Measles outbreak in Romania grows to 3,400 cases, threatens region

National public health officials said an ongoing measles outbreak in Romania has infected more than 3,400 people and killed at least 17 despite an aggressive nationwide vaccination campaign.

Meanwhile, the European Center for Disease Prevention and Control (ECDC) warned of a greater regional outbreak of measles as a result of below-target vaccination coverage numbers in Romania.

“This poses a risk of potential repeated exportation to other [European] countries and possible continuous transmission in some where vaccination coverage is suboptimal,” the ECDC said in a recent rapid risk assessment report on the Romanian outbreak.

As of March 10, Romania’s National Institute of Public Health said 3,446 cases of measles have been confirmed since the outbreak began last year. The country is one of six in the European Union or European Economic Area judged by WHO to still have endemic transmission of the vaccine-preventable disease, along with Belgium, France, Germany, Italy and Poland.

MMR vaccination rates have fallen in recent years in Romania to below the 95% threshold recommended to interrupt transmission. According to the ECDC, coverage for one dose was just 86% in 2015 in Romania compared with 97% in 2007. In 2013, the last year when data were reported for two doses, 88% had received two doses compared with 96% in 2007. According to the CDC, two doses of the MMR vaccine are about 97% effective at preventing measles, and one dose is 93% effective.

In response to the outbreak, Romania lowered the age of the first MMR vaccine dose from 12 months to 9 months as part of an effort to fully vaccinate children between the ages of 9 months and 9 years. According to the ECDC, family doctors are registering unvaccinated children for vaccination — with the goal of giving one dose of the MMR vaccine to those under age 5 years and two doses to those between the ages of 5 years and 9 years — while community nurses are mobilizing children mainly in vulnerable population groups.

The ECDC said posters, leaflets and booklets were being provided to family doctors and the general population to increase awareness of the vaccination campaign.

Three other European countries — Austria, Germany and Italy — also are currently experiencing measles outbreaks, according to the ECDC. The agency said measles outbreaks in Austria, Belgium and Ireland have been epidemiologically linked to the outbreak in Romania.

The ECDC warned that travelers to Romania who are not fully immunized against measles are at risk of being exposed or infected and said health care providers should consider recommending they be fully vaccinated.

“Any encounter with the health care system should be used as an opportunity for a catch-up vaccination against measles as well as other vaccine-preventable diseases,” the agency said. – by Gerard Gallagher

Reference:

European Center for Disease Prevention and Control. Rapid risk assessment: ongoing outbreak of measles in Romania, risk of spread and epidemiological situation in EU/EEA countries. 2017. http://ecdc.europa.eu/en/publications/_layouts/forms/Publication_DispForm.aspx?List=4f55ad51-4aed-4d32-b960-af70113dbb90&ID=1653. Accessed March 13, 2017.