Monthly measles and rubella monitoring report, May, 2017
ECDC publishes a monthly surveillance report on measles and rubella data submitted by the 30 EU/EEA countries. ECDC also monitors European and worldwide measles outbreaks through epidemic intelligence and reports on them on a monthly basis in the Communicable Disease Threat Reports.
Main developments for measles
- ECDC reports the routine measles surveillance data submitted by the 30 EU/EEA countries on a monthly basis and publishes them as Monthly Epidemiological Updates. In addition, ECDC is currently monitoring European measles outbreaks through epidemic intelligence on a weekly basis and publishing details in Weekly Epidemiological Updates and the Communicable Disease Threat Report (CDTR).
- From 1 January 2016 to mid-June 2017, more than 14 000 measles cases were reported, with 34 deaths attributed to measles (source: TESSy and Epidemic Intelligence Section at ECDC).
- Between 1 June 2016 and 31 May 2017, 30 EU/EEA Member States reported 10 165 cases of measles. Twenty-five Member States reported consistently throughout the 12-month period. Belgium, Czech Republic, Portugal and Spain did not report data for May 2017. Hungary did not report data for April and May 2017.
- In the 12-month period, the highest number of cases was reported by Romania (3 922), Italy (3 508) and Germany (950), accounting for 42%, 22% and 9% respectively of the EU/EEA cases. The diagnosis of measles was confirmed by positive laboratory results (serology, virus detection or isolation) in 65% of all EU/EEA cases.
- In the first five months of 2017, a total of 6 625 cases were reported. This was approximately 50% more cases than the total number of cases reported in 2016 (n=4 645). In the first five months of 2017 the countries contributing the majority of cases were Italy (3 037), Romania (1 744) and Germany (741).
- Cyprus reported one case, Estonia one case and Greece three cases in May 2017, after having had no cases during the preceding months of 2017. The number of cases reported in May 2017 increased in several countries (Bulgaria, France, Romania, Sweden and United Kingdom) against April 2017; however the highest number of cases in 2017 so far was observed in February (1 688) and March (1 560). This observation is compatible with the normal measles seasonality, with a peak during late winter and early spring.
- Measles is targeted for elimination in Europe. Over the 12-month period, the measles notification rate was below the elimination target (one case per million population) in nine of the 30 reporting countries. Three of these Member States reported zero cases. The highest notification rates were observed in Romania (198.5), Italy (57.8) and Belgium (27.9).
- Of all cases with known age (n=9 333), 3 637 (39%) were children under five years, while 3 958 (42%) were 15 years or older. The highest incidence was reported in children below one year of age (227 per million) and children from one to four years of age (117 per million).
- Measles continues to spread across Europe because the vaccination coverage in many EU/EEA countries is suboptimal. The latest available figures on vaccination coverage collected by WHO (2015) show that the vaccination coverage for the second dose of measles was below 95% in 15 of 23 EU/EEA countries reporting second dose coverage data. The vaccination coverage for the first dose of measles was below 95% in 12 of 27 EU/EEA countries reporting on the first dose. If the elimination goal is to be reached, the vaccination coverage rates for children targeted by routine vaccination programmes should increase in a number of countries as the vaccination coverage of the second dose must be at least 95% to interrupt measles circulation.
- Of all cases with known vaccination status (9 514), 87% were unvaccinated, 8% were vaccinated with one dose, 3% were vaccinated with two or more doses, and 1% were vaccinated with an unknown number of doses. Of all cases, 6% had an unknown vaccination status.
- The proportion of cases with unknown vaccination status was highest in adults aged 25–29 years and 30 years and above, reaching 13% and 12% respectively in these two age groups. The proportion of unvaccinated cases was highest among children under one year of age (95%). This is expected since these children are too young to have received the first dose of measles vaccine. Infants under one year of age are particularly vulnerable to complications from measles and are best protected by herd immunity which is achieved when population coverage for the second dose of a measles-containing vaccine is at least 95%.
- In the target group for the first dose of routine childhood MMR vaccination (1-4 year-old), 85% of the cases were unvaccinated, 12% were vaccinated with one dose, 0% with two doses or more, 1% with an unknown number of doses and 2% had an unknown vaccination status.
- Twenty-one deaths due to measles were reported during the 12-month period; with Germany, Italy and Portugal reporting one each and the remaining 18 reported by Romania.
- A large measles outbreak is ongoing in Romania. The number of measles cases reported to ECDC is different from the number published by the National Institute of Public Health in Romania due to the delay in case-based reporting to ECDC, compared to the aggregated data regularly published by the National Institute of Public Health. The National Institute of Public Health reported 7 233 measles cases, including 30 deaths between 1 January 2016 and 16 June 2017. ECDC has published a Rapid Risk Assessment on the current outbreak in Romania, highlighting the risk of continued measles transmission in Romania and other EU/EEA countries where vaccination coverage is suboptimal.
- Measles outbreaks are also ongoing in other EU countries. According to information from ECDC’s Epidemic Intelligence Section, in the EU measles cases have been described in Austria, Belgium, Bulgaria, Czech Republic, Denmark, France, Germany, Hungary, Iceland, Italy, Portugal, Slovakia, Spain, Sweden and the United Kingdom. See more information in the latest CDTR .
Get the latest surveillance data on measles from EU and EEA countries through the Surveillance Atlas of Infectious Diseases.
Main developments for rubella
- Between 1 June 2016 and 31 May 2017, 28 EU/EEA Member States reported 905 cases of rubella. Twenty-two Member States reported consistently throughout the 12-month period. Hungary did not report data for February, March, April and May 2017. Czech Republic, Portugal, Romania and Spain did not report in May 2017.
- Rubella is targeted for elimination in Europe. The rubella notification rate was lower than the elimination target (one case per million population) in 25 of the 28 countries. Seventeen of these 25 countries reported zero cases. The highest rate was reported by Poland (18.9 cases per million population). Austria reported 3.1 cases per million population and Germany reported 1.0 cases per million population, also above the elimination target.
- Poland accounted for 79% of all rubella cases in the period (n=716). Data from Poland were reported in an aggregated format and need to be interpreted with caution, as only 9 cases were confirmed through laboratory testing. The highest number of cases in Poland was observed in children, with 51% of cases less than 5 years of age and 24% aged from five to nine years.
- ECDC monitors European rubella outbreaks on a monthly basis through Epidemic Intelligence. No new rubella outbreaks were detected by Epidemic Intelligence in the EU/EEA since the last monthly update. See more information in the CDTR.
Maps and figures
- Measles vaccination coverage, second dose, 2014-2016, and number of cases, May 2017
- Measles notification rate, June 2016 - May 2017
- Table. Number of measles cases by month and notification rate (cases per million) by country, June 2016 to May 2017, EU/EEA countries
- Rubella vaccination coverage, first dose, 2014-2015, and number of cases, May 2017
- Rubella notification rate, June 2016 - May 2017
- Table. Number of rubella cases by month and notification rate (cases per million) by country, June 2016 to May 2017, EU/EEA countries
Measles is an acute, highly contagious viral disease capable of causing epidemics. Infectivity is close to 100% in susceptible individuals and in the pre-vaccine era measles would affect nearly every individual during childhood.Read more
Rubella is a mild febrile rash illness caused by rubella virus. It is transmitted from person to person via droplets (the virus is present in throat secretions). It affects mainly, but not only, children and when pregnant women are infected, it may result in malformation of the foetus. Humans are the only reservoir of infection.Read more