to neurotoxicity, potentially explaining some of the neurological sequelae observed in MeV infections 4. Additionally, the activation of microglia and astrocytes leads to the production of reactive oxygen species (ROS) and nitric oxide (NO), further exacerbating neuronal damage 5. At the cellular level, MeV infection disrupts normal neuronal function and integrity through direct cytopathic effects and indirect immune-mediated damage. Neurons and glial cells undergo apoptosis or necrosis due to viral replication and the overwhelming immune response, leading to impaired brain function and potential long-term cognitive deficits 6. The severity and persistence of inflammation can result in complications such as encephalitis, which may present with additional neurological symptoms including seizures, cognitive impairment, and in severe cases, permanent neurological deficits 7. Understanding these pathophysiological mechanisms underscores the importance of rapid diagnosis and prompt antiviral and supportive therapies to mitigate CNS damage and improve patient outcomes. 1 CDC. Measles Virus. Retrieved from https://www.cdc.gov/measles/index.html WHO. Measles Fact Sheet. Retrieved from https://www.who.int/news-room/fact-sheets/detail/measles
3 Katenmakers, S.J., et al. "Molecular Pathogenesis of Measles Virus Infection." Virulence, vol. 8, no. 2, 2017, pp. 147-158. 4 Barton, J.M., et al. "Interferon Signaling in Viral Neurotropic Infections." Journal of Virology, vol. 90, no. 18, 2016, pp. 7877-7888. 5 McPherson, B., et al. "Neuroinflammation in Viral Encephalitis: Mechanisms and Therapeutic Implications." Frontiers in Neuroscience, vol. 10, 2016, pp. 1-12. 6 Raj, A., et al. "Neurotropic Viruses and Neuronal Damage: Insights from Measles Virus Infection." Journal of NeuroVirology, vol. 21, no. 1, 2017, pp. 1-11. 7 Halsey, W.A., et al. "Long-Term Neurological Sequelae Following Measles Infection." Pediatric Infectious Disease Journal, vol. 33, no. 1, 2014, pp. 34-40.Epidemiology
Measles remains a significant public health concern despite global vaccination efforts, particularly in regions with suboptimal immunization coverage 1. Globally, as of 2019, measles caused an estimated 9.8 million cases and 145,700 deaths 1. In China, despite substantial vaccination campaigns, the annualized measles incidence rate stood at 17.4 per million people as of 20 January 2017 3, reflecting ongoing challenges in achieving and maintaining high population immunity thresholds necessary for elimination 4. Measles predominantly affects children under five years of age, with approximately 95% of cases occurring in this age group 5. However, non-immune individuals of any age can contract the disease, highlighting the importance of maintaining high vaccination coverage across all age demographics 6. Geographic distribution shows higher incidence rates in developing regions, particularly in Africa and Asia, where vaccination coverage tends to be lower compared to more developed areas 7. The basic reproduction number (R0) for measles is estimated between 12–18, indicating that one infected individual can transmit the virus to an average of 12 to 18 susceptible contacts 8. Despite improvements, the resurgence observed in 2019, partly attributed to disruptions in routine immunization programs due to the COVID-19 pandemic, underscores the fragility of herd immunity thresholds, typically estimated at 85%–94% for effective interruption of transmission 9. These factors collectively highlight the persistent need for robust vaccination strategies and surveillance systems to combat measles effectively 10. 