Measles Outbreaks in Europe (Update 1)

On 9 June 2017 the European Centre for Disease Prevention and Control (ECDC) published an epidemiological update on European measles outbreaks. All national public health administrations emphasize the importance of vaccination to prevent further spread of infection.

Affected countries with updates since 2 June 2017

Czech Republic: As of 1 June 2017, the Moravian-Silesian region reported 125 measles cases.

Germany: From the beginning of 2017 to 31 May, Germany has reported 668 cases. This is an increase of 34 cases since the ECDC update of 2 June.

Italy: Weekly case numbers are decreasing. From the beginning of 2017 to 4 June there have been 2 851 cases in 18 of the 21 regions. 224 of the cases are healthcare workers. 89% of cases were not vaccinated and 6% had only one dose of vaccine.

Norway: From 3 to 7 June 2017, two cases were reported in the media. These were a six-year-old girl in Hadeland and a 15-month-old baby in Oslo.

Portugal: From the start of 2017 to 5 June, 31 cases (including 1 death) have been reported. Twenty (65%) are older than 18 years of age, 19 (61%) were unvaccinated, 13 (42%) are health professionals, and 14 (45%) were hospitalised. There have been 22 cases (including 1 death) in the regions of Lisbon and Vale do Tejo, 7 in the Algarve, 1 in the North and 1 in Alentejo.

Romania: Between 1 January 2016 and 26 May 2017, Romania has reported 6 619 cases, including 29 deaths. The groups most affected are infants and young children. There have been cases in 41 of the 42 districts, with Timis near the Serbian border (1068 cases) being the most affected district.

United Kingdom: On 6 June, Public Health Wales reported four cases in a school in Newport, South Wales. In the first three months of 2017, 17 cases were reported in England, compared with 37 cases between October and December 2016. There has been 1 case Northern Ireland. No cases have been reported in Scotland.

Affected countries with no updates since 2 June 2017

Austria: From the beginning of 2017 to 1 June, Austria reported 78 cases, exceeding the cumulative number of cases in 2016.

Belgium: From 20 December 2016 to May 2017, the provinces of Wallonia (except Luxembourg) reported a total 293 cases, of which 115 were hospitalised. The rate of new infections is gradually decreasing

Bulgaria: Between mid-March 2017 and 27 May, there were 116 cases in Plovdiv, an increase of 45 cases since the previous monthly update. Cases have also been seen in Pazardzhik (5) and in Montana (2).

France: From the start of 2017 to 30 April, France reported 189 cases, an increase of 55 cases since the end of March. This total is nearly four times the number of cases in over the same period in 2016 (47 cases). The cases are mainly linked with an outbreak in Lorraine (60 cases).

Hungary: Between 21 February and 22 March 2017, 54 cases were reported.

Iceland: On 31 March 2017, Iceland reported two cases in two 10-month-old unvaccinated twins, the country’s first measles cases in 25 years.

Spain: An outbreak began in the first week of January 2017 in the Barcelona metropolitan area. As of 7 April, 46 cases have been confirmed. Most are unvaccinated or incompletely-vaccinated adults. Four cases are children.

Sweden: From mid-April to 31 May, Sweden reported four cases in the south-west of the country. Earlier in the year there were 15 cases in the Stockholm area.

Countries with imported cases only

Denmark: On 15 March an imported case was reported in an unvaccinated traveller arriving from Asia.

Slovakia: On 24 April 2017, Slovakia reported an imported case in a 25-year-old, unvaccinated Italian student

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