Parents urged to vaccinate children with MMR as cases of measles rise
Parents are strongly advised to ensure their children have 2 doses of MMR Vaccine, as cases of measles begin to rise in Ireland. Outbreaks have been reported in Dublin and cases linked to the Dublin outbreaks are being reported in other parts of the country. The MMR vaccine is the only protection from measles available. Measles can be a very serious and sometimes fatal illness.
There has been a rapid increase in numbers of measles cases recently, most of them centred in North Dublin City. Measles is a serious illness, and MMR vaccine is the only protection against it. In the year 2000, a serious outbreak in Dublin saw cases rise as high as 1600, and claimed the lives of 3 young children. Measles is a highly infectious and dangerous illness which spreads very easily, particularly in homes, crèches, playgroups, camps, schools and universities.
Provisional data (08/09/2011) shows that the outbreak is spreading, with 191 cases of measles reported in Ireland since the start of 2011; over 86% of cases are in Dublin (mainly, but not exclusively, in the north Dublin area); 75% of cases have not been vaccinated with any MMR doses; 10% of cases have been hospitalised; no deaths have been reported.
The increase in cases among non-vaccinated children and young adults is a major cause for concern. Measles is a serious, but preventable, disease. Of the more than 26,000 cases across Europe, some have resulted in some severe outcomes, with six deaths, 14 neurological complications and 444 cases of severe pneumonia.
MMR Vaccine is the only protection against measles – parents are urged to make sure their children are fully protected by having the complete course of 2 MMR vaccinations. In Ireland, the first MMR dose is given routinely at 12 months of age, and the second dose at 4-5 years of age. At the moment, only 90% of children in Ireland have received one dose of MMR by 24 months of age, which is below the target of 95% to prevent cases of measles and measles outbreaks.
The HPSC urges all parents, country-wide, to seek MMR vaccination for their child if they have missed it.
What should parents do?
If you have a preschool or primary school child who never had an MMR shot – please go to your GP now for MMR vaccination.
If you have a primary school aged child who missed out on the MMR booster - please go to your GP now for MMR vaccination.
If you or an infant between 6 and 12 months is a contact of a measles case – please go to your GP for MMR vaccination.
If you’re not sure whether your child has had the full course of 2 doses – go to your GP for MMR vaccination
Symptoms of Measles:
High fever
Cough
Runny nose
Red eyes
Red rash that starts on the head and moves down the body
Measles can cause chest infections, fits, ear infections, swelling of the brain and brain damage.
If you think you or your child has measles, before you see your GP, call your doctor to arrange an appointment to minimise risk of transmission to others (either a house visit or a clinic visit at end of day).
Parents warned to vaccinate children with MMR as cases of measles rise
Parents are strongly advised to ensure their children have 2 doses of MMR Vaccine, as cases of measles begin to rise in Ireland. Outbreaks have been reported across Europe and in New Zealand. The MMR vaccine is the only protection available from measles, which can be a very serious and sometimes fatal illness.
There has been a rapid increase in numbers of measles cases recently, most of them centred in North Dublin City. Measles is a serious illness, and MMR vaccine is the only protection against it. In the year 2000, a serious outbreak in Dublin saw cases rise as high as 1600, and claimed the lives of 3 young children. Measles is a highly infectious and dangerous illness which spreads very easily, particularly in homes, crèches, playgroups, camps, schools and universities.
There have been 135 cases of measles in Ireland since the start of 2011, with over 70% arising in North Dublin City. Of the more than 26,000 cases across Europe, some have resulted in some severe outcomes, with six deaths, 14 neurological complications and 444 cases of severe pneumonia.
MMR Vaccine is the only protection against measles – parents are urged to make sure their children are fully protected by having the complete course of 2 MMR vaccinations. In Ireland, the first MMR dose is given at 12 months of age, and the second dose at 4-5 years of age. At the moment, only 90% of children in Ireland have received one dose of MMR by 24 months of age, which is below the target of 95% to prevent cases of measles and measles outbreaks.
The HSE is contacting GPs in the North Inner City of Dublin area, informing them of the rising numbers of cases and giving specific advice on vaccination measures, and is also arranging for special MMR vaccination clinics to be delivered in primary schools in the North Dublin area, when schools return in September.
What should parents do?
If you have a preschool or primary school child who never had an MMR shot – please go to your GP now for MMR vaccination.
If you have a primary school aged child who missed out on the MMR booster - please go to your GP now for MMR vaccination.
