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Le retour (non surprenant) de la rougeole

机译：麻疹的（非突发）回归

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Measles is a potentially eradicable disease: exclusive human reservoir, no persistence in the organism, a single viral serotype, stability of the hemagglutinin neutralisation epitope, effective and cheap vaccine available. The survival strategy of the virus lies in its extreme contagiousness, which allows it to survive in a population large enough to quickly renew its stock of susceptible. Stopping the circulation of the virus requires that approximately 95% of the population be immunised. Since the implementation of the Expanded program of immunisation, all countries have vaccinated their children against measles. The establishment of Measles Regional Elimination Plans has dramatically reduced the burden of the disease and its mortality, especially in Africa. WHO region of Americas temporarily eliminated measles. This favourable situation was interrupted at the end of 2017 and the two following years were marked by the occurrence of outbreaks affecting 4 of the 6 WHO regions. Africa, West Pacific region and Europe were most affected. France, who had already suffered a major outbreak between 2008 and 2011, observed a new epidemic between 2018 and 2019, affecting all regions of the territory. This situation occurred in a context of insufficient - though steadily increasing - vaccine coverage. The undervaccination recorded in the South of France and the existence of a reservoir of susceptible among adolescents and young adults explains the epidemic outbreak in which more than 50% of the patients were aged 15 years and over. The re-emergence of measles reflects the difficulty in reducing the number of susceptible subjects required to stop the circulation of a virus with extreme potential of transmission. The spectacular success of the WHO plan to immunise all children is likely to hove generated an excessive optimism ignoring the possibility of an "honeymoon period" due to the buildup of susceptible due to suboptimal vaccine coverage rates. Improving vaccine coverage is the essential solution, but must also focus on under-vaccinated territories, difficult to reach populations and catch up in the population of susceptible adolescents and young adults. The age at onset of vaccination could be revisited. The goal of eradication seems currently unrealistic but efforts should be sustained state by state with the aim of elimination.
机译：麻疹是一种潜在的可根除的疾病：专属的人类储层，没有生物体的持久性，单个病毒血清型，血凝素中和表位的稳定性，有效且廉价的疫苗可用。该病毒的生存策略在于其极端传染性，这使其能够在足够大的人群中生存，以迅速续签其易感性的股票。停止病毒的循环要求将大约95％的人口免疫。自从扩大的免疫计划实施以来，所有国家都为子女疫苗接种了麻疹。麻疹的建立区域消除计划大大减轻了疾病及其死亡的负担，尤其是在非洲。美国谁区域暂时消除了麻疹。这种有利的情况在2017年底中断了，次年的两年是影响6个WHO地区中4个地区的疫情发生的标志。非洲，西太平洋地区和欧洲受到最大影响。法国在2008年至2011年之间已经发生了重大爆发的法国，在2018年至2019年之间发生了新的流行病，影响了该领土的所有地区。这种情况发生在疫苗覆盖范围不足（尽管稳定增加）的情况下发生。在法国南部记录的疫苗不足，在青少年和年轻人中存在易感性的水库，解释了50％以上患者的流行病暴发，年龄在15岁以上。麻疹的重新出现反映了减少停止具有极大传播潜力的病毒循环所需的易感受试者的数量。世界卫生组织计划免疫所有儿童的惊人成功可能会产生过度的乐观情绪，忽略了由于次优疫苗的覆盖率而导致易敏感的“蜜月期”的可能性。改善疫苗覆盖范围是必不可少的解决方案，但还必须专注于疫苗接种的领土，难以吸引人口并赶上易感青少年和年轻人的人口。可以重新审视接种疫苗接种时的年龄。消除目前似乎是不现实的，但应以国家的状态持续努力，以消除。

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