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Monthly measles epidemiological updates

ECDC monitors measles and rubella transmission in the EU and EEA/EFTA countries and produces monthly epidemiological updates and biannual monitoring reports. These European Monthly Measles Monitoring reports are based on information from multiple sources including routine surveillance data provided by EU/EEA Member states, national websites, the Early Warning and Response System (EWRS), validated media reports, and communication from national authorities. Annual monitoring reports are based on information from multiple sources including routine surveillance data provided by EU/EEA Member states, national websites, the Early Warning and Response System (EWRS), validated media reports, and communication from national authorities.
 
The number of cases reported in this report should be treated as preliminary data.
 

Main developments

Reporting on measles surveillance data from 1 April 2016 to 31 March 2017

Get the latest surveillance data on measles from EU and EEA countries through the Surveillance Atlas of Infectious Diseases.  
 

Measles

  • Between 1 April 2016 and 31 March 2017, 30 EU/EEA Member States reported 6 597 cases of measles. Twenty-six Member States reported consistently throughout the 12-month period. Bulgaria, Croatia, Iceland and Italy did not report data for March 2017.
  • In the 12-month period, the highest number of cases was reported by Romania (3 072), Italy (1 314) and Germany (711), accounting respectively for 47%, 20% and 11% of the EU/EEA cases.  The diagnosis of measles was confirmed by positive laboratory results (serology, virus detection or isolation) in 66% of all EU/EEA cases.
  • In the first three months of 2017, a total of 2 480 cases were observed; in comparison, a total of 530 cases were reported in the first three months in 2016. In the first three months of 2017 the countries contributing to the majority of cases were Romania (749), Italy (684) and Germany (411).
  • In Austria, Belgium, Croatia, Czech Republic, France, Germany, Hungary, Portugal, Slovenia, Spain and Sweden the number of cases reported in just 3 months in 2017 has exceeded the number of cases reported during the entire 2016.
  • In 10 countries (Austria, Belgium, Croatia, France, Germany, Italy, Poland, Romania, Spain and Sweden), the number of cases reported in January-February 2017 is more than double the number reported in January-February 2016.
  • Measles is targeted for elimination in Europe. Over the 12 months’ period, the measles notification rate was below the elimination target (one case per million population) in 11 of the 30 reporting countries. Seven of these Member States reported zero cases. The highest notification rates were observed in Romania (155.5), Belgium (27.5) and Italy (21.7).
  • Of all cases with known age (n=5 876), 2 426 (41%) were children less than 5 years of age, while 2 208 (38%) were aged 15 years or over. The highest incidence was reported in children below one year of age (128.2 per million) and children from 1 to 4 years of age (83.7 per million).
  • Measles continues to spread across Europe because the vaccination coverage in many EU/EEA countries is suboptimal. The latest available figures on vaccination coverage collected by WHO (2015) show that the vaccination coverage for the second dose of measles was below 95% in 15 of 23 EU/EEA countries reporting second dose coverage data. The vaccination coverage for the first dose of measles was below 95% in 12 of 27 EU/EEA countries reporting on the first dose.  If the elimination goal is to be reached, the vaccination coverage rates for children targeted by routine vaccination programmes will have to be increased in a number of countries; as the vaccination coverage of the second dose must be at least 95% to interrupt measles circulation.
  • Of all cases with known vaccination status (6 133), 88% were unvaccinated, 8% were vaccinated with one dose, 3% were vaccinated with two or more doses, and 1% were vaccinated with an unknown number of doses. Of all cases, 7% had an unknown vaccination status.
  • The proportion of cases with unknown vaccination status was highest in adults aged 30 years and over, reaching 15% in this age group. The proportion of unvaccinated cases was highest among children below one year of age (95%). This is expected as these children are too young to have received the first dose of measles vaccine. Infants are particularly vulnerable to complications of measles and are best protected by herd immunity which is achieved when population coverage for the second dose of a measles-containing vaccine is at least 95%.
  • In the target group for the first dose of routine childhood MMR vaccination (1-4 year-old), 85% of the cases were unvaccinated, 11% were vaccinated with one dose, 1% with two doses or more, 1% with an unknown number of doses and 2% had an unknown vaccination status.
  • Sixteen deaths due to measles were reported during the 12-month period, all in Romania.
  • A large measles outbreak is ongoing in Romania with 4 793 cases reported from 1 January 2017 to 14 April 2017. The number of measles cases reported to ECDC is different from the number published by the National Institute of Public Health in Romania due to the delay in case-based reporting to ECDC, compared to the aggregated data regularly published by the National Institute of Public Health. ECDC has published a Rapid Risk Assessment on current outbreak in Romania, highlighting the risk of continued measles transmission in Romania and in other EU/EEA countries where vaccination coverage is suboptimal.
  • Measles outbreaks are also ongoing in other EU countries. According to information from ECDC epidemic intelligence, in EU, measles cases were described in Austria, Belgium, Bulgaria, Czech Republic, Denmark, France, Germany, Hungary, Iceland, Italy, Portugal, Spain and Sweden. See more information in the latest CDTR.
  • ECDC is currently reporting on measles European outbreaks through weekly epidemiological updates
     