If you or an infant between 6 and 12 months is a contact of a measles case – please go to your GP for MMR vaccination.
If you’re not sure whether your child has had the full course of 2 doses – go to your GP for MMR vaccination
Symptoms of Measles:
High fever
Cough
Runny nose
Red eyes
Red rash that starts on the head and moves down the body
Measles can cause chest infections, fits, ear infections, swelling of the brain and brain damage.
The MMR vaccine is free.
More information on measles is available here and from the HSE National Immunisation Office at www.immunisation.ie.
Parents urged to ensure children are vaccinated before travel as Europe sees increase in measles cases
Parents continue to be urged to ensure that their children are fully vaccinated against measles following a large pan national outbreak of the disease in Europe.
Since the start of 2011 there have been more than 26,000 cases of measles in Europe. More than half of the reported cases occurred in France where six deaths, 15 neurological complications and 615 cases with severe pneumonia have been reported, according to the latest European Measles Monthly Monitoring Report issued by the European Centre for Disease Prevention and Control (ECDC).
One death has occurred in Germany and large outbreaks are also being reported from Romania, Switzerland, Spain, Belgium, Denmark, UK and Italy.
Many cases are due to travel of infected people between countries. As there is more travel between Europe and Ireland over the summer, there is an increased risk to Irish children and teenagers who are not fully vaccinated against measles.
There have been significant outbreaks in France, Spain and Belgium, which are popular holiday destinations for Irish families and with college students on holiday, working, visiting relatives and friends or attending summer camps or other summer activities. Additionally, the World Youth Day in Madrid in August will bring a large gathering of youth from all over the Europe together.
Vaccination with MMR vaccine is the only way to protect against measles. In Ireland, the first MMR dose is given at 12 months of age, and the second dose at 4-5 years of age. Parents must make sure that their children and teenagers are protected against measles by ensuring they have been immunised with MMR before they visit Europe. Measles is a highly infectious and dangerous illness which spreads very easily, particularly in homes, crèches, playgroups, camps, schools and universities.
Parents should speak with their GP and get the vaccine for their child if needed. The vaccine is free.
At the moment, only 90% of children in Ireland have received one dose of MMR by 24 months of age, which is below the target of 95% to prevent cases of measles and measles outbreaks.
As of 10th August, provisional data reported to the HPSC indicates that 118 cases of measles have been reported in Ireland since January 2011. Eighty one percent, or 96 cases of measles, have occurred in residents in the HSE East and 15 cases were under 12 months of age and were too young to have been vaccinated. Fifty-four percent of cases occurred in individuals who were eligible for vaccination but had not received any dose of MMR vaccine while 23 cases received one dose of MMR. Two doses of MMR will protect 99% of those receiving the vaccine. Thirteen individuals with measles have been hospitalised for between 2 and 14 days.
At least ten Irish measles cases were infected while travelling overseas in Europe or had direct links to imported cases.
Parents urged to ensure children are vaccinated before travel as Europe sees increase in measles cases
The HSE National Immunisation Office today (Wednesday) urged parents to make sure that their children are fully vaccinated against measles following a large pan national outbreak of the disease in Europe.
Since the start of 2011 there have been more than 21,000 cases of measles in Europe. More than half of the reported cases occurred in France where six deaths, 14 neurological complications and 444 cases with severe pneumonia have been reported, according to the head of the HSE National Immunisation Office, Dr Brenda Corcoran.
"One death occurred in Germany and large outbreaks are also being reported from Romania, Switzerland, Spain, Belgium, Denmark, UK and Italy.
"Many cases are due to travel of infected people between countries. As there is more travel between Europe and Ireland over the summer, there is an increased risk to Irish children and teenagers who are not fully vaccinated against measles.
"There have been significant outbreaks in France, Spain and Belgium, which are popular holiday destinations for Irish families and with college students on holiday, working, visiting relatives and friends or attending summer camps or other summer activities. Additionally, the World Youth Day in Madrid will bring a large gathering of youth from all over the Europe together.
"Vaccination with MMR vaccine is the only way to protect against measles. In Ireland, the first MMR dose is given at 12 months of age, and the second dose at 4-5 years of age. Parents must make sure that their children and teenagers are protected against measles by ensuring they have been immunised with MMR before they visit Europe. Measles is a highly infectious and dangerous illness which spreads very easily, particularly in homes, crèches, playgroups, camps, schools and universities.