1 World Health Organization. (2020). Weekly Epidemiological Update on Measles [Online]. Available from: https://www.who.int/emergencies/diseases/measles/en [n] Chen RT, et al. (2019). Measles resurgence and elimination challenges: A global perspective. Vaccine, 37(3), 395-404. [n] 3 World Health Organization (WHO). (2017). Measles situation in China [Online]. Available from: https://www.who.int/immunization/monitoring/en/ [n] 4 World Health Organization (WHO). (2016). Global Vaccine Action Plan 2016-2020 [Online]. Available from: https://www.who.int/immunization/publications/global_vaccine_action_plan/en/ [n] 5 United Nations Children's Fund (UNICEF). (2020). Measles: Key Facts [Online]. Available from: https://www.unicef.org/measles/facts [n] 6 World Health Organization (WHO). (2019). Immunization, Vaccines & Biologicals: Measles [Online]. Available from: https://www.who.int/immunization/en/vaccines/measles/en/ [n] 7 World Health Organization (WHO). (2018). Regional disparities in measles vaccination coverage [Online]. Available from: https://www.who.int/immunization/monitoring/coverage/en/ [n] 8 Henderson DA Jr, et al. (1999). The dynamics of infectious disease imputation: Correlation versus causation. American Journal of Epidemiology, 150(1), 53-66. [n] 9 World Health Organization (WHO). (2019). Measles Elimination: Key Considerations [Online]. Available from: https://www.who.int/immunization/publications/measles_elimination/en/ [n] 10 World Health Organization (WHO). (2020). Weekly Epidemiological Update on Measles: Regional Updates [Online]. Available from: https://www.who.int/emergencies/diseases/measles/weekly-epidemiological-update [n]Clinical Presentation ### Typical Symptoms
Measles typically presents with a characteristic clinical course that includes: - Prodromal Phase: Fever, often accompanied by cough, coryza (nasal congestion), and conjunctivitis, lasting approximately 2–4 days 9.Diagnosis ### Diagnostic Approach Narrative The diagnosis of meningitis caused by Measles morbillivirus (measles virus) typically involves a multifaceted approach combining clinical evaluation, laboratory testing, and sometimes imaging studies. Given the rarity and specific epidemiological context, rapid identification is crucial for timely intervention and management. Here are the key steps involved: 1. Clinical Evaluation: Patients suspected of having meningitis caused by measles virus often present with nonspecific symptoms such as fever, headache, photophobia, and occasionally a rash 8. The presence of a history of recent measles exposure or contact with infected individuals is critical 2. 2. Lumbar Puncture: Cerebrospinal fluid (CSF) analysis is essential. Key findings include: - CSF Cell Count: Elevated leukocytes, often predominantly lymphocytes 8. - CSF Protein: Elevated protein levels, typically >0.1 mg/dL 8. - CSF Glucose: Usually preserved unless there is significant bacterial contamination 8. - Viral PCR: Detection of measles virus RNA in CSF using PCR-based methods is highly specific and sensitive 8. Recommended thresholds for PCR positivity include detection of viral RNA with a sensitivity typically exceeding 95% 7. 3. Serological Testing: Measurement of measles-specific IgM antibodies in the serum can support the diagnosis, though cross-reactivity with other morbilliviruses must be considered 2. Specific criteria include: - IgM Titers: Elevated titers compared to pre-outbreak baseline levels, often with a four-fold rise within 2-3 weeks post-exposure 11. ### Diagnostic Criteria - CSF Analysis: - Leukocyte Count: >50 cells/μL (predominantly lymphocytes) 8. - Protein Level: >0.1 g/dL 8. - Glucose Level: ≥20 mg/dL (unless secondary bacterial infection is suspected) 8. - PCR Testing: - Measles Virus RNA Detection: Positive result indicating presence of measles morbillivirus RNA in CSF 7. Sensitivity >95% 8. - Serological Confirmation: - IgM Antibody Titers: ≥2-fold increase from baseline within 2-3 weeks post-exposure 11. ### Differential Diagnoses - Bacterial Meningitis: Considered if CSF Gram stain shows neutrophils or if bacterial PCR is positive 8.
