Epidemiological update: Measles - monitoring European outbreaks, 2 June 2017

EU/EEA countries with updates since last week: 

Austria: Since the beginning of 2017 and as of 19 May, Austria has reported 78 cases. This exceeds the cumulative number of cases reported in 2016. 

Belgium: Since 20 December 2016 and as of 8 May 2017, Wallonia has reported 293 cases, of which 115 were hospitalised. The outbreak affects all provinces of Wallonia, with the exception of the province of Luxembourg. No deaths are reported. The index case of the outbreak in Wallonia travelled to Romania during the incubation period. After a peak of 40 cases per week in the beginning of March, the epidemic is gradually decreasing. 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 27 May, Bulgaria reported 116 cases of measles in Plovdiv, an increase of 45 cases since the previous monthly update. Bulgaria also reported also cases in Pazardzhik (5) and in Montana (2). 

Czech Republic: As of 29 May 2017, the Moravian-Silesian region reported 121 measles cases, an increase of 17 cases since the previous monthly update France: Since 1 January 2017 and as of 30 April, France reported 189 cases, an increase of 55 cases since the previous monthly update and nearly four times the number of reported cases in 2016 over the same period (47). The cases are mainly linked with an outbreak in Lorraine (60 cases between February and April 2017). Two cases of encephalitis and 18 of severe pneumonia have been recorded since the beginning of the year. On 31 May, media reported 22 additional cases in Perpignan since the beginning ​of May.

Germany: Since the beginning of 2017 and as of 7 May, Germany has reported 634 cases. This is an increase of 51 cases since the previous update. In the same period in 2016, Germany reported 62 cases. On 22 May, a 37-year-old woman from Essen died from measles. 

Italy: Since the beginning of 2017 and as of 30 May, Italy has reported 2 719 cases in 18 of the 21 regions. Among these, 220 are healthcare workers. Most of the cases (73%) are above the age of 15 years, 89% of the cases were not vaccinated and 6% received only one dose of vaccine. The weekly number of cases is decreasing. 

Romania: Between 1 January 2016 and 26 May 2017, Romania has reported 6 434 cases, including 26 deaths. A possible additional death is under investigation. Cases are either laboratory-confirmed or have an epidemiological link to a laboratory-confirmed case. Infants and young children are the most affected group. Forty of the 42 districts have reported cases, Timis (West part of the country, at the border with Serbia) is the most affected district with 1 065 cases. Vaccination activities are ongoing in order to cover communities with suboptimal vaccination coverage. On 31 May, media reported an additional death, if confirmed bringing the number of deaths to 28. 

Sweden: Since mid April and as of 31 May, Sweden reported four cases of measles in the south-western part of the country. Earlier in 2017, Sweden reported 15 cases in the Stockholm area, including three imported cases. 

United Kingdom: During the first three months of 2017, England reported 17 confirmed measles cases compared with 37 in the period between October and December 2016. Northern Ireland reported one case and Scotland and Wales have reported no cases so far this year. 

EU/EEA countries with no updates since last week: 

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

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. 

Portugal: Since the beginning of 2017 and as of 29 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. 

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. 

Outside EU 

Canada: As of 13 May, Canada reports 40 cases of measles. There is active transmission in Nova Scotia. DR Congo As of March 2017, 

DR Congo: recorded 14 485 suspected measles cases, including 174 deaths in Maniema and South Kivu provinces. 

Ethiopia: As of 31 March 2017, Ethiopia confirmed 348 cases and 40 outbreaks in Addis Ababa, Afar, Amhara, Oromia, Southern Nations Nationalities and Peoples, Somali and Tigray regions. The majority of the cases (39%) are children under five years. 

Guinea: Since the beginning of this year and as of 23 May, Guinea confirmed 3 468 cases of measles, including 14 deaths throughout the country. Conakry and Nzérékoré are the most affected prefectures. Since 7 April, Médecins Sans Frontières (MSF) has launched a large measles vaccination campaign in Conakry, in collaboration with the Ministry of Health of Guinea. 

Kenya: Since the outbreak in end February, Kenya reported 14 confirmed measles cases. 

Nigeria: Between 22 August 2016 and 3 April 2017, Nigeria reported 2 890 suspected cases of measles in 13 of the 27 local government areas (LGAs) of Borno state, located at the north east of the country. 

Oman: As of the end of April 2017, Oman reported 44 cases of measles. A National Measles Immunisation Campaign started on 14 May. 

Reunion Between 20 April and 3 May 2017, five cases of measles were diagnosed in young adults residing in Réunion. 

Somalia: Since the beginning of 2017 and as of 17 May, Somalia reported 8 390 suspected cases of measles. During the entire 2016 5 657 cases were detected. Children under the age of five are most affected. Most affected regions are Banadir, Toghdeer, Lower Shabelle, Sool and Sahil. 

South Africa: As of 6 May 2017, South Africa reported 17 cases of measles in Gauteng area in Johannesburg. Ten of these cases are linked to one family, who chose not to be vaccinated due to religious reasons. Almost all cases were not vaccinated. Five of the patients are under the age of five, one is 45 years old, and the rest are between ages five and 15.

Switzerland: Since the beginning of the year, Switzerland has registered 69 cases. Throughout 2016, there were 71 cases. 

Syria: As of 29 May, Syria reported 40 laboratory-confirmed cases. Most of the cases are concentrated in the western region of Dara’a, in addition to Al-Harak area in the eastern countryside of Dara’a. The last outbreak of the disease was reported in 2006. 

Tajikistan: Since April 2017 and as of 1 May, Tajikistan notified 345 cases of measles, with 246 (71%) patients hospitalised. No deaths have been reported. The measles epidemic is gradually spreading out of Rudaki district to the capital Dushanbe and the surrounding districts. 

Thailand: As of 27 May 2017 , Thailand reported 1 638 measles cases from 67 provinces, no deaths. Most affected age groups are the 15- 24 year old (21%). The highest morbidity rate was in the south of Thailand (6.40 / 100 000 population). 

Ukraine: As of 23 May, during four months Ukraine reported 172 measles cases in in ten regions. Most affected regions are IvanoFrankivsk and Odessa area. In 2016 during the same time period eight cases were reported. 

USA: As of 31 May, Minnesota Department of Health reported 70 confirmed cases, most of them are unvaccinated pre-school children. Of these, 59 cases were notified in Hennepin County. A significant number have been hospitalised. Minnesota’s measles outbreak is about to exceed the cumulative number of 70 cases reported in the entire United States in 2016. 

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.