Epidemiological update: Measles - monitoring European outbreaks, 21 April 2017
A measles outbreak in Romania has been ongoing since February 2016 and 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 14 April 2017, Romania reported 4 793 cases. In 2016, a number of 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 countries have been epidemiologically linked to the current outbreak in Romania.
In EU, measles cases have been reported in Austria, Belgium, Bulgaria, Czech Republic, Denmark, France, Germany, Hungary, Iceland, Italy, Portugal, Spain and Sweden as well as in Romania, where 4 793 cases had been reported as of 14 April 2017.
Since the beginning of 2017 and as of 12 April, Austria has reported 71 cases, which exceeds the cumulative number of cases reported in 2016.
Since mid-March 2017 and as of 19 April, according to media Bulgaria reported 61 cases in the city of Plovdiv, an increase of 16 cases since the last report. Twenty-six cases are confirmed. Most cases have been registered in Plovdiv (30), followed by the Municipality Rodopi, Sadovo and Krichim. On 9 April 2017, Bulgaria reported the first death, a 10-month-old unimmunised child.
Since 1 January and as of 31 March 2017, France reported 134 cases, three times more than the number of reported cases in 2016 over the same period. The cases are mainly linked to an epidemic outbreak in Lorraine (60 cases). Two cases of encephalitis and 15 severe pneumopathies have been recorded since the beginning of the year.
According to the national public health institute as of 2 April 2017, 410 cases have been reported in Germany since the beginning of 2017 representing an increase of 138 cases compared with the previous update. In the same period in 2016, Germany reported 26 cases.
Since the beginning of 2017 and as of 19 April, Italy reported 1 603 cases, with 152 cases among healthcare workers. The cases are reported from 18 of the 21 regions in Italy. Most of the cases are above the age of 15 years and 88% of the cases were not vaccinated. During March 2016, 75 cases of measles were reported compared to 727 in March 2017.
Since the beginning of 2017 and as of 19 April 2017, Portugal reported 21 measles cases including one death, a 17-year-old girl who was not vaccinated. Further cases are under investigation. Contact tracing is ongoing as part of the epidemiological investigation.
Between 1 January 2016 and 14 April 2017, Romania has reported 4 793 cases of measles, including 21 deaths. Cases are either laboratory-confirmed or have an epidemiological link to a laboratory-confirmed case. Infants and young children are the most affected population. Thirty-eight of the 42 districts report cases, Caras Severin (West part of the country, at the border with Serbia) being the most affected district with 943 cases. Vaccination activities are ongoing in order to cover communities with suboptimal vaccination coverage. On 19 April, media quoting the National Institute of Public Health reported that an additional case has died, bringing the total to 22 deaths.
Countries with no updates since the last week
Since 20 December 2016 and as of 31 March 2017, Wallonia has reported 266 cases. The outbreak affects all provinces of Wallonia, with the exception of the province of Luxembourg. All age groups are affected, 52.5% of the cases are over 15 years. Most of the cases were not vaccinated or did not know their vaccination status. Nearly 40% were hospitalised. No deaths have been reported. The index case of the epidemic 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 epidemic 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.
On 15 March 2017, Denmark reported an imported case of measles in an unvaccinated adult who was infected during a holiday in Asia.
As of 10 April 2017, 38 cases of measles have been reported in the Moravian-Silesian region of the Czech Republic. Twenty of the cases are children below the vaccination age and 18 are adults. Of the 18 adults, six are healthcare workers. According to media, a hospital has been closed due to hospital staff being infected.
Between 21 February and 22 March 2017, Hungary reported 54 cases of measles. The health authorities have lifted the quarantine from the hospital in Mako, southeast Hungary, as no new cases were detected in two weeks.
On 31 March, Iceland reported two cases in two 10-month-old twin siblings. The infants were unvaccinated. 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.
An outbreak started in the first week of January in Barcelona metropolitan area in Spain, due to an imported measles case from China. As of 27 March, 44 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.
Since the beginning of 2017 and as of 21 March 2017, Sweden reported 15 cases of measles, including three imported cases.
Since the beginning of 2017 and as of 21 March 2017, Switzerland reported 52 cases of measles. In February 2017, a vaccinated man died of measles in Switzerland. He was undergoing strong immunosuppressive treatment for leukaemia, which explains why the measles vaccination did not protect him. This is the first measles death in Switzerland since 2009.
Measles outbreaks continue to occur in EU/EEA countries, and there is the 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 EU/EEA) were declared to have reached the elimination goal for measles, and an additional 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 of measles: 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.