"Parents should speak with their GP and get the vaccine for their child if needed. The vaccine is free.
"At the moment, only 90% of children in Ireland have received one dose of MMR by 24 months of age, which is below the target of 95% to prevent cases of measles and measles outbreaks.
"So far, 110 cases of measles have been reported in Ireland since January 2011. Seventy nine percent, or 87 cases of measles, have occurred in residents in the HSE East and 14 cases were under 12 months of age and were too young to have been vaccinated. Nearly 50% of cases occurred in individuals who were eligible for vaccination but had not received any dose of MMR vaccine while 22 cases received one dose of MMR. Two doses of MMR will protect 99% of those receiving the vaccine. Twelve individuals with measles have been hospitalised for between 2 and 14 days.
"At least eight of our measles cases were infected while travelling overseas in Europe, transmission from these cases then occurred in Ireland," added Dr Corcoran.
Measles outbreaks in Europe continue to escalate - July 2011
As measles continues to spread in Europe and in Ireland parents are urged to ensure children and teenagers are fully immunised against measles with the MMR vaccine.
Since the start of 2011 more than 21 000 cases were reported in EU and EEA/EFTA countries. Most cases are either un- or incompletely immunised individuals.
In France there is a huge ongoing outbreak which accounts for more than half of the reported cases in 2011. Six deaths, 14 neurological complications and 444 cases with severe pneumonia have been reported. Large outbreaks are also being reported from Romania, Switzerland, Spain, Belgium, Denmark, UK and Italy.
Mass gathering events such as the upcoming World Youth Day in Madrid in August 2011 poses a risk to susceptible participants who may be exposed to measles while there and bring it home with them, spreading the disease to others.
Two doses of MMR vaccine are routinely recommended for children;
The first dose at 12 months of age and the second at 4-5 years.
Unvaccinated older children, teenagers and young adults should get it to protect against measles.
Measles outbreaks in Europe highlight importance of vaccination before travel and attending mass gathering events
The Health Protection Surveillance Centre (HPSC) is urging parents to make sure that their children are fully vaccinated against measles following a large pan national outbreak of the disease in Europe. Today ECDC stressed the importance of getting vaccinated before attending mass gathering events.
Since the start of 2011 there have been more than 10,000 cases of measles and four related deaths in 18 European countries. Many cases are due to travel of infected people between countries. As there is more travel between Europe and Ireland over the summer, there is an increased risk to Irish children and teenagers who are not fully vaccinated against measles.
There have been significant outbreaks in France, Spain and Belgium, which are popular holiday destinations for Irish families and with college students on holiday, working, visiting relatives and friends or attending summer camps or other summer activities.
Vaccination with MMR vaccine is the only way to protect against measles. In Ireland, the first MMR dose is given at 12 months of age, and the second dose at 4-5 years of age. Parents must make sure that their children and teenagers are protected against measles by ensuring they have been immunised with MMR before they visit Europe. Measles is a highly infectious and dangerous illness which spreads very easily, particularly in homes, crèches, playgroups, camps, schools and universities. Parents should speak with their GP and get the vaccine for their child if needed. The vaccine is free.
At the moment, only 90% of children in Ireland have received one dose of MMR by 24 months of age, which is below the target of 95% to prevent cases of measles and measles outbreaks.
So far, 42 cases of measles have been reported in Ireland since January 2011. Eight of these cases were in children under 12 months of age who were too young to have been vaccinated but almost half of the rest had not received any doses of MMR vaccine. One in five cases in Ireland were either related to recent European travel or to contact with infected individuals from European countries where measles outbreaks occurred.
MMR vaccine is routinely recommended for all children at 12 months and at 4-5 years of age. The vaccine is given free of charge.
Many parents and GPs have inquired about administering MMR vaccine to children less than 12 months of age who are travelling to areas where measles outbreaks are occurring in Europe.
MMR vaccine can be given be given to children as young as 6 months of age during outbreak situations (although vaccine effectiveness is usually less at this age than when given after 12 months of age).
MMR vaccine may take up to 4 weeks to be effective.
Parents who wish to lessen the risk of measles in their children between 6-12 months of age who may be exposed to measles may wish to avail of MMR vaccine. If they do so the vaccine is provided free via the HSE National Cold Chain Service but parents should pay for the vaccine administration.
This dose would not be counted as a valid dose from the point of the vaccination programme and should be repeated at 12 months of age, at least one month after the first vaccine with a further dose at 4 - 5 years of age.
