The World Health Organization and the European Center for Disease Prevention and Control (ECDC) expressed their strong concern about the sharp and rapid increase in measles cases.

Measles is on the rise in Europe and poses a threat to people of all age groups. The estimate is that measles cases are expected to continue to increase in the coming months due to the decline in vaccination coverage of the population, which was recorded during the Covid pandemic, the high probability of introduction from areas with high circulation of the virus and the fact that in the next months the peak of measles is expected.

This highly contagious disease that can cause serious complications, especially in children and vulnerable people, can be prevented through vaccination, which is why health systems have launched information and awareness campaigns.

But what is happening in Greece?

The health authorities in our country are also on heightened alert, as it is estimated that the upward trend is expected to continue if no measures are taken.

In 2024, six suspected cases were confirmed and the results of the phylogenetic analysis are awaited to accurately determine the entry gates of the virus in the country.

The APE-MPE addressed the Measles and Erythelas Reference Laboratory located at the Hellenic Pasteur Institute and, under the scientific supervision of Dr. E. Angelakis, medical biopathologist, Director of Research and the technical guidance of Dr. E. Horeftis, biologist, specialist functional scientist, is active in the laboratory investigation of suspected cases caused by the measles and rubella viruses.

The Laboratory participates in the global network of laboratories (one from each country) established by the World Health Organization to monitor measles. The Laboratory is accredited annually by the World Health Organization (WHO) and the European Measles and Rubella Reference Laboratory in Luxembourg.

Regarding the elimination of the measles virus in Europe, the National Reference Laboratory and the other members of the European Network (LabNet) are on hand to identify the “hot spots” of the virus circulation and to determine their transmission routes from country to country.

The role of the National Reference Laboratory is to confirm measles cases, by molecular testing of pharyngeal swabs and serological testing by examining the patient’s blood, in order to achieve the correct diagnosis, given that other rash diseases have a similar picture. Also, the Laboratory carries out the further investigation and confirmation of cases from all public and private laboratories of the country. The laboratory uses specialized techniques for the analysis of the genome and the genetic characterization of the measles virus strains, aiming at the epidemiological course of the virus and the virus strains are isolated in cultures.

The current situation

“The increase in confirmed cases of measles in many European countries since the beginning of the year has caused intense concern to the Public Health Authorities of our country,” Mr. Angelakis tells APE-MBE.

In the period 2000-2017 globally, the annual number of confirmed measles cases decreased by an average of 59%. Since 2017, measles outbreaks have occurred on all continents without exception.

According to the World Health Organization, there were 941 confirmed cases of measles in 41 European countries in 2022, while in 2023 there was an alarming increase, resulting in the number reaching 42,200.

Specifically, Romania, France, Germany and Italy recorded 1,078, 101, 73 and 39 cases, respectively. The increase in cases has been accelerating in recent months and the upward trend is expected to continue if immediate measures are not taken to prevent further spread, emphasizes Mr. Angelakis.

In Greece, from 2020 to 2023 no measles cases were confirmed.

In 2024, and specifically in the first half of February, six suspected cases were confirmed, one from Thessaloniki, four from Chania and one from Athens. Although the epidemiological data show that the cases from the aforementioned areas are not connected to each other, the results of the phylogenetic analysis are awaited in order to accurately determine the gateways of the virus into the country. So far, no other suspected cases have occurred, while surveillance continues with the cooperation of the EODY and the country’s Health Authorities.

Measles: Highly Contagious and Serious Disease – The Complications

Measles is an acute viral respiratory disease. It is transmitted through droplets found in the mucous membranes of the nose and pharynx and is highly contagious: one infected person can potentially transmit the virus to at least eight others, while the SARS-CoV-2 virus that causes COVID-19, in just three. The most general symptoms of the infection include high fever – up to 40°C – malaise, cough and conjunctivitis, while the appearance of Koplik’s spots in the oral cavity and the rapid spread of a maculopapular rash throughout the body are characteristic (Fig.1).

It is a serious disease, where 6 – 20% of people who get sick will have complications like otitis, diarrhea, or pneumonia, while one in 1000 patients will develop encephalitis.

A rare complication of the disease is subacute sclerosing panencephalitis, which occurs up to seven years after infection. In addition, measles has a severe clinical picture in immunocompromised individuals such as, for example, from HIV infection, leukemia, lymphoma, malignancy, or radiation therapy.

Prevention by vaccination

The main measure of disease prevention is vaccination. In Greece, the vaccine was included in the National Immunization Program in 1981 with one dose, while since 1999 two doses have been administered. The effectiveness of the vaccine is high, 93% after the first dose and 97% after the second, in the first and fifth years of age respectively, while the duration of immunity is lifelong.

The following vaccines are available in Greece:

1. MMR VaxPro (Sanofi Pasteur): Attenuated strains of measles (Ender’s/Edmonston) and mumps (Jeryl Lynn) and attenuated strains of rubella (Wistar RA 27/3) grown in human diploid cells.

2. PRIORIX (GSK): Attenuated strains of measles (Schwarz) and mumps viruses (RIT 4385 derived from the Jeryl Lynn strain) grown in chicken embryo fibroblasts and the attenuated rubella virus strain (Wistar RA 27/3 ) which is cultured in human diploid cells.

3. PRIORIX-TETRA (GSK): Contains the attenuated strains of measles, mumps, and rubella viruses as in PRIORIX, plus the attenuated varicella virus strain (Oka-strain), which has been cultured in human diploid cells.

According to the instructions of the National Immunization Committee and the corresponding Circular issued on February 9 of this year by the Deputy Minister of Health Irini Agapidaki, the following are recommended:

1. 2 doses of the MMR vaccine are recommended for children and adolescents, with the 2nd dose given at 24-36 months of age (but can be given earlier as long as 4 weeks have passed since the first dose). Both doses should be given after 12 months of age. Children and adolescents who have not been vaccinated with the 2nd dose should catch up as soon as possible.

2. During epidemic periods MMR vaccination can be done from the age of 6 months. In this case, they should be revaccinated with 2 doses of MMR after 12 months of age according to the schedule. Infants aged 6 to 11 months who are going to visit countries in which

endemic for measles, mumps and rubella are recommended to be vaccinated with one (1) dose of the MMR vaccine prior to departure.

3. Regarding adults, it is emphasized that according to the adult vaccination schedule, people born before 1970 are considered immune.

Those born after 1970 should have been vaccinated with two (2) doses of MMR, with an interval of at least 4 weeks between doses. In case there is no history of disease or vaccination history is unknown, the person is considered unvaccinated and two doses of vaccine with a minimum interval of four weeks are recommended.

Population groups at particularly high risk for measles are the following:

– Workers in health care facilities

– Educators

– Students, students of higher education

– Adults who are going to travel abroad

– Family members of immunosuppressed individuals

– Patients with HIV infection (vaccination is recommended when CD4 ≥200/μL)”