- Maladie due à un virus enveloppé : virus de la rougeole (MeV : Measles virus, autre nom plus ancien = Rubeola virus, attention différent de Rubella virus)
- Virus de la famille des Paramyxoviridae du genre Morbillivirus (ordre Mononegavirales)
- Génome viral de type ARN monocaténaire linéaire de polarité négative
- 24 génotypes décrits :
- génotype vaccinal : génotype A (souche Edmonston)
- 2018 : 4 génotypes circulants dans le monde (B3, D4, D8, H1)
- 1 seul sérotype décrit
- Maladie à déclaration obligatoire en France
- Les cellules cibles préférentielles sont les lymphocytes B et T, les cellules épithéliales de l’arbre respiratoire supérieur sont infectées secondairement et contribuent à la transmission de l’infection
Légende panel A :
Photographie par microscopie électronique à transmission en coloration négative. L’aspect pléiomorphe de la particule virale est caractéristique. On distingue nettement les spicules hérissés à la surface de l’enveloppe et la nucléocapside hélicoïdale à l’intérieure de la particule (Pierre Lebon). Source : Paramyxoviridae In : Traité de Virologie Médicale : Société Française de Microbiologie Ed ; 2019: p. 607-23.
Source figure B : https://viralzone.expasy.org/86?outline=all_by_species
- La rougeole est une maladie virale grave extrêmement contagieuse, R0>15 (transmission de type respiratoire, directe et indirecte).
- L’incubation est de 10 jours classiquement, mais peut atteindre 20 jours. Puis la phase invasive dure environ 4 jours associant un catarrhe oculo-respiratoire (toux, rhinite, conjonctivite), de la fièvre, une altération de l’état général et l’apparition du signe de Köplick (points blanchâtres entourés d’un halo inflammatoire siégeant à la face interne des joues), inconstant mais décrit comme caractéristique de l’infection.
- Après cette phase d’invasion, apparaît une éruption maculopapuleuse, non prurigineuse qui dure en moyenne 5 à 6 jours, et qui s’étend progressivement de façon descendante de la face vers les mains et les pieds.
- Il existe de nombreuses complications possibles : respiratoires (pneumopathie interstitielle morbilleuse conduisant à un SDRA), défaillance multiviscérale, surinfections bactériennes, atteintes encéphalitiques (post-infectieuse ou à plus long terme). Les personnes souffrant de malnutrition ou immunodéprimées sont plus à risques de faires de formes graves avec complications.
- Il n’existe pas de traitement antiviral spécifique contre la rougeole. L’infection par le virus sauvage induit une immunisation protectrice à vie, les réinfections sont exceptionnelles.
- Le vaccin vivant atténué (2 doses) induit une immunisation protectrice de très longue durée (> 20 ans). Cependant, au-delà d’un certain temps, et chez certains individus, des réinfections par virus sauvage peuvent être observées sous forme de rougeole atténuée, peu ou pas transmissibles (situation d’échec vaccinal secondaire). Le diagnostic sérologique est alors peu contributif du fait de la préexistence d’IgG anti-rougeole et de la présence inconstante d’IgM spécifique.
- La vaccination systématique des enfants contre la rougeole est une stratégie essentielle pour réduire le nombre de décès par rougeole dans le monde et les risques de complications. L’OMS a mis en place un plan stratégique mondial de lutte contre la rougeole sur la période 2012-2020 avec des objectifs de couverture vaccinale à atteindre. Les 6 régions de l’OMS font l’objet d’un plan d’élimination de la rougeole (objectif = < 1 cas de rougeole / millions d’habitants, arrêt de la circulation endémique pendant > 36 mois) ; il existe un réseau de surveillance appelé GMRLN pour Global Measles and Rubella Laboratory Network, incluant 704 laboratoire dans 191 pays.
- En France, la vaccination systématique des enfants avec deux doses d’un vaccin trivalent contre la rougeole, les oreillons et la rubéole (vaccin ROR) est actuellement obligatoire pour les enfants nés à partir du 1er janvier 2018 et il est recommandé de favoriser le rattrapage vaccinal des adolescents et jeunes adultes nés depuis 1980.
Pr Astrid Vabret : vabret-a@chu-caen.fr
(Chef de service du laboratoire de Virologie, Pôle de Biologie, CHU de Caen, Directeur du Centre National de Référence des Virus de la Rougeole, Rubéole et Oreillons)
Dr Sonia BURREL : sonia.burrel@aphp.fr
(Maître de Conférences des Universités – Praticien Hospitalier, Centre National de Référence Herpèsvirus – Laboratoire associé, Service de Virologie Hôpitaux Universitaires La Pitié-Salpêtrière – Charles Foix)
Pour en savoir plus …
CNR des virus de la rougeole, rubéole et oreillons : https://www.chu-caen.fr/cnrrougeole.html
Pages dédiées sur le site internet de l’OMS :
https://www.who.int/topics/measles/fr/ (français)
https://www.who.int/immunization/diseases/measles/en/ (anglais)
https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/
http://www.euro.who.int/en/media-centre/sections/press-releases/2019/european-region-loses-ground-in-effort-to-eliminate-measles
Chapitre de livre :
Paramyxoviridae In : Traité de Virologie Médicale : Société Française de Microbiologie Ed ; 2019: p. 607-23.
Revues récentes dans la littérature scientifique :
Moss WJ. Measles. Lancet. 2017 Dec 2;390(10111):2490-2502. https://www.ncbi.nlm.nih.gov/pubmed/28673424
Strebel PM, Orenstein WA. Measles. N Engl J Med. 2019 Jul 25;381(4):349-357.https://www.ncbi.nlm.nih.gov/pubmed/31184814
Presse grand public :
http://sante.lefigaro.fr/article/les-cas-de-rougeole-dans-le-monde-ont-triple-depuis-janvier-selon-l-oms/
https://www.lequotidiendumedecin.fr/actus-medicales/politique-de-sante/plus-de-41-000-cas-et-37-deces-une-epidemie-de-rougeole-inedite-sevit-en-europe
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