Parents who wish to lessen the risk of measles in their children between 1-5 years of age who may be exposed to measles may wish to avail of a second dose of MMR vaccine. If they do so the vaccine is provided free via the HSE National Cold Chain Service but parents should pay for the vaccine administration.
This dose would usually be counted as a valid dose from the point of the vaccination programme and no further MMR vaccine is required.
Note: If a child under 18 months of age receives a second MMR vaccine within three months of the first MMR a third MMR vaccine should be given at 4-5 years of age.
For more information:
See press release issued by HSE Communications - 30/5/11
Parents urged to ensure children are fully vaccinated against measles
The Health Protection Surveillance Centre (HPSC) is urging parents to make sure that their children are fully vaccinated against measles following a large pan national outbreak of the disease in Europe.
Since the start of 2011 there have been more than 10,000 cases of measles and four related deaths in 18 European countries. Many cases are due to travel of infected people between countries. As there is more travel between Europe and Ireland over the summer, there is an increased risk to Irish children and teenagers who are not fully vaccinated against measles.
There have been significant outbreaks in France, Spain and Belgium, which are popular holiday destinations for Irish families and with college students on holiday, working, visiting relatives and friends or attending summer camps or other summer activities.
Vaccination with MMR vaccine is the only way to protect against measles. In Ireland, the first MMR dose is given at 12 months of age, and the second dose at 4-5 years of age. Parents must make sure that their children and teenagers are protected against measles by ensuring they have been immunised with MMR before they visit Europe. Measles is a highly infectious and dangerous illness which spreads very easily, particularly in homes, crèches, playgroups, camps, schools and universities. Parents should speak with their GP and get the vaccine for their child if needed. The vaccine is free.
At the moment, only 90% of children in Ireland have received one dose of MMR by 24 months of age, which is below the target of 95% to prevent cases of measles and measles outbreaks.
So far, 42 cases of measles have been reported in Ireland since January 2011. Eight of these cases were in children under 12 months of age who were too young to have been vaccinated but almost half of the rest had not received any doses of MMR vaccine. One in five cases in Ireland were either related to recent European travel or to contact with infected individuals from European countries where measles outbreaks occurred.
MMR vaccine is routinely recommended for all children at 12 months and at 4-5 years of age. The vaccine is given free of charge.
Many parents and GPs have inquired about administering MMR vaccine to children less than 12 months of age who are travelling to areas where measles outbreaks are occurring in Europe.
MMR vaccine can be given be given to children as young as 6 months of age during outbreak situations (although vaccine effectiveness is usually less at this age than when given after 12 months of age).
MMR vaccine may take up to 4 weeks to be effective.
Parents who wish to lessen the risk of measles in their children between 6-12 months of age who may be exposed to measles may wish to avail of MMR vaccine. If they do so the vaccine is provided free via the HSE National Cold Chain Service but parents should pay for the vaccine administration.
This dose would not be counted as a valid dose from the point of the vaccination programme and should be repeated at 12 months of age, at least one month after the first vaccine with a further dose at 4 - 5 years of age.
Parents who wish to lessen the risk of measles in their children between 1-5 years of age who may be exposed to measles may wish to avail of a second dose of MMR vaccine. If they do so the vaccine is provided free via the HSE National Cold Chain Service but parents should pay for the vaccine administration.
This dose would usually be counted as a valid dose from the point of the vaccination programme and no further MMR vaccine is required.
Note: If a child under 18 months of age receives a second MMR vaccine within three months of the first MMR a third MMR vaccine should be given at 4-5 years of age.
For more information:
See press release issued by HSE Communications - 30/5/11
Measles in Ireland and Europe: Challenges to elimination
Measles outbreaks are widespread in Europe at the moment. Although the large measles outbreak that occurred in Ireland last year has abated, HPSC is aware that measles is still circulating in the community, with four individuals diagnosed with laboratory confirmed measles this year so far and others under investigation. Both children and adults have been affected with measles.
The risk of getting measles is also present in other countries of Europe. Large measles outbreaks are occurring in France, Belgium, Switzerland, Denmark, Germany, the Netherlands, Norway, Serbia, Switzerland and the former Yugoslav Republic of Macedonia. Turkey recently reported an outbreak in Istanbul, in addition to cases linked to a large outbreak in Bulgaria in 2010. In addition, small outbreaks have occurred in the Russian Federation (in Krasnoyarsk and Tomsk), linked to Uzbekistan.
