#17,912
Although the next `pandemic threat' remains high on our watch list, old scourges - like Whooping Cough (Pertussis), Scarlet Fever and IGAS, a wide array of NPEVs (Non-Polio Enteroviruses), and Measles - continue to resurface, sometimes after acquiring genetic changes.While many of these diseases were largely suppressed during the pandemic - in part due to COVID mitigation efforts - now that the masks have come off, they are beginning to flourish once again.
Add in growing vaccine hesitancy - often propelled by vehement anti-vaccine rhetoric on social media - and you have a recipe for a global resurgence of serious, and largely preventable, diseases. Last summer, in UKHSA: Risk Assessment for Measles Resurgence in the UK, we looked at concerns over a measles uptick in the UK.
While no European country makes it into the CDC's list (see above) of countries reporting measles, the ECDC continues to see a rise in cases, and today has released a Threat Assessment Brief on the rise of measles in the EU/EEA.
First, a brief excerpt from a press release, followed by the risk assessment summary and a link to the full (12-page) report. I'll have a bit more after the break.High vaccination coverage key against expected increase of measles cases in the EU/EEA
News story
16 Feb 2024
Measles cases are expected to continue increasing in the EU/EEA in the coming months due to sub-optimal vaccination coverage for measles-containing vaccines (MCV) in a number of EU/EEA countries, the high probability of importation from areas experiencing high circulation and the fact that the coming months represent the seasonal peak of the virus.
The evaluation is included in a recent ECDC assessment: Measles on the rise in the EU/EEA: Considerations for public health response.
ECDC data shows that in January and early February 2024, the number of EU/EEA countries reporting measles cases has increased. At least seven deaths have been reported from two countries.
Andrea Ammon, ECDC Director said:“Nobody should die from measles. The increase in cases of measles, a highly contagious, but vaccine-preventable disease, is a stark reminder that all Member States should maximise efforts to achieve and maintain high vaccination coverage for all vaccine-preventable diseases. Vaccines are a safe and effective way to reduce the health burden of infectious diseases and avoid unnecessary loss of life.”Measles poses a threat to individuals of all age groups, which highlights the importance of maintaining high vaccination coverage across the entire population. The highest potential impact of measles, due to the high morbidity following infection, is for infants too young to be immunised (usually those under the age of 12 months, depending on national schedules). Unvaccinated children under five years old are also at increased risk, as measles can have several complications in this age group. Additionally, other groups such as the immunocompromised are at risk of severe outcomes from measles.
Threat assessment brief: Measles on the rise in the EU/EEA - Considerations for public health response
Risk assessment
16 Feb 2024
In 2023, significant increases in the number of measles cases and outbreaks were observed globally, including in 40 of the 53 countries of the European region, and in at least ten EU/EEA countries.Measles cases are expected to continue increasing in the EU/EEA in the coming months due to sub-optimal vaccination coverage for measles containing vaccines (MCV) in a number of EU/EEA countries, the high probability of importation from areas experiencing high circulation and the fact that the coming months represent the seasonal peak of the virus.
Executive summary
The risk from measles was assessed for four different population groups by the probability of infection and its impact. The overall risk is assessed as moderate for infants <12 months of age for whom vaccination is not indicated in most countries, and for children ≥1-5 years of age who are known to be at risk of higher morbidity and mortality due to measles complications.
In addition, the overall risk is assessed as moderate for immunocompromised persons. Older unvaccinated children (>5 years of age) and unvaccinated adults are estimated to have low to moderate risk from measles, as they do not usually present with severe disease or complications. Finally, for the population that is immune to measles, the risk is low due to the high protection conferred by the two-dose vaccination scheme or the lifelong protection from natural disease. ECDC encourages EU/EEA public health authorities to focus on the following activities in view of the expected rise of measles cases:Download
- Close immunity gaps and achieve and maintain high vaccination coverage for MCV (>95% with the second dose). Identify and reach, including with immunisation information systems, unvaccinated or partially vaccinated populations and provide opportunities for vaccination, including during key healthcare encounters.
- Strive towards high quality surveillance, and adequate public health capacity, especially for early detection, diagnosis, response and control of outbreaks at local, regional, and national level. Prompt diagnosis facilitates reporting. Early detection mechanisms prevent further transmission and facilitate control of new clusters. Strengthening of laboratory diagnostic capacity will facilitate tracking virus genotypes and transmission chains.
- Increase clinical awareness of health professionals for the prompt diagnosis of measles, e.g. through training on the current measles epidemiology, clinical presentation, and on non-typical affected population groups such as older children and adults.
- Promote vaccine acceptance and uptake. Identify drivers of sub-optimal vaccine uptake to ensure tailored interventions. Initiatives should include risk communication, awareness raising and training for healthcare providers to support them in their conversations around vaccination, and community-based interventions that address barriers in under-served population groups. Several resources and examples of national activities are provided in the Technical Annex of this assessment.
Threat Assessment Brief - Measles on the rise in the EU-EEA - EN - [PDF-669.45 KB]
Lest anyone think that measles is a benign childhood `rite of passage', in the History of Measles, the CDC writes:
In the decade before 1963 when a vaccine became available, nearly all children got measles by the time they were 15 years of age. It is estimated 3 to 4 million people in the United States were infected each year. Also each year, among reported cases, an estimated 400 to 500 people died, 48,000 were hospitalized, and 1,000 suffered encephalitis (swelling of the brain) from measles.
Last year, in a joint report from the CDC and WHO which was published in the CDC's MMWR, it was estimated that globally 136,000 people - mostly children - died from the measles in 2022.
While a considerable improvement of the 776,000 who died from measles in the year 2000, it was a sharp (43%) increase over 2021.
Progress Toward Measles Elimination — Worldwide, 2000–2022
Weekly / November 17, 2023 / 72(46);1262–1268
Anna A. Minta, MD1; Matt Ferrari, PhD2; Sebastien Antoni, MPH1; Allison Portnoy, ScD3; Alyssa Sbarra, MPH4; Brian Lambert2; Cynthia Hatcher, MPH5; Christopher H. Hsu, MD, PhD5; Lee Lee Ho, MPH1; Claudia Steulet, MPH1; Marta Gacic-Dobo, MSc1; Paul A. Rota, PhD6; Mick N. Mulders, PhD1; Anindya Sekhar Bose, MD1; William Perea Caro, MD1; Patrick O’Connor, MD1; Natasha S. Crowcroft, MD1
Summary
What is already known about this topic?
Global coverage with measles-containing vaccine (MCV) declined during the COVID-19 pandemic to the lowest levels since 2008, and measles surveillance was suboptimal.
What is added by this report?
During 2000–2022, estimated measles vaccination prevented approximately 57 million deaths worldwide. However, millions of children missed vaccinations during the COVID-19 pandemic, resulting in an 18% increase in estimated measles cases and a 43% increase in estimated measles deaths in 2022 compared with 2021. Large or disruptive outbreaks were reported in 37 countries. Measles surveillance remains suboptimal.
What are the implications for public health practice?
To continue progress toward measles elimination, all children should receive 2 MCV doses to address pandemic-related immunity gaps and measles surveillance should be strengthened.
Health experts say that a 95% vaccination rate is needed to protect communities from outbreaks. According to this report, the global rate has dropped to 83% for a first dose and 74% for a second, with many countries falling far below those numbers.
Even in the United States the uptake for the first MCV dose has fallen to 93%, with many states reporting numbers dipping into the mid-to-upper 80s.
All of which leaves us, and the world, vulnerable to new outbreaks in the future.
