Atypical measles in a patient twice vaccinated against measles: transmission from an unvaccinated household contact

Described are two cases within the same household that were involved in an outbreak of measles in Niteroi, RJ. Measles diagnosis was confirmed serolog ically by specific IgM detection in Case 1 (classic measles) who was unvacc inated, and rising measles specific IgG in the absence of IgM in Case 2 (mi ld modified measles) who had a history of two vaccinations with measles-con taining vaccines. Measles virus was detected by reverse transcriptase polym erase chain reaction (RT-PCR) in saliva samples from both cases. The nuclei c acid amplified by RT-PCR was sequenced and showed identical measles seque nce in the two cases. This study highlights the difficulty of diagnosing no nclassical measles infection on clinical and serological grounds, and the u sefulness of PCR for viral RNA sequencing from noninvasive specimens for co nfirming epidemiologic links. (C) 2000 Elsevier Science Ltd. All rights res erved.