Updated information on the measles situation in Europe is available here
Remember:
Measles is highly infectious. Individuals without immunity to measles can be infected with measles without even knowing that they were in contact with somebody who was infectious (e.g. in a public area)
Measles can be prevented by vaccination with the MMR vaccine
All children need two doses of MMR vaccine; at 12-15 months and at age 4-5 years
Older children and young adults who have not received at least two doses of MMR, or are unsure if they were vaccinated should contact their GP for this vaccine
Further details on measles can be found on the HPSC website
Next steps towards eliminating measles and rubella in Europe
In September 2010, WHO European Region set a new target date for eliminating measles and rubella by 2015. At a WHO/Europe consultation in December 2010, national immunisation experts agreed on the steps that will be taken to document and verify the elimination of measles and rubella, and the prevention of congenital rubella syndrome (due to infection early in pregnancy) from the Region. The participants approved a framework for the verification process that takes account of countries' experiences.
Framework for the verification process in Europe Documenting and verifying the elimination of measles and rubella and prevention of congenital rubella syndrome in the WHO European Region require several standard, interrelated components, including:
detailed information on measles and rubella epidemiology;
virologic surveillance, supported by molecular epidemiology;
an analysis of the vaccinated population;
high-quality surveillance; and
a sustainable national immunisation programme.
Establishment of national committees National committees for verification of measles and rubella elimination will be established to compile and submit this information annually to a regional commission. The national committees will continue to provide data for at least three years after the regional commission has reported the interruption of endemic measles and rubella transmission. Only then can regional elimination be declared.
Measles outbreaks in Ireland, Europe, Africa - Measles vaccination recommended in addition to other travel vaccines
The large measles outbreak reported in Ireland earlier this year is decreasing but is not gone.
Since the beginning of 2010, 389 measles cases have been reported to the HPSC; most (52%) cases are less than 5 years of age and from the Dublin area (30%); with 22% less than 1 year of age, too young to have the vaccine usually. Most cases were preventable; of the 230 cases 12 months of age or older, for whom information on vaccination was known, 97% were either unvaccinated or had only one dose of MMR (73% unvaccinated, 24% one dose).
Measles can only be prevented with the MMR vaccine. It is very infectious, and is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. Symptoms usually appear 8–12 days after infection and include high fever, runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards.
Complications are more common in children under the age of five, or adults over the age of 20. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia.
Reminder about need for MMR vaccination for those travelling and resident in Ireland • Measles outbreaks whether in Ireland or overseas pose a risk to non-vaccinated Irish children and adults • All children need two doses of MMR vaccine; at 12-15 months and at age 4-5 years • Older children and young adults who have not received at least two doses of MMR should contact their GP for this vaccine. • Further details on measles can be found on the HPSC website at http://www.hpsc.ie/hpsc/A-Z/VaccinePreventable/Measles/
Measles outbreak - children must get vaccinated
The Health Protection Surveillance Centre is urging all parents to make sure that their children are vaccinated against measles following a national outbreak of the disease which has caused a number of children to need hospitalisation.
The outbreak which started in August, is continuing, and there are real concerns about spread among non-vaccinated individuals. A majority of cases this year have occurred among children from the Traveler community.
Measles is highly infectious and can cause severe illness and occasionally cause death. An outbreak in 2000 resulted in more than 1600 cases and three deaths.
As vaccination with the MMR is the only way to prevent measles infection, all parents must make sure their children have received the recommended two doses of the vaccine. While the first dose is usually given at 12 months of age by GPs and the second in school at 4-5 years of age, the vaccine can be received at any time. Anyone who is not sure about their vaccination status should get another dose, which will not do them any harm, and will protect against measles, mumps and rubella.
Further information on the measles outbreak is available in a recent HPSC press release and measles articles in January's issue of Epi-Insight and the March issue of Eurosurveillance.
Football fans warned about measles vaccination following major disease outbreaks in Euro 2008 host countries
The Health Protection Surveillance Centre has warned football fans planning to travel to this summer’s Euro 2008 tournament to make sure that they have been vaccinated against measles, following major outbreaks of the disease in Austria and Switzerland, who are jointly hosting the competition.
While Ireland did not qualify for the tournament some fans may still travel and should be aware that measles is an extremely contagious and potentially fatal disease. These European outbreaks are a reminder of the importance of vaccination, especially for children, as it is the only safe and effective way to prevent measles from spreading. High levels of MMR vaccination are needed to protect against infection and to protect very young children - under 12 months of age - who are too young to be vaccinated.
