Epidemiological update: Measles - monitoring European outbreaks, 15 September 2017
Measles outbreaks continue to occur in a number of EU/EEA countries, with a risk of spread and sustained transmission in areas with susceptible populations.
Since 15 September 2017, ECDC has been reporting EU and global outbreaks of measles in the CDTR on a monthly basis. If there are critical events, additional reports are published.
Update of the week
Updates for EU/EEA countries are provided for Italy and Romania. Updates outside the EU/EEA are provided for Switzerland, Ukraine, DR Congo, Liberia, Nigeria, Somalia, South Africa, South Sudan, Syria, Thailand, Australia and the USA.
Epidemiological summary
Updates are provided for Italy and Romania. According to national public health authorities, measles has caused 43 deaths in EU countries in 2016 and 2017. In 2016, 12 deaths occurred in Romania and one in the UK. In 2017, 30 deaths were reported from Romania (22), Italy (3), Bulgaria (1), Germany (1), Portugal (1), France (1) and Spain (1). All EU/EEA countries have reported measles cases this year, except for Latvia, Liechtenstein, Malta and Norway.
Updates outside EU/EEA countries are provided for Switzerland, Ukraine, DR Congo, Liberia, Nigeria, Somalia, South Africa, South Sudan, Syria, Thailand, Australia and the US.
Epidemiological summary for EU/EEA countries, with updates since last week
Italy has reported 43 cases since the previous report on 8 September 2017. In 2017, as of 13 September, Italy has reported 4 487 cases, including three deaths. Of these cases, 297 are healthcare workers. The median age is 27 years; 88% of the cases were not vaccinated, and 7% received only one dose of vaccine. In 2016, Italy reported 861 cases.
Romania has reported 122 cases and one additional death since the previous report on 8 September 2017. Since 1 January 2016 and as of 8 September 2017, Romania has reported 9 104 cases, including 34 deaths. Of these, 1 969 cases were reported in 2016, and 7 135 cases were reported in 2017.
Epidemiological summary for countries outside EU/EEA since last month
Switzerland: In 2017, as of 4 September, Switzerland has reported 76 cases of measles. In the same period in 2016, 42 cases were reported.
Ukraine: In 2017, as of the end of July, Ukraine has reported 1 386 cases of measles, compared to 10 cases in the same period in 2016. Most cases of measles were reported in the Ivano-Frankivsk (637) and Odessa regions (526).
DR Congo: In 2017, as of 22 August, DR Congo has reported 30 211 suspected measles cases, including 370 deaths. This is an increase of 5 366 since the previous report on 25 August. The incidence has declined since the peak of the current outbreak in early 2017.
Liberia: In 2017, as of 27 August, Liberia has reported 1 048 suspected measles cases, an increase of 21 cases since the previous report on 25 August. Of the suspected cases, 884 were tested with 147 positive, 691 negative and 46 equivocal. One hundred sixty-four of the suspected cases were compatible with measles and had an epidemiological link. Of the 737 equivocal and negative cases, 708 samples have been tested for rubella, 312 of which were positive.
Nigeria: In 2017, as of 20 August, Nigeria has reported 16 833 suspected measles cases, including 101 deaths. During the same time period in 2016, 21 604 suspected cases and 86 deaths were reported.
Somalia: In 2017, as of 31 August, Somalia has reported almost 16 000 suspected cases. This is almost three times the number of cases reported in 2016 (5 657 cases).
South Africa: In 2017, as of 18 August, South Africa has reported 133 cases of measles. Most cases where reported from an ongoing outbreak in Gauteng province (68 cases) and from an outbreak in Western Cape province (31 cases). In KwaZulu-Natal Province, a measles outbreak has been declared with 19 confirmed or probable cases in three districts: Ethekwini (12), Umgungundlovu (5), and Ilembe (2).
South Sudan: In August 2017, South Sudan reported six additional cases of measles. In 2017, as of 31 August, South Sudan has reported 1 025 measles cases and 24 deaths.
Syria: Between 30 July and 5 August 2017, Syria has reported 45 suspected measles cases, with most cases reported from Dar’a (9), Damascus (8) and Ar-Raqqa (8). In 2017, as of end of June, Syria has reported 352 confirmed measles cases. Most of the cases were reported in April (92 cases).
Thailand: In 2017, as of 2 September, Thailand has reported 2 231 cases from 72 provinces. No deaths were reported.
Australia: On 30 August 2017, Australia reported one additional case since the previous report on 25 August. Since the beginning of August 2017 and as of 30 August, Australia has reported four measles cases in a school in Perth, in Western Australia. In 2017, as of end of August, Australia has reported 58 cases. In the same time period in 2016, 63 cases were reported.
USA: In 2017, as of 12 August, 118 cases were reported from 14 states (California, Florida, Kansas, Maine, Maryland, Michigan, Minnesota, Nebraska, New Jersey, New York, Pennsylvania, Utah, and Washington). In 2016, 70 measles cases were reported from 16 states.
ECDC links: Measles web page | ECDC Communicable Disease Threats Reports (CDTR) | ECDC rapid risk assessment ongoing outbreak of measles in Romania, risk of spread and epidemiological situation in EU/EEA countries, 3 March 2017 Sources: National Public Health Institutes | Ministries of Health | media
ECDC assessment
Measles outbreaks continue to occur in a number of EU/EEA countries. There is a risk of spread and sustained transmission in areas with susceptible populations. Vaccination with at least two doses remains the most effective measure. 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 sixth meeting of the RVC for Measles and Rubella in June 2017, of 53 countries in the WHO European Region, 33 (22 of which are in the EU/EEA) were declared to have reached the elimination goal for measles, and nine countries (four 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, four EU/EEA countries were judged to still have endemic transmission: Belgium, France, Italy and Romania.
ECDC link: Measles page
ECDC published a rapid risk assessment on measles on 6 March 2017.
Actions
All EU/EEA countries report measles cases through TESSy on a monthly basis to ECDC; data are published every month. ECDC also monitors EU/EEA and worldwide outbreaks on a monthly basis through epidemic intelligence activities.