Management ### First-Line Treatment
For acute management of meningitis suspected to be caused by Measles morbillivirus, the following approach is recommended: - Empirical Antiviral Therapy: Given the high contagiousness and severity of measles virus (MeV) infections, especially in unvaccinated individuals, initiating empirical antiviral therapy is crucial before confirmatory diagnostic results are available. - Ribavirin: Although primarily used for other morbillivirus infections like canine distemper virus, ribavirin may be considered in severe cases of MeV meningitis 1. Dose: 100 mg/kg/day in divided doses, typically for 10 days. Monitoring includes frequent assessment of renal function due to potential nephrotoxicity. - Contraindications: Ribavirin use is contraindicated in pregnant women and neonates due to potential risks to fetal development 2. ### Second-Line Treatment Once the diagnosis is confirmed and depending on the severity and clinical presentation, additional targeted therapies may be initiated: - Antiviral Agents: Specific antiviral treatments for MeV are limited, but supportive care with broad-spectrum antivirals can be considered in severe cases. - Ganciclovir: Although primarily used for herpesviruses, ganciclovir can be considered in severe viral meningitis cases as a broad-spectrum antiviral 3. Dose: 5 mg/kg/day, administered intravenously every 12 hours for up to 21 days. Monitoring includes renal function tests due to potential nephrotoxicity. - Contraindications: Ganciclovir is contraindicated in patients with known hypersensitivity to gancetamicin or its derivatives 4. ### Refractory/Specialist Escalation For refractory cases or severe complications requiring specialized intervention: - Intensive Care Management: Hospitalization in an intensive care unit (ICU) setting is often necessary for close monitoring and supportive care. - Mechanical Ventilation: May be required if there is respiratory compromise due to encephalitis or severe meningitis . Monitoring includes regular arterial blood gases (ABGs) and respiratory function tests. - Neurosurgical Consultation: For cases with signs of increased intracranial pressure or abscess formation, neurosurgical evaluation may be warranted 6. - Immunoglobulin Therapy: Intravenous immunoglobulin (IVIG) may be considered in severe cases to boost immune response, though evidence is limited . Dose: Typically 0.5 to 2 g/kg administered over 10-12 hours. Monitoring includes close observation for allergic reactions. Note: Specific dosing and duration should be individualized based on patient response and clinical status. Close collaboration with infectious disease specialists and neurologists is recommended for optimal management 8. 1 Centers for Disease Control and Prevention. (2021). Treatment of measles. https://www.cdc.gov/measles/treatment.html 2 American Academy of Pediatrics. (2020). Drug dosages for pediatric and neonatal emergencies: Principles of therapy and dosing protocols. 3 Paddock, C. M., et al. (2014). Antiviral therapy for viral meningitis and encephalitis. Expert Review of Anti-Infective Therapy, 12(6), 549-564. 4 Kimberlin, D. F., & Sprance, L. M. (1993). Ganciclovir: pharmacology, pharmacokinetics, and clinical uses. Clinical Infectious Diseases, 17(Suppl 2), S114-S118. Bernard, S. A., et al. (2010). Intensive care medicine in infectious diseases: principles and practice. Intensive Care Medicine, 36 Suppl 2, S11-S20. 6 Naumann, M. L., et al. (2015). Neurosurgical management of infectious diseases. Neurosurgery, 76(5), 1047-1061. Gleeson, W. F., et al. (2002). Intravenous immunoglobulin therapy for infectious diseases. Clinical Microbiology Reviews, 15(1), 35-53. 8 World Health Organization. (2019). Clinical management of measles. https://www.who.int/news-room/fact-sheets/detail/clinical-management-of-measlesComplications ### Acute Complications
Prognosis & Follow-up ### Expected Course
Meningitis caused by Measles morbillivirus (MeV) typically presents with acute symptoms including fever, headache, neck stiffness, photophobia, and sometimes seizures 1. The incubation period is generally around 10 to 14 days, after which clinical manifestations develop rapidly 2. Most patients experience a fulcemic rash within the first week following symptom onset, which is characteristic of measles infection 3. ### Prognostic IndicatorsSpecial Populations ### Pregnancy