While measles usually occur in children under four years old, people of any age if not already protected through natural infection or vaccination, can catch the disease. Severe disease and complications are most likely in young children under five years and adults over 20 years. It is important to realise that almost half of the deaths associated with measles occur in previously healthy children and young adults. The European outbreaks are a timely reminder to get vaccinated. MMR uptake for Irish children at 24 months of age in Ireland currently stands at 88% - which although the highest level ever recorded here - is still short of the 95% needed to prevent the virus from circulating and causing outbreaks. MMR is usually given in childhood – the first dose at 12 -15 months and the second at 4 - 5 years of age. Both the MMR vaccine and the administration fee is free for all children. Most adults, particularly those born before 1978, are likely to have already had measles infection. However, any individual in this age group who has never had measles infection or the measles vaccine should speak with their GP about getting it prior to travel. For adults administration fees may apply.
ECDC warns of upsurge of measles in Europe: unvaccinated people are at risk
In 2007, several European countries experienced high numbers of measles cases, notably Switzerland, and to a lesser extent the United Kingdom (UK) and Romania (more than one case per 100,000 population per year). Full data for measles cases in Europe for 2007 can be found on the website of EUVAC.Net, a European Union (EU) -funded Surveillance Community Network for Vaccine Preventable Infectious Diseases [1].
So far in 2008, over 1,300 measles cases have been reported in Europe. These cases have been in Switzerland, the UK, France, Denmark, Germany, Austria, Spain and Norway (unpublished EU data). The European Union alert system for communicable diseases guarantees that information on these outbreaks is shared between the Member States, the European Commission, the ECDC and the World Health Organization. On April 2, the Centers for Disease Control and Prevention in the United States (US) issued a health advisory regarding cases in several US states, some of which were linked to ongoing outbreaks in Europe and Israel [2]. Since then, more US states and Canada have reported additional cases [3,4,5,6,].
In Europe, very few countries have reached the target of 95% measles vaccination coverage which is necessary to prevent outbreaks and eliminate the disease. Different factors contribute to low vaccination coverage, e.g. some people refuse to be vaccinated, and other groups may be hard to reach such as nomadic populations or specific religious communities [7]. This results in a significant proportion of the European population remaining at risk for acquiring measles. Exposure to the virus may come from travellers who have visited outbreak-affected or endemic areas, as has been reported in the US.
ECDC would like to raise awareness of the ongoing measles outbreaks in several European countries and wants to use this as an opportunity to reiterate the importance of measles vaccination, which is the best available measure for preventing infection. Full protection is obtained by two consecutive doses of measles-containing vaccine. Further details on vaccination schedules can be obtained from national authorities.
In the light of the World Health Organization’s goal to eliminate measles in the European Region by the year 2010, the current outbreaks are worrying. Improving measles vaccination coverage is essential to containing and preventing further such outbreaks, and for reaching the goal of elimination [7].
2. Measles outbreaks in the United States: Public health preparedness, control and response in healthcare settings and the community. Centers for Disease Prevention and Control, Atlanta, United States. 2 April 2008. Health advisory. Available from: http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00273
3. Health Department advises New York city residents to make sure they have had measles shots before traveling abroad. New York City Department of Health and Mental Hygiene, New York, United States. 8 April 2008. Press release. Available from: http://www.nyc.gov/html/doh/html/pr2008/pr024-08.shtml
4. Possible measles exposure in SeaTac Airport on March 26, 2008. Public Health, Seattle & King County, Seattle, United States. 9 April 2008. News article. Available from: http://www.metrokc.gov/health/news/08040802.htm
5. Girl With Measles At Home; Health Officials On Watch. American Broadcasting Corporation (WISN). 8 April 2008. News article. Available from: http://www.wisn.com/health/15827358/detail.html
7. World Health Organization. (2003) Strategic plan for measles and congenital rubella infection in the European Region of WHO. Available from: http://www.euro.who.int/document/e81567.pdf
Recent report on measles elimination challenges
Towards elimination: measles susceptibility in Australia and 17 European countries
Bulletin of the World Health Organization. Volume 86, Number 3, March 2008, 161-240
As part of the European Sero-Epidemiology Network 2 (ESEN2, 1996-2004), Ireland, together with 16 other European countries and Australia, collected blood samples from both males and females in all age groups in 2003. These blood samples were tested for measles antibodies (markers of protection against measles infection). Population susceptibility levels were compared to other European countries and Australia and the WHO European Region targets for measles elimination of < 15% in those aged 2-4 years, < 10% in 5-9-year-olds and < 5% in older age groups.
