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Epidemiological update: Measles - monitoring European outbreaks

12 May 2017

​A measles outbreak in Romania has been ongoing since February 2016. Cases continue to be reported despite ongoing response measures that have been implemented at national level through reinforced vaccination activities. Between 1 January 2016 and 5 May 2017, Romania reported 5 290 cases including 25 deaths. In 2016, a number of additional EU/EEA countries reported measles outbreaks, and an increase in the number of cases continues to be observed in 2017. Some previous and ongoing measles outbreaks in other EU/EEA countries have been epidemiologically linked to the current outbreak in Romania.

Weekly summary

In addition to Romania, the following EU/EEA countries have reported measles cases in 2017: Austria, Belgium, Bulgaria, Czech Republic, Denmark, France, Germany, Hungary, Iceland, Italy, Portugal, Slovakia, Spain and Sweden.

 

Epidemiological summary

EU/EEA countries with updates since last week :
 
Austria: Since the beginning of 2017 and as of 5 May, Austria has reported 75 cases. This exceeds the cumulative number of cases reported in 2016.
 
Bulgaria: Since mid-March 2017 and as of 3 May, media in Bulgaria have reported 71 cases. Thirty-seven cases are confirmed, mostly in the city of Plovdiv (34). This represents an increase by six cases since the last report on 24 April.
 
Czech Republic: As of 9 May 2017, the Moravian-Silesian region has reported 90 measles cases, including 82 confirmed. Thirteen confirmed cases have been reported among healthcare workers.
 
Romania: Between 1 January 2016 and 9 May 2017, Romania has reported 5 290 cases, including 25 deaths. Cases are either laboratory-confirmed or have an epidemiological link to a laboratory-confirmed case. Infants and young children are the most affected group. Thirty-eight of the 42 districts have reported cases, Caras Severin (West part of the country, at the border with Serbia) being the most affected with 966 cases. Vaccination activities are ongoing in order to cover communities with suboptimal vaccination coverage.
 
Portugal: Since the beginning of 2017 and as of 9 May, Portugal has reported 28 confirmed cases, of which 18 (64%) are older than 18 years of age, 17 (61%) were unvaccinated, 12 (43%) are health professionals and 13 (46%) were hospitalised. One death has been reported. On 10 May, media reported an additional case, bringing the number of cases to 29.
 
EU/EEA countries with no updates since last week:
 
Belgium: Since 20 December 2016 and as of 16 April 2017, Wallonia has reported 288 cases, of which 163 are confirmed, 81
probable and 44 clinical (ECDC 2012 definition). The outbreak affects all provinces of Wallonia, with the exception of the province of
Luxembourg. Thirty-seven cases are among healthcare workers (31 confirmed, four probable and two possible). Of the 288 cases, 111 (38%) were hospitalised. Two of the cases had acute encephalitis. No deaths are reported. The index case of the outbreak in Wallonia travelled to Romania during the incubation period. In Flanders, one isolated imported case was reported in January and another in March, with possible links to a cluster in Wallonia. In the Brussels Capital Region, one isolated imported case was reported in February and two cases were notified in March without known links to the outbreak in Wallonia. Both imported cases had a travel history to Romania during the incubation period, and the national reference centre for measles, mumps and rubella (WIV-ISP) identified genotype B3, which is the same strain found in Romania, Italy and Austria, at the end of 2016.
 
Denmark: On 15 March 2017, Denmark reported an imported case in an unvaccinated adult who was infected during a holiday in Asia.
France: Since 1 January 2017 and as of 31 March, France has reported 134 cases, three times more than over the same period in 2016. The cases are mainly linked to an outbreak in Lorraine (60 cases). Two cases of encephalitis and 15 severe pneumopathies have been recorded since the beginning of the year.
 
Germany: Since the beginning of 2017 and as of 16 April, Germany has reported 504 cases. This is an increase by 42 cases since the previous update. In the same period in 2016, Germany reported 33 cases.
Hungary: Between 21 February and 22 March 2017, Hungary has reported 54 cases. Health authorities have lifted the quarantine from the hospital in Mako, Southeast Hungary, as no new cases were detected in two weeks.
 
Iceland: On 31 March 2017, Iceland reported two cases in two 10-month-old unvaccinated twin siblings. The first case was diagnosed 10 days before the second case. This is the first time in a quarter of a century that measles infection has occurred in Iceland.
 
Italy: Since the beginning of 2017 and as of 30 April, Italy has reported 1 920 cases in 18 of the 21 regions. Among these, 176 cases occurred among healthcare workers. Most of the cases are above the age of 15 years and 88% of the cases were not vaccinated.
 
Slovakia: On 24 April 2017, Slovakia reported an imported case in a 25-year-old, unvaccinated Italian who studies in Kosice. In Slovakia, the last endemic cases were reported in 1998 and the last imported cases in 2011 and 2012.
 
Spain: An outbreak started in the first week of January in Barcelona metropolitan area, due to an imported case from China. As of 7 April, 46 cases have been confirmed. Most of the cases are unvaccinated or incompletely-vaccinated adults. Four of the cases are children, and ten cases were hospitalised.
 
Sweden: On 30 April, Sweden reported five cases in the Southern part of the country. Since the beginning of 2017 and as of 21 March, Sweden has reported 15 cases in Stockholm area, including three imported cases.
 

ECDC assessment

Measles outbreaks continue to occur in EU/EEA countries. There is a risk of spread and sustained transmission in areas with susceptible populations. The national vaccination coverage remains less than 95% for the second dose of MMR in the majority of EU/EEA countries. The progress towards elimination of measles in the WHO European Region is assessed by the European Regional Verification Commission for Measles and Rubella Elimination (RVC). Member States of the WHO European Region are making steady progress towards the elimination of measles. At the fifth meeting of the RVC for Measles and Rubella in October 2016, of 53 countries in the WHO European Region, 24 (15 of which are in the EU/EEA) were declared to have reached the elimination goal for measles, and 13 countries (nine in the EU/EEA) were concluded to have interrupted endemic transmission for between 12 and 36 months, meaning they are on their way to achieving the elimination goal. However, six EU/EEA countries were judged to still have endemic transmission: Belgium, France, Germany, Italy, Poland and Romania.
 
More information on strain sequences would allow further insight into the epidemiological investigation. All EU/EEA countries report measles cases on a monthly basis to ECDC and these data are published every month. Since 10 March 2017, ECDC has been reporting on measles outbreaks in Europe on a weekly basis through epidemic intelligence activities.
 

Actions

ECDC published a rapid risk assessment on 6 March. ECDC monitors measles transmission and outbreaks in the EU/EEA on weekly basis through enhanced surveillance and epidemic intelligence activities.

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