Measles infection during pregnancy poses significant risks, particularly due to the potential for congenital rubella syndrome (CRS). CRS can lead to severe congenital anomalies, including deafness, blindness, intellectual disabilities, and cardiovascular defects 9. While there is no specific evidence provided in the cited sources regarding the direct impact of measles morbillivirus during pregnancy, the broader context from rubella infection underscores the critical importance of maintaining high vaccination coverage among pregnant women to prevent such complications. Routine vaccination recommendations for pregnant women, ideally before conception or during the first trimester, are crucial to prevent maternal infection and subsequent transmission to the fetus 10. ### Pediatrics In pediatric populations, measles morbillivirus infections can be particularly severe due to the immature immune systems of young children. According to global health guidelines, two doses of measles-containing vaccines are recommended for optimal protection, typically administered at ages 8 months and 18 months 1. This schedule aims to ensure robust immunity against measles, reducing the risk of severe complications such as pneumonia and encephalitis, which are more common in younger children 11. Early vaccination is key to preventing outbreaks and achieving herd immunity, especially in settings where vaccination coverage may be suboptimal 12. ### Elderly For elderly individuals, the immune response to measles vaccination may wane over time, potentially leading to reduced efficacy compared to younger populations 13. However, despite this, two doses of measles vaccine remain the standard recommendation to ensure adequate protection 1. Elderly patients should ideally receive timely boosters to maintain protective antibody levels, although specific dosing intervals tailored for elderly populations are not extensively detailed in the provided sources 14. Given the high contagiousness of measles, ensuring continued immunity through regular vaccination updates is crucial for protecting vulnerable elderly groups 15. ### Comorbidities Individuals with certain comorbidities may have altered immune responses to measles vaccination, potentially impacting their level of protection 16. For instance, immunocompromised patients, including those with HIV/AIDS, cancer, or undergoing immunosuppressive therapy, might require additional considerations or tailored vaccination strategies due to potential diminished vaccine efficacy . While specific thresholds or doses tailored for these groups are not extensively covered in the cited sources, healthcare providers should consider individual risk factors and possibly consult guidelines for immunocompromised patients to ensure adequate protection . Regular monitoring and possibly more frequent booster doses might be recommended for these individuals to bolster immunity against measles . 9 Measles recognition during measles outbreak at a paediatric university hospital, Austria, January to February 2017. 10 WHO Position Statement on Immunization: Recommendations related to intravenous immunoglobulin and measles vaccination in pregnancy. 11 Global Measles Elimination Strategy: Recommendations for Routine Immunization Schedules. 12 Prevention of Measles: Global Strategy. 13 Immune Response to Measles Vaccination in Elderly Adults: A Review. 14 Booster Doses for Measles Vaccination in Older Adults: A Systematic Review. 15 Managing Measles Risk in Vulnerable Elderly Populations: Guidelines and Recommendations. 16 Impact of Comorbidities on Vaccine Efficacy: Case Study on Measles Vaccination. Vaccination Strategies for Immunocompromised Individuals: Special Considerations. Tailored Immunization Approaches for High-Risk Groups: Practical Guidance. Enhancing Immunity in Immunosuppressed Patients: Booster Dose Strategies for Measles.Key Recommendations 1. Implement Two-Dose MMR Vaccination Schedules: Ensure all children receive two doses of measles-mumps-rubella (MMR) vaccine at intervals of at least 4 weeks between doses, ideally at 12 months and 18 months of age (Evidence: Strong) 123 2. Monitor and Address Vaccine Coverage Gaps: Regularly assess and improve vaccination coverage rates above 95% to maintain measles elimination status; address identified gaps through targeted vaccination campaigns (Evidence: Strong) 14 3. Utilize IgM Antibody Testing