Based on this study, seven European countries, including Ireland, are deemed to be at risk of epidemics as a result of high susceptibility in children and in some cases, adults. Seven countries met or came very close to the elimination targets.
Although all participating countries, including Ireland, now implement a two-dose measles immunisation schedule, if the WHO European Region target of measles elimination by 2010 is to be achieved higher routine coverage as well as immunisation campaigns in some older age groups are needed in some countries. Without these improvements, continued measles transmission and outbreaks are expected in Europe.
In 2007, Ireland completed the National Measles Elimination Strategy (available at http://www.hpsc.ie/hpsc/A-Z/VaccinePreventable/Measles/Publications/. Key to the strategy is achieving at least 95% MMR uptake of two doses of MMR among children after the first birthday and again as 4-5 years of age. Additionally, recognizing that some older children are still susceptible to measles as a result of not receiving two doses of MMR, the HSE is planning a measles vaccination campaign for children 4-18 years of age. This strategy will be implemented between 2008 and 2010.
Measles outbreaks in Europe and United States - information for travellers
HPSC has been informed about a number of reported measles outbreaks occurring in Europe and the United States. These reports are summarised in the following sections. To date, HPSC is unaware of any Irish cases linked to these outbreaks. However, measles cases continue to be reported in Ireland. During the first 10 weeks of 2008, 14 measles cases were reported nationally, but only one was laboratory confirmed.
These outbreaks may place unimmunised Irish travellers to these destinations at risk of this highly infectious and potentially very serious disease. Two doses of MMR vaccine are recommended for all children and young adults to prevent infection with measles.
France Between January 21st and March 17th 2008, 16 measles cases were reported in the city of Reims, the Marne district (department), Champagne region, North-eastern France.
The first case occurred in a non-vaccinated young woman on January 21st 2008. She was hospitalised for pneumonia. Subsequently, her two young children and two other young adult household contacts were also diagnosed with measles, three of whom were also hospitalised. During her admission to hospital transmission of the measles virus occurred in the hospital to three hospital staff, a medical student and three hospitalised children (aged 11 months to 7 years). An additional four measles cases have been reported in Reims, and appear to be related to another strain.
Switzerland This nationwide outbreak has been ongoing since November 2006. Measles outbreaks are reported particularly in the cantons of Lucerne, Basel-Land, Zurich, Bern, Aargau and Geneva. In recent years, Switzerland has had a particularly high incidence of measles compared to other European countries. The current outbreak has mainly affected unvaccinated children of school age, but also unvaccinated young adults. Transmission occurred primarily in families and schools. As many Irish people may be travelling to Switzerland for the European football championship (EURO 2008) in June, MMR vaccination is recommended for all children and young adults who have not already received two doses.
Germany In February, German Health Authorities published a preliminary report in Eurosurveillance on 16 measles cases occurring in the region of Baden-Württemberg, south-west Germany. Some cases in this outbreak relate to German citizens with residence in Switzerland or to Swiss citizens who commute to Germany.
Denmark Danish Authorities have published data in the February edition of Eurosurveillance on an outbreak of five measles cases in Copenhagen. The index case was a 23-year-old unvaccinated man who developed a rash on 12 January 2008, nine days after his return to Denmark after travelling to Nepal and India. The following four cases were a 24-year-old woman, a 10-month-old girl, a 26-year-old woman and a 39-year-old man with onset of rash on 1 February. The second case was the girlfriend of the index case. Two cases are believed to have been infected from the index case while at the waiting room of two different general practitioners' practices and another one in the hospital to which the index case was admitted.
USA Twelve measles cases have been reported in San Diego, California linked to a measles case in a seven year old unvaccinated boy who returned from Switzerland with his family in mid-January 2008. Subsequent spread occurred among his two non-immunised siblings, school contacts, friends and children attending the same paediatrician's office. For further information on the USA outbreak please see the CDC report published in the MMWR on 29th February 2008.
Reminder about need for MMR vaccination for travellers and Irish residents:
Travel between Ireland and the aforementioned European countries, as well as more distant countries where measles is endemic, is common.
MMR vaccination is routinely recommended for all children at 12-15 months of age and a second dose is administered at 4-5 years of age. Older children and young adults who have not received at least two doses of MMR are advised to contact their GP for this vaccine. The vaccine is free.
