Epidemiological update: Measles - monitoring European outbreaks, 22 June 2017
Romania is experiencing a large outbreak of measles since February 2016. Cases continue to be reported despite ongoing response measures implemented at national level through reinforced vaccination activities. Between 1 January 2016 and 16 June 2017, Romania has reported 7 233 measles cases, including 30 deaths. In 2016, several 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 Update
In addition to Romania, the following EU/EEA countries have reported measles cases in 2017: Austria, Belgium, Bulgaria, the Czech Republic, Denmark, France, Germany, Hungary, Iceland, Italy, Portugal, Slovakia, Spain, Sweden and the United Kingdom
Epidemiological summary
EU/EEA countries with updates since last week: Bulgaria: Since mid-March 2017 and as of 18 June, Bulgaria has reported 140 cases in Plovdiv, an increase of 10 cases since the previous CDTR. Bulgaria also reported also cases in Pazardzhik (15) and in Montana (4). Czech Republic: As of 16 June 2017, the Moravian-Silesian region reported 130 measles cases, of which 123 were laboratory-confirmed. Nineteen cases are among health care workers.
Since 1 January 2017 and as of 31 May, France has reported 295 cases, an increase of 106 cases since the previous CDTR and almost six times the number of reported cases in 2016 over the same period (47 cases). The cases are mainly linked with an outbreak in Lorraine (60 cases between February and April 2017) and several outbreaks in New Aquitaine and Occitania. The incidence is highest in children under 1 year (5.2 / 100 000 with 43 cases), which represents 14.6% of cases declared. Two cases of encephalitis and 22 cases of severe pneumonia have been recorded since the beginning of the year. Of the cases with known vaccination status (258 cases out of 295), 190 (74%) were not vaccinated, 40 (16%) received a single dose, 25 (10%) received 2 doses and for 3 cases (1%) the number was unknown.
Since the beginning of 2017 and as of 14 June, Germany has reported 723 cases. This is an increase of 25 cases since the previous CDTR. In the same period in 2016, Germany reported 100 cases.
Between 1 January 2016 and 16 June 2017, Romania has reported 7 233 cases, including 30 deaths. A possible 31st 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-one of the 42 districts have reported cases, Timis (West part of the country at the border with Serbia) is the most affected district with 1 167 cases. Vaccination activities are ongoing in order to cover communities with suboptimal vaccination coverage.
EU/EEA countries with no updates since last week:
Since the beginning of 2017 and as of 8 June, Austria has reported 78 cases. This exceeds the cumulative number of cases reported in 2016.
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 as identified in Romania, Italy and Austria at the end of 2016.
On 15 March 2017, Denmark reported an imported case in an unvaccinated adult who was infected during a holiday in Asia.
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.
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.
Since the beginning of 2017 and as of 11 June, Italy has reported 2 988 cases in 18 of the 21 regions. Among these, 237 are healthcare workers. The median age is 27 years, 89% of the cases were not vaccinated and 6% received only one dose of vaccine.
Since the beginning of 2017 and as of 5 June, Portugal has reported 31 confirmed cases, of which 20 (65%) are older than 18 years of age, 19 (61%) were unvaccinated, 13 (42%) are health professionals, and 14 (45%) were hospitalised. Twentytwo cases have been confirmed in the regions of Lisbon and Vale do Tejo, followed by seven cases in the Algarve, one in the North and one in Alentejo. One death has been reported.
On 24 April 2017, Slovakia reported an imported case in a 25-year-old, unvaccinated Italian who studies in Kosice, Slovakia. In Slovakia, the last endemic cases were reported in 1998 and the last imported cases in 2011 and 2012.
An outbreak started in the first week of January in Barcelona metropolitan area, related 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.
Since mid-April and as of 31 May, Sweden has reported four cases in the south-western part of the country. Earlier in 2017, Sweden reported 15 cases in the Stockholm area, including three imported cases.
On 6 June, Public Health Wales reported four cases in a high school in Newport, Wales. During the first three months of 2017, England reported 17 confirmed cases, compared with 37 between October and December 2016. Northern Ireland has reported one case and Scotland has reported no cases so far this year.
Outside EU since last month
As of 4 June, Canada reports 44 cases of measles. There is active transmission in Nova Scotia.
As of 23 May 2017, DR Congo recorded 19 512 suspected measles cases, including 229 deaths. The incidence of new cases has declined since the current outbreak peaked in early 2017.
As of 4 June 2017, Ethiopia reported 1 981 cases of which 961 confirmed cases. Oromia is the most affected region with 32% of the reported cases and this is followed by Amhara (29%), Addis Ababa (15%) and SNNPR (11%). Majority of the cases (38%) are children under five years.
Israel (source: email)
Since beginning of 2017 and as of 11 June, Israel has reported seven measles cases (six confirmed), all in the Jerusalem district. All cases were women in the age range 21-41. Two of the cases were among health care workers, one of whom was fully immunised. The immunisation status of the other cases is not known. An epidemiological link has been found between two of the cases. Five of the cases required hospitalisation. Israel reported eight cases in the whole year 2016.
Since the start of the outbreak end February and as of 16 June 2017, Kenya reported 14 confirmed measles cases.
Since the beginning of 2017 and as of 4 June, Liberia reported 864 suspected cases, of which 84 were positive. One hundred twenty of the suspected cases were compatible with measles and epi-linked while sixty pending laboratory confirmation. Of the 600 equivocal and negative cases, 291 (48.5%) samples have been tested for rubella, of which, 135 (46.4%) were positive.
Since the beginning of 2017 and as of 31 May, Nigeria reported 1 538 cases of measles.
On 12 June media reported measles outbreak in Pakistan in Dera Ghazi Khan District, due to which hundreds of children have been affected.
Since the beginning of 2017 and as of 16 June, Somalia reported 9 813 cases of measles.
Since the beginning of 2017 and as of 31 May, South Sudan reported 644 suspected cases of measles have been reported from 20 counties, including three deaths. The majority of cases have been reported in Wau, Western Bahr el Ghazal. However, cases have also been reported from Jonglei and Eastern Equatoria.
As of 6 June 2017, Syria reported nearly 150 cases of measles in the southern regions, mostly new-borns and young children.
As of 10 June 2017, Thailand reported 1 681 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 (6.7 / 100 000 population).
As of 13 June 2017, Ukraine recorded 735 measles cases in 15 regions, of which 536 cases in children and adolescents. Most cases were reported in Ivano-Frankivsk (392) and Odessa (267).
As of 16 June 2017, Minnesota Department of Health reported 78 confirmed cases of measles, most of them are unvaccinated preschool children. Of these, 69 cases were notified in Hennepin County. Minnesota’s measles outbreak has exceeded 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. On 15-17 June 2017, the sixth meeting of the RVC for Measles and Rubella elimination was held in Bucharest, Romania. The results of this meeting will be available shortly. 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.
