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Epidemiological update: Measles - monitoring European outbreaks

19 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 12 May 2017, Romania reported 5 728 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 12 May, Austria has reported 76 cases. This exceeds the cumulative number of
cases reported in 2016.

Czech Republic: As of 16 May 2017, the Moravian-Silesian region has reported 104 measles cases, including 95 confirmed.
Fourteen confirmed cases have been reported among healthcare workers.

Italy: Since the beginning of 2017 and as of 14 May, Italy has reported 2 395 cases in 18 of the 21 regions. Among these, 197
cases occurred among healthcare workers. Most of the cases (73%) are above the age of 15 years, 89% of the cases were not
vaccinated and 7% received only one dose of vaccine.

Portugal: Since the beginning of 2017 and as of 16 May, Portugal has reported 29 confirmed cases, of which 19 (66%) are older
than 18 years of age, 17 (59%) were unvaccinated, 13 (45%) are health professionals and 13 (45%) were hospitalised. Twentyone
cases have been confirmed in the regions of Lisbon and Vale do Tejo, followed by seven cases in the Algarve and one in the
North. One death has been reported.

Romania​: Between 1 January 2016 and 12 May 2017, Romania has reported 5 728 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-nine of the 42 districts have reported cases, Timis (West part of the country, at the border with Serbia)
being the most affected with 1 051 cases. Vaccination activities are ongoing in order to cover communities with suboptimal
vaccination coverage. On 16 May, media reported an additional death, bringing the number of deaths to 26.

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.

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.

Denmark: On 15 March 2017, Denmark reported an imported case in an unvaccinated adult who was infected during a holiday in

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

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.



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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