Monthly measles and rubella monitoring report, February, 2017

surveillance report
Publication series: Monthly measles and rubella monitoring report
Time period covered: This reports covers the period from 1 March 2016 to 28 February 2017.

ECDC publishes a monthly surveillance report on measles and rubella data submitted by the 30 EU/EEA countries. ECDC also monitors European and worldwide measles outbreaks through epidemic intelligence and reports on them on a monthly basis in the Communicable Disease Threat Reports (CDTR).

Executive summary

Measles surveillance data from 1 March 2016 to 28 February 2017

  • Between 1 March 2016 and 28 February 2017, 30 EU/EEA Member States reported 5 881 cases of measles. Twenty-nine Member States reported consistently throughout the 12-month period. Hungary did not report data for February 2017.
  • The highest number of cases was reported by Romania (2 703), Italy (1 387) and the United Kingdom (555), accounting respectively for 46%, 24% and 9% of the EU/EEA cases in the 12-month period.  The diagnosis of measles was confirmed by positive laboratory results (serology, virus detection or isolation) in 67% of all EU/EEA cases.
  • A total of 1 524 cases were observed in the first two months in 2017, similar to the number observed in November and December 2016 (1 407 cases). In comparison, a total of 140 cases were reported in November -December 2015. The total number of cases reported in 2015 and 2016 were respectively 4 003 and 4 648 cases with observed peaks respectively in March 2015 (716 cases) and November 2016 (763 cases).
  • In Austria, Belgium, Croatia, Slovenia and Sweden the number of cases reported in just 2 months in 2017 has exceeded the number of cases reported during the entire 2016.
  • In 10 countries (Austria, Belgium, Croatia, France, Germany, Italy, Poland, Romania, Spain and Sweden), the number of cases reported in January-February 2017 is more than double the number reported in January-February 2016.
  • Measles is targeted for elimination in Europe. Over the 12 months’ period, the measles notification rate was below the elimination target (one case per million population) in 15 of the 30 reporting countries. Ten of these Member States reported zero cases. The highest notification rates were observed in Romania (136.8), Italy (22.9) and Belgium (15.4). 
  • Of all cases with known age (n=5 876), 2 426 (41%) were children less than 5 years of age, while 2 208 (38%) were aged 15 years or over. The highest incidence was reported in children below one year of age (128.2 per million) and children from 1 to 4 years of age (83.7 per million). 
  • Measles continues to spread across Europe because the vaccination coverage in many EU/EEA countries is suboptimal. The latest available figures on vaccination coverage collected by WHO (2015) show that the vaccination coverage for the second dose of measles was below 95% in 15 of 23 EU/EEA countries reporting second dose coverage data. The vaccination coverage for the first dose of measles was below 95% in 12 of 27 EU/EEA countries reporting on the first dose.  If the elimination goal is to be reached, the vaccination coverage rates for children targeted by routine vaccination programmes will have to be increased in a number of countries; the vaccination coverage of the second dose must be at least 95% to interrupt measles circulation. 
  • Of all cases with known vaccination status (5 520), 88% were unvaccinated, 8% were vaccinated with one dose, 3% were vaccinated with two or more doses, 1% were vaccinated with an unknown number of doses. Of all cases, 6% had an unknown vaccination status.
  • The proportion of cases with unknown vaccination status was highest in adults aged 30 years and over, reaching 14% in this age group. The proportion of unvaccinated cases was highest among children below one year of age (98%). This is expected as these children are too young to have received the first dose of measles vaccine. Infants are particularly vulnerable to complications of measles and are best protected by herd immunity which is achieved when population coverage for the second dose of a measles-containing vaccine is at least 95%.
  • In the target group for the first dose of routine childhood MMR vaccination (1-4 year-olds), 85% of the cases were unvaccinated, 11% were vaccinated with one dose, 1% with two doses or more, 1% with an unknown number of doses and 2% had an unknown vaccination status. 
  • Fourteen deaths due to measles were reported during the 12-month period, thirteen in Romania and one in the United Kingdom. 
  • A measles outbreak is ongoing in Romania. The number of measles cases reported to ECDC is different from the number published by the National Institute of Public Health in Romania due to the delay in case-based reporting to ECDC, compared to the aggregated data regularly published by the National Institute of Public Health. ECDC has published a Rapid Risk Assessment on current outbreak in Romania, highlighting the risk of continued measles transmission in Romania and in other EU/EEA countries where vaccination coverage is suboptimal. 
  • Measles outbreaks are also ongoing in other EU countries. Outbreaks were detected by epidemic intelligence in Austria, Belgium, Bulgaria, Denmark, France, Germany, Hungary, Italy, Spain, Sweden and Romania. Outside the EU, outbreaks were detected in Australia, Canada, Democratic Republic of Congo, Guinea, Mali, South Sudan, Syria and South Africa. See the CDTR.
  • ECDC is currently reporting on measles European outbreaks through weekly epidemiological updates.

Maps and tables

Rubella surveillance data from 1 March 2016 to 28 February 2017

  • Between 1 March 2016 and 28 February 2017, 28 EU/EEA Member States reported 1 121 cases of rubella. Twenty-five Member States reported consistently throughout the 12-month period. Croatia did not report data for January and February 2017, Hungary and Romania did not report data for February 2017.
  • Rubella is targeted for elimination in Europe. The rubella notification rate was lower than the elimination target (one case per million population) in 26 of the 28 countries. Seventeen of these 26 countries reported zero cases. The highest rate was reported by Poland (25.3 cases per million population). Germany reported 1.1 cases per million population, also above the elimination target.
  • Poland accounted for 86% of all rubella cases in the period (n=1 121). Data from Poland were reported in an aggregated format and need to be interpreted with caution, as only 16 cases were confirmed through laboratory testing. The highest number of Polish cases was observed in children, with 48% of cases less than 5 years of age and 25% aged from five to nine years.
  • No new rubella outbreaks were detected by epidemic intelligence in the EU/EEA since the last monthly update. See the CDTR.

Maps and tables