Recent surge in European measles cases driven by vaccination gaps

Health officials warned that a recent surge in measles cases in Europe is being driven by below-target vaccination rates and is threatening the continent’s progress toward eradication.

According to WHO, countries in the European region reported 559 new measles cases in January — many of them in Italy and Romania — and preliminary data for February showed the number of new infections was “sharply rising.”

Robb Butler, manager of WHO’s vaccine-preventable diseases and immunization program, said routine immunization schedules have had a drastic effect in Europe, slashing the number of new measles cases to approximately 5,000 in 2016 — a record low. However, Butler said the number of new cases are still “unnecessarily high” and blamed continuing outbreaks in Europe on gaps in immunization.

Butler is concerned that measles is circulating in 14 European countries where the disease is still endemic and where vaccination rates for two doses of a measles-containing vaccine are consistently lower than the 95% threshold recommended for eradication.

“This is opening the door to measles outbreaks in countries that have eliminated the disease,” he told Infectious Disease News. “If transmission continues, the status of these countries could be undermined and regional progress toward elimination reversed.”

According to WHO, despite the availability of a safe vaccine and a cost of only about $1 to immunize a child, measles is one of the leading causes of death in children around the world.

Source: WHO

Of the 559 new measles cases reported in January across Europe, 474 came from seven countries where the disease is still endemic: France, Germany, Italy, Poland, Romania, Switzerland and Ukraine. In all seven countries, the estimated rate of coverage for two doses of a measles vaccine is below 95%.

In Italy, which reported 238 new cases in January, immunization coverage is just 83%, and WHO said it appeared the outbreak was going to be at least as bad and perhaps even worse in February. (By comparison, Italy reported around 850 measles cases in all of 2016.)

Romania reported 111 new measles cases in January, most of them in areas where immunization coverage is especially low, according to WHO. As of March 31, Romania’s National Institute of Public Health said there had been more than 4,000 cases and 18 deaths attributed to a large measles outbreak that began last year, spurring an aggressive nationwide campaign to raise its ebbing immunization rate, which was 88% in 2013, the last year data were reported. That was down from 96% coverage in 2007.

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The measles vaccine is equally effective when used alone or in combination with vaccines for mumps and rubella, WHO said. According to the CDC, two doses of the measles, mumps and rubella vaccine are about 97% effective at preventing measles, and one dose is 93% effective.

Butler said high immunization levels and a quick response can work to keep outbreaks small. “But in countries where immunization rates are suboptimal, the number of cases is likely to increase rapidly with potentially tragic consequences,” he said.

Romania responded to its outbreak by lowering the age requirement of children who receive their first measles 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. At the clinician level, family doctors are registering unvaccinated children for vaccination, and community nurses are mobilizing children mainly in vulnerable populations, according to the European Center for Disease Prevention and Control.

Butler said clinicians are instrumental in the prevention and control of measles because they are the on front line in promoting and administering vaccines and are often the most trusted source of information about vaccines for their patients.

“Measles is a highly contagious virus that does not respect national borders. As long as it remains endemic anywhere in the world, the risk of importation is high for all countries, including those that have achieved elimination,” Butler said. “Clinicians should be aware of the disease description, vaccination requirements and travel recommendations, so that they can identify the disease quickly and also advise their patients and others about vaccination.” – by Gerard Gallagher

Disclosure: Butler reports no relevant financial disclosures.