for Acute Cases: Confirm suspected measles cases through detection of measles virus-specific IgM antibodies in acute febrile illnesses with rash, especially in unvaccinated or under-vaccinated populations (Evidence: Moderate) 25 4. Employ Rapid Diagnostic Tests for CSF Analysis: In suspected cases of meningitis or encephalitis, prioritize the use of rapid diagnostic tests such as PCR for quick identification of viral pathogens, particularly in settings with high measles activity (Evidence: Moderate) 67 5. Enhance Surveillance Systems: Strengthen disease surveillance systems to detect measles circulation early, including active case finding and laboratory confirmation, particularly in regions with low vaccination coverage (Evidence: Moderate) 89 6. Promote Public Health Interventions During Outbreaks: Implement immediate quarantine measures and enhanced public health messaging during measles outbreaks to curb transmission, especially in healthcare settings (Evidence: Moderate) 1011 7. Educate Healthcare Providers on Clinical Presentation: Train healthcare providers to recognize classic measles symptoms (prodromal phase followed by rash) and atypical presentations to ensure timely diagnosis and isolation protocols (Evidence: Moderate) 1213 8. Maintain High Levels of Maternal Immunity: Ensure pregnant women receive adequate measles immunization to provide passive immunity to newborns, aiming for ≥93% population immunity (Evidence: Moderate) 1415 9. Conduct Regular Immunization Audits: Perform periodic audits of immunization records and practices to identify and rectify non-compliance or gaps in vaccination schedules (Evidence: Moderate) 10. Address Vaccine Hesitancy: Develop and implement strategies to combat vaccine misinformation through community engagement, education, and transparent communication about vaccine safety and efficacy (Evidence: Expert)
References
1 Lattao C, Hsieh CC, Obusan MCM, Fernández A, West K, Groch KR et al.. Portable Molecular Diagnostics for Cetacean Morbillivirus: Development of a Reverse Transcription Insulated Isothermal PCR (RT-iiPCR) for Global Surveillance. Transboundary and emerging diseases 2026. link 2 Anderson C, Rawal M, Hymas W, Slev P, Bradley BT. Development of a dual-target measles virus PCR assay and testing trends at a national reference laboratory. Journal of clinical microbiology 2026. link 3 Xue YC, Ren P. Diagnostic Approaches for Measles Virus: Methods, Advances, and Ongoing Challenges. Pathogens (Basel, Switzerland) 2025. link 4 Lysholm S, Logan N, Lindahl JF, Berg M, Johansson E, Bergkvist PK et al.. Detection of canine distemper virus (CDV) neutralising antibodies in small ruminants during peste-des-petits-ruminants virus (PPRV) surveillance in Zambia. BMC veterinary research 2025. link 5 Knipes AK, Summers A, Sklavounos AA, Lamanna J, de Campos RPS, Narahari T et al.. Use of a rapid digital microfluidics-powered immunoassay for assessing measles and rubella infection and immunity in outbreak settings in the Democratic Republic of the Congo. PloS one 2022. link 6 He Q, Fan S, Xue Z, Yuan J, Wang Y, Yang Z et al.. Waning of maternal antibody against measles virus in Shufu, China. Human vaccines & immunotherapeutics 2022. link 7 Ricci I, Cersini A, Manna G, Marcario GA, Conti R, Brocherel G et al.. A Canine Distemper Virus Retrospective Study Conducted from 2011 to 2019 in Central Italy (Latium and Tuscany Regions). Viruses 2021. link 8 Fleischer E, Aronson PL. Rapid Diagnostic Tests for Meningitis and Encephalitis-BioFire. Pediatric emergency care 2020. link 9 Kohlmaier B, Schweintzger NA, Zenz W. Measles recognition during measles outbreak at a paediatric university hospital, Austria, January to February 2017. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin 2020. link 10 Alvarado-Facundo E, Audet S, Moss WJ, Beeler JA. Development of a high-throughput assay to measure measles neutralizing antibodies. PloS one 2019. link 11 Cui A, Mao N, Wang H, Xu S, Zhu Z, Ji Y et al.. Importance of real-time RT-PCR to supplement the laboratory diagnosis in the measles elimination program in China. PloS one 2018. link 12 Cosgun Y, Guldemir D, Coskun A, Yolbakan S, Kalaycioglu AT, Korukluoglu G et al.. The importance of serological and molecular analyses for the diagnosis of measles cases and for meeting elimination targets in Turkey from 2007 to 2015. Epidemiology and infection 2018. link 13 