Monthly measles and rubella monitoring report, March, 2017

surveillance report
Publication series: Monthly measles and rubella monitoring report
Time period covered: This reports covers the period from 1 April 2016 to 31 March 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 April 2016 to 31 March 2017

  • Between 1 April 2016 and 31 March 2017, 30 EU/EEA Member States reported 6 597 cases of measles. Twenty-six Member States reported consistently throughout the 12-month period. Bulgaria, Croatia, Iceland and Italy did not report data for March 2017.
  • In the 12-month period, the highest number of cases was reported by Romania (3 072), Italy (1 314) and Germany (711), accounting respectively for 47%, 20% and 11% of the EU/EEA cases.  The diagnosis of measles was confirmed by positive laboratory results (serology, virus detection or isolation) in 66% of all EU/EEA cases.
  • In the first three months of 2017, a total of 2 480 cases were observed; in comparison, a total of 530 cases were reported in the first three months in 2016. In the first three months of 2017 the countries contributing to the majority of cases were Romania (749), Italy (684) and Germany (411).
  • In Austria, Belgium, Croatia, Czech Republic, France, Germany, Hungary, Portugal, Slovenia, Spain and Sweden the number of cases reported in just 3 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 11 of the 30 reporting countries. Seven of these Member States reported zero cases. The highest notification rates were observed in Romania (155.5), Belgium (27.5) and Italy (21.7).
  • 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; as the vaccination coverage of the second dose must be at least 95% to interrupt measles circulation.
  • Of all cases with known vaccination status (6 133), 88% were unvaccinated, 8% were vaccinated with one dose, 3% were vaccinated with two or more doses, and 1% were vaccinated with an unknown number of doses. Of all cases, 7% had an unknown vaccination status.
  • The proportion of cases with unknown vaccination status was highest in adults aged 30 years and over, reaching 15% in this age group. The proportion of unvaccinated cases was highest among children below one year of age (95%). 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-old), 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.
  • Sixteen deaths due to measles were reported during the 12-month period, all in Romania.
  • A large measles outbreak is ongoing in Romania with 4 793 cases reported from 1 January 2017 to 14 April 2017. 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. According to information from ECDC epidemic intelligence, in EU, measles cases were described in Austria, Belgium, Bulgaria, Czech Republic, Denmark, France, Germany, Hungary, Iceland, Italy, Portugal, Spain and Sweden. See more information in the latest CDTR.
  • ECDC is currently reporting on measles European outbreaks through weekly epidemiological updates.

Maps and tables

Rubella surveillance data from 1 April 2016 to 31 March 2017

  • Between 1 April 2016 and 31 March 2017, 28 EU/EEA Member States reported 1 078 cases of rubella. Twenty-three Member States reported consistently throughout the 12-month period. Croatia did not report data for January, February and March 2017. Hungary and Romania did not report data for February, March 2017. Iceland and Italy did not report data for March 2017.
  • Rubella is targeted for elimination in Europe. The rubella notification rate was lower than the elimination target (one case per million population) in 25 of the 28 countries. Seventeen of these 25 countries reported zero cases. The highest rate was reported by Poland (23.7 cases per million population). Austria reported 3.1 cases per million population and Germany reported 1.2 cases per million population, also above the elimination target.
  • Poland accounted for 83% of all rubella cases in the period (n=898). Data from Poland were reported in an aggregated format and need to be interpreted with caution, as only 17 cases were confirmed through laboratory testing. The highest number of cases in Poland was observed in children, with 50% of cases less than 5 years of age and 24% 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 more information in the CDTR.

Maps and tables