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26 Mar 2013

Measles & Rubella - Multistate (EU) - Monitoring European outbreaks (ECDC/CDTR, March 26 2013, edited)

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


Week 12, 17-23 March 2013



Measles - Multistate (EU) - Monitoring European outbreaks

Opening date: 9 February 2011 Latest update: 14 March 2013


Epidemiological summary

UK – update

There are on-going outbreaks in the UK reported earlier in the CDTR.

In Wales, the number of cases in the Swansea area outbreak reached 316 with 64 new cases reported in the last week alone.

Measles infection has now spread to children in 111 secondary and primary schools, nurseries and playgroups, increasing the likelihood that unvaccinated children will come into contact with those already infected.

Forty two people have been hospitalised.



A new research article demonstrates that direct contact tracing of aeroplane passengers seated immediately around an infected person is not an effective strategy to prevent further cases. Despite secondary measles transmission occurring in one in five international flights with infectious cases, the risk was not clearly related to seating proximity and contact tracing was ineffective, especially given delays in diagnosis, notification, and accessing flight manifests. The 45 people in the study appeared to have infected 22 fellow passengers. Fifty-five percent had been seated further away than the two-row zone closest to the original case.

The authors recommend that direct contact tracing to identify susceptible people exposed to measles cases on aeroplanes should not be undertaken routinely. Other strategies should be considered, such as the media, email and mobile phone text messages, to try to alert everyone who was on a plane that they may have been exposed to measles.



ECDC assessment

So far in 2013, only the UK and Sweden have 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


There is an on-going outbreak in Poznan since the beginning of March 2013 with approximately 200 cases affected, most of whom are young men. Another outbreak is reported in Wielkopolska where 854 cases of rubella were notified during the first quarter of 2013, almost five times more than in the past two years.

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.