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Background <p>While the live attenuated measles virus vaccine is generally safe and highly effective, it has been associated with a significant number of vaccine-associated rash illnesses (VARIs). Some VARIs had been identified through the measles case-based surveillance system in Shandong province.</p> Methods <p>In our study, we comprehensively examined the epidemiological characteristics of VARIs using a cross-sectional study design with comparative subgroup analysis. Additionally, we conducted a detailed analysis of the genetic properties of VARIs.</p> Results <p>Among the 189 cases of VARIs, 90.47% (171 cases) were children aged 8 to 18 months who had received a single dose of measles-containing vaccine (MCV). Additionally, 16.40% (31/189) of these VARIs exhibited at least one symptom such as cough, coryza, or conjunctivitis. A significant linear correlation was observed between measles morbidity and the incidence of VARIs (R = 0.76, p = 0.03). Of the 189 VARIs, 109 cases were sampled throat swabs and 47.09% cases (89/189) were sampled within 5 days after the onset of rash, and only 30.28% (33/109) of these were successfully genotyped. Among the successfully genotyped sequences, 90.91% (30 sequences) were 100% consistent with the Shanghai-191 strain, with nucleotide identities ranging from 99.7% to 100%. Selective pressure analysis revealed no evidence of positive selection within the genotype A sequences from Shandong.</p> Conclusion <p>Our data demonstrate that VARI cases predominantly occur in children after single-dose MCV vaccination. Genotyping remains essential to prevent misdiagnosis and ensure accurate surveillance. This highlights the urgent requirement for either improved genotyping efficiency or vaccine-strain-specific rapid tests.</p> Clinical trial <p>Not applicable.</p>

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Molecular and epidemiological analysis of measles vaccine-associated rash illnesses in Shandong province, China, 2014–2021.

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  • 发表日期：

    2025年12月9日

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  • Suting Wang,
  • Xueqiang Fang,
  • Xiaodong Liu,
  • Yao Liu,
  • Ping Xiong,
  • Qing Xu,
  • Li Zhang,
  • Meng Chen,
  • Zexin Tao,
  • Aiqiang Xu

摘要

Background

While the live attenuated measles virus vaccine is generally safe and highly effective, it has been associated with a significant number of vaccine-associated rash illnesses (VARIs). Some VARIs had been identified through the measles case-based surveillance system in Shandong province.

Methods

In our study, we comprehensively examined the epidemiological characteristics of VARIs using a cross-sectional study design with comparative subgroup analysis. Additionally, we conducted a detailed analysis of the genetic properties of VARIs.

Results

Among the 189 cases of VARIs, 90.47% (171 cases) were children aged 8 to 18 months who had received a single dose of measles-containing vaccine (MCV). Additionally, 16.40% (31/189) of these VARIs exhibited at least one symptom such as cough, coryza, or conjunctivitis. A significant linear correlation was observed between measles morbidity and the incidence of VARIs (R = 0.76, p = 0.03). Of the 189 VARIs, 109 cases were sampled throat swabs and 47.09% cases (89/189) were sampled within 5 days after the onset of rash, and only 30.28% (33/109) of these were successfully genotyped. Among the successfully genotyped sequences, 90.91% (30 sequences) were 100% consistent with the Shanghai-191 strain, with nucleotide identities ranging from 99.7% to 100%. Selective pressure analysis revealed no evidence of positive selection within the genotype A sequences from Shandong.

Conclusion

Our data demonstrate that VARI cases predominantly occur in children after single-dose MCV vaccination. Genotyping remains essential to prevent misdiagnosis and ensure accurate surveillance. This highlights the urgent requirement for either improved genotyping efficiency or vaccine-strain-specific rapid tests.

Clinical trial

Not applicable.