Measles is re-emerging, giving outbreaks, due to the decrease in vaccinations at the international level. It is hyper-contagious, as the average number of people someone will infect with the virus exceeds 15 people. According to data from the World Health Organization, measles cases last year rose by 18% to 9 million worldwide. Measles deaths increased by 43%.

The Greek Health Authorities are on alert and the EODY is taking preventive measures to deal with a possible epidemic wave of measles. From the beginning of 2024 until today, 5 cases of measles have been detected in Greece.

The EODY aims to strengthen vaccination, with an emphasis on the vaccination of special population groups and on informing the population and especially those who are going to travel to countries where there is an outbreak of cases.

The reduction of vaccinations in Europe and Greece

The reason for the dispersion in the community is the decrease in vaccinations and as the president of EODY, professor of Hygiene and Epidemiology – Department of Medicine, School of Health Sciences of the University of Thessaly, Christos Hatzichristodoulou, reveals to APE-MPE, the pandemic contributed to the reduction of the coverage rate with the first dose of the measles vaccine. The coverage rate from 94-95% that was, has reached close to 91-92% in Europe.

A downward trend in vaccinations is also observed in Greece and according to a first analysis of the data by EODY, from 2020 a small drop is recorded regarding the first dose. There was always a percentage of children who were not vaccinated and this percentage was around 5-6%, the professor says. Today this percentage is close to 8-9%.

“We have the conditions that favor an outbreak of cases, we have not reached the desired level of vaccination coverage which is 95% of the child population and so we have a number of sick children and adults and when it becomes a critical mass we have the outbreak, which occurs approximately every 6 to 7 years”, Mr. Hatzichristodoulou told APE-MBE.

The last outbreak we had was in 2017-2018. During the period 2004-2023, three measles epidemics occurred in our country and a total of 4,151 cases and 4 deaths were reported. The majority of cases involved Greek Roma (56.9%), but also young adults from the general population who were unvaccinated or incompletely vaccinated. The disease showed the highest incidence in the age group 0-4 years.

During the years 2021, 2022 and 2023, no measles cases were reported and the EODY points out the possibility of under-reporting due to the COVID-19 pandemic.

The targeted measures of EODY

According to Mr. Hatzichristodoulou, the epidemiological surveillance of the disease and the timely implementation of vaccination are the most appropriate measures to control the disease.

In this context, the vigilance of health professionals is deemed necessary on the one hand and on the other hand the intensification of vaccinations with an emphasis on the vaccinations of special population groups, (Roma and immigrants), young teenagers and adults who have not completed their vaccination in the past, as well as continued vigilance of local and national authorities. EODY in collaboration with municipalities and the NGO “Health for All” will carry out a mass vaccination in Roma camps with the assistance of COMY. Echelons of the EODY will also visit refugee and immigrant accommodation centers and inform about vaccination and prevention measures.

At the same time, EODY is in contact with travel agents, so that travelers are informed about the completion of their vaccination (two doses of the mixed measles-rubella-mumps-MMR vaccine) before their trip, especially if they are going to travel to countries with outbreaks, such as Romania.

Finally, special actions will concern areas where, according to the results of the 2020-2021 study, low vaccination coverage was found, in order to strengthen vaccination in the child population.

As Mr. Hatzichristodoulou explains, at this stage there is no reason for particular concern, but the competent authorities must be alert, as there is an increase in cases in European countries and what we need to do is to prepare for a possible outbreak of measles in Greece as well .

European countries with increased cases

According to recent international epidemiological data, there is an increase in measles cases in European Union countries. Specifically: From January 1, 2023 to November 30, 2023, 2,242 confirmed cases of measles were reported from 22 countries of the European Union. The majority of cases are observed in Romania (1,687), Austria (172), France (111), Germany (72), Belgium (70), Poland (32), Italy (27), Spain ( 12) and in Sweden (11). The remaining countries have reported less than 10 confirmed cases in the corresponding period.

On 9-10 January 2024, 954 new confirmed cases of measles were reported from six European Union countries, of which 932 were in Romania. The remaining 22 confirmed cases were reported by Austria (17), Poland (3), the Czech Republic (1) and Denmark (1).

Measles: Contagiousness, symptoms, effects

Measles is a viral infection caused by the measles virus.

Incubation time ranges from 7-21 days (usually 10-12 days from exposure to precursor stage and 14 days from exposure to rash).

The disease is transmitted from person to person airborne, by droplets and by direct contact with nasal or pharyngeal secretions of patients. Less commonly, it is transmitted through objects recently contaminated with nasopharyngeal secretions.

The measles virus can remain on contaminated surfaces and in the environment (in droplets) for up to 2 hours after the patient leaves.

Measles is very highly contagious with a secondary infection rate of up to 90% among infected individuals (eg unimmunized individuals).

All people who have not been infected or vaccinated are susceptible to measles.

Vaccination schedule

Vaccination with the mixed measles-rubella-mumps vaccine (MMR vaccine) is recommended for children, adolescents and adults who have not been vaccinated with the necessary doses.

According to the National Immunization Program, children, adolescents and adults born after 1970 who do not have a history of the disease should be vaccinated with 2 doses of measles vaccine.

Complications

About 30% of measles cases have one or more complications that are more common in children <5 ετών και ενήλικες >20 years old.

The most frequent complications appear from the digestive, respiratory and Central Nervous System.

More serious complications are pneumonia viral (giant cell) or secondary to microbes (frequency 6%), which is also the most frequent cause of death, acute suppurative otitis media (7%), acute encephalitis (0.1%), which projects with hyperpyrexia, restlessness, agitation, clouding of intellect, convulsions, and coma.

Subacute sclerosing panencephalitis (SSPE), a rare complication, occurs an average of 7 years after the onset of measles and is due to damage to brain cells by the measles virus that persists and multiplies after the disease resolves.

Adults rarely get measles but more seriously than children. Complications are mainly respiratory: pneumonia (30%), purulent otitis media (29%), sinusitis (25%). The disease during pregnancy is associated with miscarriage, premature birth, low birth weight newborn.

Measles deaths have been reported in developed countries in 1-2‰ of cases. Mortality in developing countries reaches 25%.