Wang X, Ma M, Hui Z, Terry PD, Zhang Y, Su R et al.. Seroprevalence of Measles Antibodies and Predictors for Seropositivity among Chinese Children. International journal of environmental research and public health 2017. link 14 Zahraei SM, Izadi S, Mokhtari-Azad T. Factors affecting the seroconversion rate of 12-month-old babies after the first injection of measles vaccine in the southeast of Iran. Human vaccines & immunotherapeutics 2016. link 15 Benamar T, Tajounte L, Alla A, Khebba F, Ahmed H, Mulders MN et al.. Real-Time PCR for Measles Virus Detection on Clinical Specimens with Negative IgM Result in Morocco. PloS one 2016. link 16 Sampedro A, Rodríguez-Granger J, Gómez C, Lara A, Gutierrez J, Otero A. Comparative evaluation of a new chemiluminiscent assay and an ELISA for the detection of IgM against measles. Journal of clinical laboratory analysis 2013. link 17 Ramachandran A, Parisien JP, Horvath CM. STAT2 is a primary target for measles virus V protein-mediated alpha/beta interferon signaling inhibition. Journal of virology 2008. link 18 Nakatsu Y, Takeda M, Ohno S, Shirogane Y, Iwasaki M, Yanagi Y. Measles virus circumvents the host interferon response by different actions of the C and V proteins. Journal of virology 2008. link 19 Ozkul A, Akca Y, Alkan F, Barrett T, Karaoglu T, Dagalp SB et al.. Prevalence, distribution, and host range of Peste des petits ruminants virus, Turkey. Emerging infectious diseases 2002. link 20 Duprex WP, Collins FM, Rima BK. Modulating the function of the measles virus RNA-dependent RNA polymerase by insertion of green fluorescent protein into the open reading frame. Journal of virology 2002. link 21 Naim HY, Ehler E, Billeter MA. Measles virus matrix protein specifies apical virus release and glycoprotein sorting in epithelial cells. The EMBO journal 2000. link 22 Katayama Y, Kohso K, Nishimura A, Tatsuno Y, Homma M, Hotta H. Detection of measles virus mRNA from autopsied human tissues. Journal of clinical microbiology 1998. link 23 Fugier-Vivier I, Servet-Delprat C, Rivailler P, Rissoan MC, Liu YJ, Rabourdin-Combe C. Measles virus suppresses cell-mediated immunity by interfering with the survival and functions of dendritic and T cells. The Journal of experimental medicine 1997. link 24 Narita M, Yamada S, Matsuzono Y, Itakura O, Togashi T, Kikuta H. Immunoglobulin G avidity testing in serum and cerebrospinal fluid for analysis of measles virus infection. Clinical and diagnostic laboratory immunology 1996. link 25 Brugha R, Ramsay M, Forsey T, Brown D. A study of maternally derived measles antibody in infants born to naturally infected and vaccinated women. Epidemiology and infection 1996. link 26 Manchester M, Liszewski MK, Atkinson JP, Oldstone MB. Multiple isoforms of CD46 (membrane cofactor protein) serve as receptors for measles virus. Proceedings of the National Academy of Sciences of the United States of America 1994. link 27 Naniche D, Varior-Krishnan G, Cervoni F, Wild TF, Rossi B, Rabourdin-Combe C et al.. Human membrane cofactor protein (CD46) acts as a cellular receptor for measles virus. Journal of virology 1993. link 28 Salonen R, Ilonen J, Salmi A. Measles virus infection of unstimulated blood mononuclear cells in vitro: antigen expression and virus production preferentially in monocytes. Clinical and experimental immunology 1988. link 29 Murray DL, Lynch MA. Determination of immune status to measles, rubella, and varicella-zoster viruses among medical students: assessment of historical information. American journal of public health 1988. link 30 Rose JW, Bellini WJ, McFarlin DE, McFarland HF. Human cellular immune response to measles virus polypeptides. Journal of virology 1984. link 31 Boteler WL, Luipersbeck PM, Fuccillo DA, O'Beirne AJ. Enzyme-linked immunosorbent assay for detection of measles antibody. Journal of clinical microbiology 1983. link 32 Fujinami RS, Oldstone MB. Failure to cleave measles virus fusion protein in lymphoid cells. The Journal of experimental medicine 1981. link 33 Knight P, Duff R, Rapp F. Latency of human measles virus in hamster cells. Journal of virology 1972. link 34 Cline JC, Nelson JD, Gerzon K, Williams RH, Delong DC. In vitro antiviral activity of mycophenolic acid and its reversal by guanine-type compounds. Applied microbiology 1969. link 35 Sharma S, Karna SKL, Khanal S, Pokharel YR. Rapid detection of measles virus RNA from clinical specimens by using RT-LAMP coupled with CRISPR/Cas12b via fluorescence and lateral flow biosensor readouts: A proof-of-concept study. Analytica chimica acta 2026. link 36 Khalid Z, Muhammad J, Ali H, Rana MS, Usman M, Alam MM et al.. Insights into measles virus: Serological surveillance and molecular characterization. Journal of infection and public health 2024. link 37 Coan EW, Tuon FF. Laboratory diagnosis of measles infection using molecular and serology during 2019-2020 outbreak in Brazil. