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11 Mar 2013

Measles & Rubella - Multistate (EU) - Monitoring European outbreaks (ECDC/CDTR, March 11 2013, edited)

[Source: European Centre for Disease Prevention and Control (ECDC), full PDF document: (LINK). Edited.]


Week 10, 3-9 March 2013



Measles - Multistate (EU) - Monitoring European outbreaks

Opening date: 9 February 2011 Latest update: 5 March 2013


Epidemiological summary

During the week leading up to 8 March 2013, the Swedish Institute for Infectious Disease Control (SMI) reported on two on-going measles outbreaks in two different counties in Sweden, Uppsala and Stockholm. There are nine confirmed cases in Stockholm and five confirmed cases in Uppsala to date. The most recent measles case in Uppsala fell ill on 1 March 2013. No new cases have been reported in Stockholm since the beginning of February, but the outbreak is not considered to be over.

In the United Kingdom, the Health Protection Agency reported on-going outbreaks in the North East of England. Since the beginning of September 2012 and as of 25 February 2013, there have been 115 confirmed cases and 108 suspected cases of measles in the North East of England. Thirty-nine percent of the cases in this outbreak are aged between 10 and 19 years, the majority of which are unvaccinated school children and young adults. There is an increase in cases in children under the age of one, who are too young to be offered routine MMR vaccination.

In Wales, according to a media report, 209 cases of measles infection have been reported in Swansea and in the Neath-Port Talbot area since November 2012. This is more cases than has been reported in the whole of Wales during the past three years.

According to another media report, the outbreak has affected 32 secondary schools, primary schools and nurseries. Public Health Wales estimates that more than 8 500 schoolchildren are at risk of measles infection in the area.



ECDC assessment

So far in 2013, only the UK and Sweden has reported outbreaks.

In 2012, considerably fewer measles cases were reported in the EU than in 2011, primarily due to the dramatic decrease in the number of cases reported from France. There was no increase in the number of cases during the peak transmission season from February to June and there have been very few outbreaks detected by epidemic intelligence methods in 2012.

There have been no measles-related deaths during the last 12 months, but seven cases were complicated by acute measles encephalitis. The reduction in notified cases in 2012 indicates that the incidence at EU/EEA level is back at the level before the 2010–2011 outbreaks, but does not signify a long-term downward trend in measles notifications.

ECDC closely monitors measles transmission and outbreaks in the EU and neighbouring countries in Europe through enhanced surveillance and epidemic intelligence activities. The countries in the WHO European Region, which include all EU Member States, have committed to eliminating measles and rubella transmission by 2015.

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.



Rubella - Multistate (EU) - Monitoring European outbreaks

Opening date: 7 March 2012 Latest update: 19 September 2012


Epidemiological summary

No new outbreaks have been identified since the last update.

There were 27 267 cases of rubella reported during 2012 by the 26 EU and EEA countries which contribute to the enhanced surveillance for rubella. Poland and Romania accounted for 99% of all reported rubella cases in the 12-month period.



ECDC assessment

As rubella is typically a mild and self-limiting disease with few complications, the rationale for eliminating rubella would be weak if it were not for the virus’ teratogenic effect. When a woman is infected with the rubella virus within the first 20 weeks of pregnancy, the foetus has a 90% risk of being born with congenital rubella syndrome (CRS), which entails a range of serious incurable illnesses.

CRS surveillance plays an important role but tends to be biased towards the severe end of the spectrum as the rubella infection is known to cause a wide range of conditions from mild hearing impairment to complex malformations which are incompatible with life.

Routine control of immunity during antenatal care is important for identifying susceptible women who can be immunised after giving birth and for surveillance of the size of the susceptible female population. The increase in the number of rubella cases reported in 2012 compared with 2011 and the potential for an increase in the number of babies born with CRS are of concern.



ECDC closely monitors rubella transmission in Europe by analysing the cases reported to the European Surveillance System and through its epidemic intelligence activities. Twenty-four EU and two EEA countries contribute to the enhanced rubella surveillance.

The purpose of the enhanced rubella monitoring is to provide regular and timely updates on the rubella situation in Europe in support of effective disease control, increased public awareness and the achievement of the 2015 rubella and congenital rubella elimination target.