Number of measles cases by month and notification rate (cases per million) by country, April 2016 to March 2017, EU/EEA countries

 

Country 2016 2016 2016 2016 2016 2016 2016 2016 2016 2017 2017 2017 Total cases Cases per million Total 
lab-positive
cases
Apr
May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Austria
2
1
1 8 3
4
3
1
4
28
34
8
97
11.16 86
Belgium
13
17 9
1
0
2
2 2 3
27
79
156
311
27.5 192
Bulgaria

0

0 0 0 0 0 0 0 0 0 0
NR
0
0 0
Croatia 2
0
0 1
0
1
0
0
0 2
5
NR
11 2.62 11
Cyprus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Czech Republic 0
4
0
0 0 1
0
1
0
0 0 19
25
2.37 24
Denmark 1
0
0 0 1
0
0 0 1
0
0
1
4
0.7 4
Estonia 1
0
0 0 0 0 0 0 0 0 0 0 1 0.76 1
Finland 0 0 0 0 0 0 0 0 0 3 0 0 3 0.55 3
France 3
0
7
6
4
7
2
2
4
34
53
47
169
2.53
113
Germany 28
45
72
38
28
31
11
25
22
48
157
206
711 8.65 518
Greece 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Hungary 0 0 0 0 0 0 0 0 0 1
11
3
15
1.53
15
Iceland 0 0 0 0 1
0
0 0 0 0 0
NR
1 3.01 1
Ireland 0 19
14 3
5
1
0
0 0
0 1 2
45 9.52 43
Italy 76 84
84 46
34
56
76 84
90
265
419
NR
1314 21.66 956
Latvia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lithuania 10
10 2
0
0 0 0 0 0 0 0 0 22 7.62 22
Luxembourg 0 0 0 0 0 0 0 0 0 0 0 3
3
5.21
3
Malta 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Netherlands 0 0 0 0 2
0
0 0 4
0
0 0 6 0.35 5
Norway 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Poland 0
2
3
6
39
40
24
13
4
6
6
4
147 3.87 90
Portugal 0 0 0 0 0 0 0 0 0 0 2
10
12
1.16
9
Romania 67 78 116
112 185 219
426
614
506
484
104
161
3072
155.46 1611
Slovakia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Slovenia 0 1
0
0 0 0 0 0 0 2
4
0
7 3.39 7
Spain 9
0
2
3
2
3
2
6
2
10
26
19
84
1.81 74
Sweden 1
0
0 0 2
0
0 0 0 2
8
7
20
2.03 20
United Kingdom 56
48
76
132
108 29
37
14
1 10 1
5
517 7.91 517
Total 269 309
386
356 414
394
583
762
644
919
910
651
6597
12.8 4325
Date of data retrieval from TESSy 29 March 2017
NR = Data not reported. Notification rates were calculated using the most recent population estimates available from Eurostat (2015).


Comment:
The target to monitor progress towards elimination is achievement of an incidence of less than one case per million population per year (including confirmed, probable and possible cases but excluding imported cases). Achieving this target is consistent with progress towards elimination but does not define elimination or confirm that it has been achieved. In the table, all cases (endemic, imported, import-related) are included for the calculation of the notification rate.

For countries that did not report data for all 12 months, notification rates might be underestimated.
All confirmed, probable, possible or unknown cases, as defined by the EU 2008 case definition, are included.
Note: 
The number of cases are displayed according to month of statistics, which contains a date chosen by the country for reporting purposes. This date may indicate the onset of disease, the date of diagnosis, the date of notification, or the date of laboratory confirmation.
Countries report on measles and other vaccine-preventable diseases to TESSy at their own convenience. This implies that the date of retrieval can influence the presentation of data. Inconsistencies with measles data reported previously might arise as countries may update their data in TESSy retrospectively.
Comparisons between countries should be made with caution because of dissimilar surveillance sensitivities, completeness of reporting and different reporting procedures. Moreover, under-notification is a well recognized limitation of nationwide mandatory notification systems.
 

Maps

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Measles maps
Measles notification rate, April 2016 to March 2017
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