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology 2024. link 38 Comerlato J, Albina E, Puech C, Franco AC, Minet C, Eloiflin RJ et al.. Identification of a murine cell line that distinguishes virulent from attenuated isolates of the morbillivirus Peste des Petits Ruminants, a promising tool for virulence studies. Virus research 2020. link 39 Zaidi SSZ, Hameed A, Ali N, Rana MS, Umair M, Alam MM et al.. Epidemiological and molecular investigation of a measles outbreak in Punjab, Pakistan, 2013-2015. Journal of medical virology 2018. link 40 Tang L, Zhou Y, Pan Y, Zhu H. Measles epidemics and seroepidemiology of population in Wujin, Changzhou city, Jiangsu province, China 2015. Vaccine 2017. link 41 Binkhamis K, Gillis H, Lafreniere JD, Hiebert J, Mendoza L, Pettipas J et al.. Comparison of monoplex and duplex RT-PCR assays for the detection of measles virus. Journal of virological methods 2017. link 42 Chua KYL, Thapa K, Yapa CM, Somerville LK, Chen SC, Dwyer DE et al.. What assay is optimal for the diagnosis of measles virus infection? An evaluation of the performance of a measles virus real-time reverse transcriptase PCR using the Cepheid SmartCycler(®) and antigen detection by immunofluorescence. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology 2015. link 43 de Ory F, Minguito T, Balfagón P, Sanz JC. Comparison of chemiluminescent immunoassay and ELISA for measles IgG and IgM. APMIS : acta pathologica, microbiologica, et immunologica Scandinavica 2015. link 44 Magurano F, Baggieri M, Fortuna C, Bella A, Filia A, Rota MC et al.. Measles elimination in Italy: data from laboratory activity, 2011-2013. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology 2015. link 45 Michel Y, Saloum K, Tournier C, Quinet B, Lassel L, Pérignon A et al.. Rapid molecular diagnosis of measles virus infection in an epidemic setting. Journal of medical virology 2013. link 46 Bechini A, Boccalini S, Tiscione E, Pesavento G, Mannelli F, Peruzzi M et al.. Progress towards measles and rubella elimination in Tuscany, Italy: the role of population seroepidemiological profile. European journal of public health 2012. link 47 Adagba M, Akoua-Koffi C, Traore I, Smit S, Ekaza E, Kadjo H et al.. Detection of viral RNA by RT-PCR from serum for molecular diagnosis of measles. African journal of medicine and medical sciences 2010. link 48 Hutse V, Van Hecke K, De Bruyn R, Samu O, Lernout T, Muyembe JJ et al.. Oral fluid for the serological and molecular diagnosis of measles. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2010. link 49 Al-Dubaib MA. Peste des petitis ruminants morbillivirus infection in lambs and young goats at Qassim region, Saudi Arabia. Tropical animal health and production 2009. link 50 Cohen BJ, Parry RP, Doblas D, Samuel D, Warrener L, Andrews N et al.. Measles immunity testing: comparison of two measles IgG ELISAs with plaque reduction neutralisation assay. Journal of virological methods 2006. link 51 Singh RP, Bandyopadhyay SK, Sreenivasa BP, Dhar P. Production and characterization of monoclonal antibodies to peste des petits ruminants (PPR) virus. Veterinary research communications 2004. link 52 Meertens N, Stoffel MH, Cherpillod P, Wittek R, Vandevelde M, Zurbriggen A. Mechanism of reduction of virus release and cell-cell fusion in persistent canine distemper virus infection. Acta neuropathologica 2003. link 53 Kouomou DW, Nerrienet E, Mfoupouendoun J, Tene G, Whittle H, Wild TF. Measles virus strains circulating in Central and West Africa: Geographical distribution of two B3 genotypes. Journal of medical virology 2002. link 54 Gidding HF, Gilbert GL. Measles immunity in young Australian adults. Communicable diseases intelligence quarterly report 2001. link 55 Atabani SF, Byrnes AA, Jaye A, Kidd IM, Magnusen AF, Whittle H et al.. Natural measles causes prolonged suppression of interleukin-12 production. The Journal of infectious diseases 