Epidemiological update: Measles - monitoring European outbreaks, 9 June 2017

Romania is experiencing a large outbreak of measles since February 2016. 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 6 June 2017, Romania has reported 6 619 measles cases, including 29 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 epidemiologicaly linked to the current outbreak in Romania. 

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, Norway, Portugal, Slovakia, Spain, Sweden and the United Kingdom.​

Epidemiological summary 

EU/EEA countries with updates since last week: 

Czech Republic: As of 1 June 2017, the Moravian-Silesian region reported 125 measles cases, of which 118 were laboratoryconfirmed and 7 clinical cases.

Germany: Since the beginning of 2017 and as of 31 May, Germany has reported 668 cases. This is an increase of 34 cases since the previous update. In the same period in 2016, Germany reported 70 cases. 

Italy: Since the beginning of 2017 and as of 4 June, Italy has reported 2 851 cases in 18 of the 21 regions. Among these, 224 are healthcare workers. The median age is 27 years, 89% of the cases were not vaccinated, and 6% received only one dose of vaccine. The weekly number of cases is decreasing.

Norway: Between 3 and 7 June 2017, media reported two cases in Norway, a six-year-old girl from Hadeland (north of Oslo) and a 15-month-old baby from Oslo.

Portugal: 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.

Romania: Between 1 January 2016 and 26 May 2017, Romania has reported 6 619 cases, including 29 deaths. 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 1 068 cases. Vaccination activities are ongoing in order to cover communities with suboptimal vaccination coverage.

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.

EU/EEA countries with no updates since last week:

Austria: Since the beginning of 2017 and as of 1 June, 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 as identified in Romania, Italy and Austria at the end of 2016. Bulgaria: Since mid-March 2017 and as of 27 May, Bulgaria has reported 116 cases in Plovdiv, an increase of 45 cases since the previous monthly update. Bulgaria also reported also cases in Pazardzhik (5) and in Montana (2).

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 30 April, France has 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 cases). The cases are mainly linked with an outbreak in Lorraine (60 cases between February and April 2017). Two cases of encephalitis and 18 cases 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.

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.

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.

Spain: 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.

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. 

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.

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.