Giuseppe
Emeritus
[Source: European Centre for Disease Prevention and Control (ECDC), full PDF document: (LINK). Extract.]
COMMUNICABLE DISEASE THREATS REPORT
Week 27, 30 June-6 July 2013
(?)
Measles - Multistate (EU) - Monitoring European outbreaks
Opening date: 9 February 2011 Latest update: 3 July 2013
Epidemiological summary
EU Member States
The Netherlands ? update
An outbreak mainly affecting unvaccinated children in the "Bible belt" region of the country is on-going in the Netherlands. As of 4 July 2013, 230 cases have been reported to national public health authorities. The actual number of patients is thought to be much higher as not all patients are seen at healthcare facilities. According to the media at least five children needed hospitalisation. The first dose of MMR is scheduled to be given at 14 months of age in the Netherlands. Now, in response to the outbreak, children aged 6 to 14 months in all municipalities except one, where MMR vaccination coverage is below 90%, are invited for vaccination through a letter sent to their home. The latest measles epidemic in the country occurred in 1999/2000 and affected the same area. During this epidemic three children died and around 150 children were hospitalised as a result of measles infection.
Germany ? update
As of 17 June, five times more cases of measles (905) were reported in 2013 to the Robert Koch Institut than during the whole of 2012 (166 cases). Most were from Bavaria (388 cases) and Berlin (356 cases). Almost half of the cases, 426, (47%) were 20 years or older, 329 (36%) were hospitalised, and two suffered from measles encephalitis. The majority of cases were unvaccinated (70%), vaccination status was unknown for 155 cases, and 113 patients had one or more vaccinations.
114 cases (33 from Bavaria, 61 from Berlin and 20 from Brandenburg) were of genotype D8. Genotype D4 had been detected in six patients from another chain of transmission in Berlin.
Vaccination is recommended for all people born after 1970, who are either unvaccinated, whose vaccination status is unknown or who were vaccinated only once during childhood. In addition, the Standing Committee on Vaccination at the Robert Koch Institute recommends post-exposure prophylaxis irrespective of age starting from 9 months with MMR vaccine for persons who only received one dose or if their vaccination status is unclear.
Wales, UK ? update
The outbreak affecting Wales is now declared to be over as there have been no laboratory confirmed measles cases linked to the outbreak area since 22 May. The outbreak, which started in November 2012, resulted in 1 219 notifications of measles. Eighty-eight people needed hospitalisation and there was one death. Efforts to bring the outbreak to an end have seen 75 868 unscheduled MMR vaccinations given at GP surgeries, weekend drop-in sessions and schools and occupational health vaccination sessions in Wales during the outbreak period. More than 95% of under two-year-olds in the Swansea area have had at least one dose of the MMR vaccine following the measles outbreak. But Public Health Wales is warning that there are still around 30 000 unvaccinated children in the 10-18 years age group across Wales, and that there is still a possibility of a further outbreak in the future. Emerging data suggest that in the outbreak area one dose of MMR vaccine protects against measles in more than 95 out of every 100 vaccinated, and two doses protect in around 99 out of every 100 vaccinated. This is in line with, or better than, levels of effectiveness expected based on other published data.
Italy
A new outbreak was reported by local media in Milan where during the first quarter of 2013 there were 77 notified cases of measles compared with 25 in all of 2012. Most cases are young adults.
(?)
ECDC assessment
The transmission season for measles persists in Europe. Although there are several on-going outbreaks, the number of aggregated cases is lower than in previous years.
So far in 2013, Sweden, Denmark, Germany, Italy, the UK, Lithuania and the Netherlands have reported outbreaks. The largest outbreak has been in Wales where more than 1 300 cases, including one death, have been notified so far. In the EU neighbourhood, a large outbreak of more than 4000 cases was reported from Georgia. This may result in some imported cases in EU/EEA countries.
The target year for measles elimination in Europe is 2015. The current outbreaks suggest that endemic measles transmission continues in many EU Member States and the prospect of achieving the 2015 objective is diminishing. During the period April 2012-March 2013, 14 EU/EEA countries met the elimination target of less than one case of measles per million population.
Actions
ECDC closely monitors measles transmission and outbreaks in the EU and neighbouring countries in Europe through enhanced surveillance and epidemic intelligence activities. Elimination of measles requires consistent vaccination coverage above 95% with two doses of measles vaccine in all population groups, strong surveillance and effective outbreak control measures.