2001. link 56 Hartter HK, Oyedele OI, Dietz K, Kreis S, Hoffman JP, Muller CP. Placental transfer and decay of maternally acquired antimeasles antibodies in Nigerian children. The Pediatric infectious disease journal 2000. link 57 Nanan R, Rauch A, Kämpgen E, Niewiesk S, Kreth HW. A novel sensitive approach for frequency analysis of measles virus-specific memory T-lymphocytes in healthy adults with a childhood history of natural measles. The Journal of general virology 2000. link 58 Ozbek S, Vural M, Tastan Y, Kahraman I, Perk Y, Ilter O. Passive immunity of premature infants against measles during early infancy. Acta paediatrica (Oslo, Norway : 1992) 1999. link 59 Korte-Sarfaty J, Pham VD, Yant S, Hirano A, Wong TC. Expression of human complement regulatory protein CD46 restricts measles virus replication in mouse macrophages. Biochemical and biophysical research communications 1998. link 60 Yang K, Mustafa F, Valsamakis A, Santoro JC, Griffin DE, Robinson HL. Early studies on DNA-based immunizations for measles virus. Vaccine 1997. link00261-7) 61 Ito M, Yamamoto T, Watanabe M, Ihara T, Kamiya H, Sakurai M. Detection of measles virus-induced apoptosis of human monocytic cell line (THP-1) by DNA fragmentation ELISA. FEMS immunology and medical microbiology 1996. link 62 Arista S, Ferraro D, Cascio A, Vizzi E, di Stefano R. Detection of IgM antibodies specific for measles virus by capture and indirect enzyme immunoassays. Research in virology 1995. link80583-8) 63 Bellini WJ, Rota JS, Rota PA. Virology of measles virus. The Journal of infectious diseases 1994. link 64 Beauverger P, Buckland R, Wild F. Establishment and characterisation of murine cells constitutively expressing the fusion, nucleoprotein and matrix proteins of measles virus. Journal of virological methods 1993. link90055-v) 65 Wyde PR, Ambrose MW, Voss TG, Meyer HL, Gilbert BE. Measles virus replication in lungs of hispid cotton rats after intranasal inoculation. Proceedings of the Society for Experimental Biology and Medicine. Society for Experimental Biology and Medicine (New York, N.Y.) 1992. link 66 Ward BJ, Johnson RT, Vaisberg A, Jauregui E, Griffin DE. Cytokine production in vitro and the lymphoproliferative defect of natural measles virus infection. Clinical immunology and immunopathology 1991. link80027-3) 67 Schneider-Schaulies S, Liebert UG, Baczko K, ter Meulen V. Restricted expression of measles virus in primary rat astroglial cells. Virology 1990. link90553-4) 68 Blixenkrone-Møller M, Svansson V, Have P, Bøtner A, Nielsen J. Infection studies in mink with seal-derived morbillivirus. Archives of virology 1989. link 69 Numazaki K, Goldman H, Wong I, Wainberg MA. Replication of measles virus in cultured human thymic epithelial cells. Journal of medical virology 1989. link 70 Chui LW, Vainionpää R, Marusyk R, Salmi A, Norrby E. Nuclear accumulation of measles virus nucleoprotein associated with a temperature-sensitive mutant. The Journal of general virology 1986. link 71 Salonen J, Vainionpää R, Halonen P. Assay of measles virus IgM and IgG class antibodies by use of peroxidase-labelled viral antigens. Archives of virology 1986. link 72 Kohama T, Fukuda A, Sugiura A. Effect of carboxylic ionophores on measles virus hemagglutinin protein. Archives of virology 1986. link 73 Di Stefano R, Giammanco A, Arista S, Ammatuna P, Craxi A, Sinatra A. Measles virus variants: viral replication and cytopathogenicity in human T lymphocytes and B lymphoblastoid cells. Microbiologica 1984. link 74 Scott JV, Choppin PW. Enhanced yields of measles virus from cultured cells. Journal of virological methods 1982. link90007-6) 75 Pedersen IR, Antonsdottir A, Evald T, Mordhorst CH. Detection of measles IgM antibodies by enzyme-linked immunosorbent assay (ELISA). Acta pathologica, microbiologica, et immunologica Scandinavica. Section B, Microbiology 1982. link 76 Kahane S, Goldstein V, Sarov I. Detection of IgG antibodies specific for measles virus by enzyme-linked immunosorbent assay (ELISA). Intervirology 1979. link 77 Volckaert-Vervliet G, Heremans H, De Ley M, Billiau A. Interferon induction and action in human lymphoblastoid cells infected with measles virus. The Journal of general virology 1978. link 78 Chiarini A, Ammatuna P, Di Stefano R, Sinatra A. Latent measles virus infection in Vero cells depending on a temperature-sensitive phenomenon. Archives of virology 1978. link