Outbreak of measles in Haut-Rhin, Alsace, France, April 2015

Risk assessment

European Centre for Disease Prevention and Control. Outbreak of measles in France, Haut-Rhin, April 2015. Stockholm: ECDC; 2015

​An outbreak of measles involving 67 cases (median age 15 years) has been reported in the French region of Alsace, in the department of Haut-Rhin bordering Germany and Switzerland. The French index case had most probably been infected during a school trip to Berlin, following contact with a confirmed case in the German host family. Due to the low vaccination coverage among the students in the French anthroposophical school, the virus spread rapidly, leading to secondary cases in siblings and friends of the infected student.

Executive summary

A measles outbreak involving 67 patients has been reported in the region of Alsace by French health authorities. The first case, a student of an anthroposophical private school, was most probably infected by a member of his German host family who was confirmed to have measles, during a school trip to Berlin. A large measles outbreak has been ongoing in Berlin since October 2014 with more than 1100 cases reported as of 22 April 2015.
The median age of all cases is 15 (ranging from 2-23 years) and over 58 per cent (39) of them attend an anthroposophical private school in the Alsace region. Two-dose measles vaccination coverage in France is low, 67 percent, and considering school holidays began in Alsace on 25 April, the outbreak may spread further to other French regions or across the border. 
Measles outbreaks continue to occur in Europe because of low vaccination coverage in some countries and pockets of susceptible people who are either not vaccinated or under-immunised.  ECDC surveillance data show that in the recent 12 months (March 2014 to February 2015), 3700 measles cases were reported by 30 EU countries; France reported 203 cases in the same period.
Measles is not a mild disease and can be fatal.  It is extremely contagious; it is estimated that 90 per cent of non-immune people exposed to an infective person will contract the disease. A person with measles can further infect 12 to 18 non-immune people.
Immunisation is the only effective preventive measure against measles. To control measles outbreaks, measures should be implemented in all affected countries, primarily, identify and provide immunisation to high-risk groups to improve vaccination coverage. All EU countries need to maintain at least 95 percent measles vaccination coverage to prevent future outbreaks.