Measles Outbreaks in Europe (Update 12)

The European Centre for Disease Prevention and Control (ECDC) reportedthat since the beginning of 2018, large outbreaks of measles continue to be reported as follows:

Romania - In the first two months of 2018, 757 confirmed cases of measles were reported, including three deaths.

Italy - In January 2018, Italy reported 168 cases of measles, including two deaths. Cases were reported from 12 regions with the majority from Sicily, Lazio, Calabria and Liguria. The median age of the cases is 25 years (range 2 days to 62 years), and 15 cases were children under one year of age.

France - So far in 2018, 429 cases were reported including one death in February. Cases have been reported across almost all regions in the past weeks, with half of all cases from the region Nouvelle Aquitaine.

Greece - So far in 2018, 1 131 cases were reported including one death. The outbreak mainly affects southern Greece and especially the regions of Dytiki Ellada, Peloponnese and Attica. Molecular characterisation of the circulating measles virus in Greece identified B3 genotype

Portugal - A recent measles outbreak in the northern region of Portugal was reported to include 145 suspected cases of which 53 have been confirmed. Twenty-eight of the confirmed cases are healthcare workers

Countries outside the European Union /European Economic Area.

Ukraine - In European countries outside the EU, the largest outbreak of measles continues in Ukraine, with 6 484 cases in 2018 as of 6 March, including seven deaths (five children and two adults). Among the cases, 66% were children and 34% adults. Most of the cases were reported from Ivano-Frankivsk, Zakarpattia, Odesa, Chernivtsi and Lviv regions.

Serbia and Kosovo - Outbreaks of measles were reported from the Balkan region in 2018. As of 12 March, 3 442 measles cases, of which 1 778 were laboratory confirmed, were detected in Serbia and from Kosovo*. The majority of cases are below five years of age and over 30 years of age. In Serbia, the majority of cases were reported from Belgrade. Of all cases, 95% were unvaccinated or had unknown vaccination status, 32% were hospitalised and 383 cases developed neurological or pulmonary complications. Since the beginning of the outbreak, nine people have died of pulmonary measles complications, including two children aged four and two years.

Advice for Healthcare Professionals

Travel may increase an individual’s risk of exposure to measles virus, and facilitate the spread of disease to unvaccinated and susceptible populations. The travel consultation provides healthcare practitioners with a valuable opportunity to ensure individuals are protected against the measles virus. Consider vaccinating:

• All travellers who have not previously had two doses of a measles containing vaccine or prior measles infection.
• Particularly children and those who will be living or working closely with the local population at their destination, in countries with high endemnicity or recent outbreaks.
• To help decide whether your traveller may be at risk of measles based on year of birth and vaccination history please read the table for measles recommendations

Charging for Measles Containing Vaccine:

• In Scotland, GP practices may charge for the administration of MMR vaccine if the traveller does not fall into one of the groups that can receive free vaccine and it is solely being given for the purposes of travel, but have discretion not to charge.
• In England, GPs will be reimbursed for administering one or two doses of MMR vaccine as required to all unvaccinated patients aged 16 and over who present to the GP surgery requesting vaccination.
• Further explanantion on charging arrangements can be found here Vaccine Charges FAQ

Advice for Travellers

It should be confirmed that children have received their recommended doses of MMR at 12-13 months of age and again pre-school around 3 years 4 months. Consider vaccinating all unimmunised adults who have not had the disease themselves, particularly if they are going to be at higher risk. Two doses of MMR vaccine, at least one month apart, are required to give adequate protection.

For further information see Measles