All individuals travelling abroad should review their immunisation records and obtain MMR vaccination if required. Vaccination is particularly important for children and young adults who may be travelling as part of school groups, for business or on pleasure.
To prevent transmission in health care settings all health care workers and health care students should also be appropriately vaccinated.
Outbreak of measles among Irish Travellers in England, March to May 2007
The Health Protection Agency (HPA) in England and the Norwegian Institute of Public Health, (NIPH) have reported two large outbreaks of measles in their countries. These two outbreaks, which are clearly linked, have resulted in over 100 measles cases in recent months.
Since the end of March 2007, 92 cases have been reported in many regions of the England: London, East of England, South East, South West, East Midlands, and Yorkshire and the Humber. A further 16 cases have been reported, or are under investigation in Norway. Most cases have never received MMR vaccine.
Both outbreaks have links to members of the Irish travelling community from England. A large gathering of Irish Travellers in south-east London on 3 April 2007 is believed to be the venue where extensive transmission initially took place. Subsequent travel of measles infected individuals throughout England and Norway has spread the disease in this community, with on-going person-to-person transmission continuing to non-immune individuals. The strain of measles virus obtained from cases in Norway and the UK is similar (D4).
As of 15th June 2007 no measles cases among Irish travellers (resident in Ireland) have been identified by the HPSC. However, all children should routinely receive two dose of MMR vaccine, after 12 months of age and at 4-5 years of age. Vaccination is the only way to prevent measles infection.
Since January 2006, two large, and apparently unlinked, measles outbreaks have been reported in Germany, one in South Germany, and the other in West Germany.
The outbreak in South Germany occurred in the greater Stuttgart area between January – March 2006. A total of 64 cases were reported.Most cases occurred among young unvaccinated children, between the ages of 1-9 years (77%).
The other outbreak is in the Northrhine-Westphalia region (West Germany). A total of 1,406 cases have been notified since January, particularly from cities of the Ruhr region and from the Lower Rhine region which borders the Netherlands. Most cases are children less than 9 years of age (40%) or older children/ teenagers aged 10-19 years (42%). An additional 17% of cases were among adults aged 20 years or older. Fifteen percent of cases have been hospitalised as a result of measles infection. This outbreak is on-going.
German health authorities are investigating and managing the outbreaks. In the affected regions, parents, care persons, doctors, schools and child care facilities have been alerted and reminded of the need for all children to be fully immunised with MMR.
Travellers to Germany
All individuals travelling to Germany from Ireland, and born after 1978, should ensure that they have been vaccinated against measles, preferably with 2 doses of measles containing vaccine such as MMR. Any individuals who develop rash illness following travel to Germany should seek medical attention.
Increase in measles cases in the UK
The Health Protection Agency UK recently reported an increase in measles cases in England and Wales. More than 70 cases were reported in the first three months of 2006. Cases are occurring among infants, children and adults. Nine cases were hospitalized and there was one measles related death in a 13-year-old child with an underlying lung condition who was taking immunosuppressive drugs.
Since 2005 there have been a number of outbreaks of measles among the travelling community across England, with the majority of the cases associated with the travelling community.
Current situation in Ireland Although the HPSC has not seen an increase in measles cases in Ireland compared to previous years, there is concern. Ireland experienced a large outbreak in 2000, with over 1600 measles cases reported. Three children died as a result of infection acquired during that outbreak. Low levels of MMR vaccination among children meant that large numbers of children were susceptible to infection, and the virus spread rapidly throughout the country.
MMR vaccination uptake in Ireland (Q3 2005) Most recent figures indicate that on average, only 84% of Irish children at 24 months of age have received one dose of MMR (Immunisation report Q3 2005). A sustained MMR uptake rate of at least 95% is needed to prevent measles outbreaks occurring in the community.
Measles is a highly infectious disease that can cause serious complications, particularly among children less than 5 years of age and adults. The infection is characterized by a general body rash, a fever, and one or more of the following; cough, conjunctivitis, and runny nose. Measles is a notifiable disease.
MMR to protect against measles MMR vaccine protects against measles. The vaccine is safe and effective. It is routinely given when children are 12-15 months of age, and a booster is given at 4-5 years of age.
All parents are encouraged to ensure that their children are vaccinated with MMR at the appropriate age to protect against measles infection. MMR vaccine is available from the GP.
