Epidemiological update: Measles - monitoring European outbreaks, 7 July 2017
Romania has been 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 30 June 2017, Romania reported 7 491 measles cases, including 31 deaths. In 2016, several other 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. Overall, more than 14 000 cases have been reported in the EU/EEA since January 2016, including 35 deaths.
Update of the week
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:
Austria: Since the beginning of 2017 and as of 30 June, Austria has reported 79 cases, an increase of one case since the CDTR on 30 June 2017. This exceeds the cumulative number of cases reported in 2016. https://www.bmgf.gv.at/home/Masern
Bulgaria: Since the beginning of 2017 and as of 6 July, Bulgaria reported 161 cases. In the same period in 2016, Bulgaria reported one case. http://mmr.gateway.bg/
Germany: Since the beginning of 2017 and as of 28 June, Germany has reported 766 cases. This is an increase of 15 cases since the CDTR on 30 June 2017. In the same period in 2016, Germany reported 130 cases. http://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2017/Ausgaben/26_17.pdf?__blob=publicationFile
Italy: Since the beginning of 2017 and as of 4 July, Italy has reported 3 346 cases in 18 of the 21 regions, including 2 deaths. This is an increase of 272 cases since the CDTR on 30 June 2017. Among these, 252 cases are healthcare workers. The median age is 27 years, 88% of the cases were not vaccinated and 7% received only one dose of vaccine. http://www.epicentro.iss.it/problemi/morbillo/bollettino/Measles_WeeklyReport_N15eng.pdf
Portugal: Since the beginning of 2017 and as of 5 July, Portugal has reported 31 confirmed cases. Of these 20 (65%) were over 18 years of age, 19 (61%) were unvaccinated, 13 (42%) are health professionals, and 14 (45%) were hospitalised. Twenty-two cases have been confirmed in the regions of Lisbon and Vale do Tejo, seven cases in the Algarve, one in the North and one in Alentejo. One death has been reported. On 5 July 2017 Portugal declared the end of the measles epidemic. https://www.dgs.pt/a-direccao-geral-da-saude/comunicados-e-despachos-do-director-geral/declaracao-publica-sobre-o-fim-daatividade-epidemica-do-sarampo-em-portugal.aspx
Romania: Between 1 January 2016 and 30 June 2017, Romania has reported 7 491 cases, including 31 deaths. This is an increase of 209 cases since the previous CDTR on 30 June 2017. 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, in the western part of the country closest to the border with Serbia, is the most affected district with 1 171 cases. Vaccination activities are ongoing in order to cover communities with suboptimal vaccination coverage. http://www.cnscbt.ro/index.php/informari-saptamanale/rujeola-1/720-situatia-rujeolei-in-romania-la-data-de-30-06-2017/file
Spain: Since the beginning of 2017 and as of 4 July, Spain reported 137 measles cases, an increase of eight cases since the previous CDTR on 30 June 2017. http://www.isciii.es/ISCIII/es/contenidos/fd-servicios-cientifico-tecnicos/fd-vigilancias-alertas/fd-boletines/fd-boletinepidemiologico-semanal-red/pdf_2017/IS-170704-WEB.pdf
EU/EEA countries with no updates since last week:
Belgium: As of 08 May 2017, Belgium has reported 293 measles cases, of which 115 were hospitalized. Thirty-one percent were not vaccinated and 58% did not know their vaccination status. Twelve percent of cases were among health professionals. https://www.wiv-isp.be/matra/PDFs/flash201706.pdf
Czech Republic: As of 30 June 2017, the Moravian-Silesian region reported 130 measles cases, 123 of which were laboratoryconfirmed. Nineteen cases are among healthcare workers. http://www.khsova.cz/docs/01_aktuality/files/spalnicky_20170630.pdf
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 15 June, France has reported 295 cases, almost six times the number of reported cases in 2016 over the same period (47 cases). The cases are mainly linked to 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 one 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%) had received a single dose, 25 (10%) had received two doses and for three cases (1%) the number was unknown. http://invs.santepubliquefrance.fr/fr/Dossiers-thematiques/Maladies-infectieuses/Maladies-a-preventionvaccinale/Rougeole/Points-d-actualites/Epidemiologie-de-la-rougeole-en-France.-Donnees-de-surveillance-au-15-juin-2017
Hungary: Between 21 February and 22 March 2017, Hungary reported 54 cases. Health authorities have lifted the quarantine from the hospital in Mako, south-east Hungary, as no new cases have been detected in two weeks.
Iceland: On 31 March 2017, Iceland reported two cases in 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. Slovakia: 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.
Sweden: 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.
United Kingdom: 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.
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 deemed 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 link: Measles page
Actions ECDC published a rapid risk assessment on 6 March. ECDC monitors measles transmission and outbreaks in the EU/EEA on a weekly basis through enhanced surveillance and epidemic intelligence activities.