(?)
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COMMUNICABLE DISEASE THREATS REPORT
Week 27, 30 June-6 July 2013
(?)
Measles - Multistate (EU) - Monitoring European outbreaks
Opening date: 9 February 2011 Latest update: 3 July 2013
Epidemiological summary
EU Member States
The Netherlands ? update
An outbreak mainly affecting unvaccinated children in the "Bible belt" region of the country is on-going in the Netherlands. As of 4 July 2013, 230 cases have been reported to national public health authorities. The actual number of patients is thought to be much higher as not all patients are seen at healthcare facilities. According to the media at least five children needed hospitalisation. The first dose of MMR is scheduled to be given at 14 months of age in the Netherlands. Now, in response to the outbreak, children aged 6 to 14 months in all municipalities except one, where MMR vaccination coverage is below 90%, are invited for vaccination through a letter sent to their home. The latest measles epidemic in the country occurred in 1999/2000 and affected the same area. During this epidemic three children died and around 150 children were hospitalised as a result of measles infection.
Germany ? update
As of 17 June, five times more cases of measles (905) were reported in 2013 to the Robert Koch Institut than during the whole of 2012 (166 cases). Most were from Bavaria (388 cases) and Berlin (356 cases). Almost half of the cases, 426, (47%) were 20 years or older, 329 (36%) were hospitalised, and two suffered from measles encephalitis. The majority of cases were unvaccinated (70%), vaccination status was unknown for 155 cases, and 113 patients had one or more vaccinations.
114 cases (33 from Bavaria, 61 from Berlin and 20 from Brandenburg) were of genotype D8. Genotype D4 had been detected in six patients from another chain of transmission in Berlin.
Vaccination is recommended for all people born after 1970, who are either unvaccinated, whose vaccination status is unknown or who were vaccinated only once during childhood. In addition, the Standing Committee on Vaccination at the Robert Koch Institute recommends post-exposure prophylaxis irrespective of age starting from 9 months with MMR vaccine for persons who only received one dose or if their vaccination status is unclear.
Wales, UK ? update
The outbreak affecting Wales is now declared to be over as there have been no laboratory confirmed measles cases linked to the outbreak area since 22 May. The outbreak, which started in November 2012, resulted in 1 219 notifications of measles. Eighty-eight people needed hospitalisation and there was one death. Efforts to bring the outbreak to an end have seen 75 868 unscheduled MMR vaccinations given at GP surgeries, weekend drop-in sessions and schools and occupational health vaccination sessions in Wales during the outbreak period. More than 95% of under two-year-olds in the Swansea area have had at least one dose of the MMR vaccine following the measles outbreak. But Public Health Wales is warning that there are still around 30 000 unvaccinated children in the 10-18 years age group across Wales, and that there is still a possibility of a further outbreak in the future. Emerging data suggest that in the outbreak area one dose of MMR vaccine protects against measles in more than 95 out of every 100 vaccinated, and two doses protect in around 99 out of every 100 vaccinated. This is in line with, or better than, levels of effectiveness expected based on other published data.
Italy
A new outbreak was reported by local media in Milan where during the first quarter of 2013 there were 77 notified cases of measles compared with 25 in all of 2012. Most cases are young adults.
(?)
ECDC assessment
The transmission season for measles persists in Europe. Although there are several on-going outbreaks, the number of aggregated cases is lower than in previous years.
So far in 2013, Sweden, Denmark, Germany, Italy, the UK, Lithuania and the Netherlands have reported outbreaks. The largest outbreak has been in Wales where more than 1 300 cases, including one death, have been notified so far. In the EU neighbourhood, a large outbreak of more than 4000 cases was reported from Georgia. This may result in some imported cases in EU/EEA countries.
The target year for measles elimination in Europe is 2015. The current outbreaks suggest that endemic measles transmission continues in many EU Member States and the prospect of achieving the 2015 objective is diminishing. During the period April 2012-March 2013, 14 EU/EEA countries met the elimination target of less than one case of measles per million population.
Actions
ECDC closely monitors measles transmission and outbreaks in the EU and neighbouring countries in Europe through enhanced surveillance and epidemic intelligence activities. Elimination of measles requires consistent vaccination coverage above 95% with two doses of measles vaccine in all population groups, strong surveillance and effective outbreak control measures.
(?)
-
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