Rubella Epidemic Strain, Greece, 1999

drum Sciaenops ocellatus mortalities associated with Streptococcus iniae infection. et al. Invasive infections due to a fish pathogen, Streptococcus iniae. S. Streptococcus iniae, a human and animal pathogen: specific identification by the chaperonin 60 gene identification method. To the Editor: A recent extensive study on global distribution of rubella virus genotypes by Zheng et al. (1) showed that most of the isolates tested were rubella genotype I (RGI) and that subgenotypes within RGI were apparent. Of these subgenotypes, three were currently active, one in the United States and Latin America, one in China represented by two specimens , and one international subgeno-type that originated in Asia and spread to Europe and North America. More RGI subgenotypes, which have not yet been identified in specimen collections , may be currently active. In Zheng, et al. the distribution of rubel-la subgenotypes is shown; Greece is one of the four European countries where only RGI viruses were found. This letter provides more information about rubella in Greece and the strain that was responsible for the 1999 epidemic there. Rubella virus is endemic in Greece. Vaccination in the private sector only was introduced in 1981 with a mono-valent rubella vaccine. In 1989, a single dose of the measles-mumps-rubel-la (MMR) vaccine was introduced in the national vaccination program for 15-month-old infants. Because of the rubella outbreak of 1993, the vaccination policy changed. In 1997, a second vaccination was recommended for 11-to 12-year-old children. However, another major rubella epidemic occurred in 1999, beginning in late December 1998 and lasting until May 1999, with a peak in the number of cases in January. During this period, 1,438 rubella cases were reported throughout Greece; 765 were in the northern part of the country. In previous rubella epidemics in Greece, children were most affected. However, in the 1999 epidemic, a higher incidence rate was observed mostly among 15-to 19-year-old persons (2). During this epidemic, four cases of congenital rubella syndrome were reported. Because of this epidemic, the vaccination policy was revised. The new policy consists of two doses of the MMR vaccine, one to be given at 15 months of age and another to be given at 4–6 years of age (3). During the 1999 epidemic, oral samples were collected from patients within a week of the onset of symptoms. Most of the samples were sent to Colindale, London, for testing; a few of them were stored at –70°C …