Measles outbreaks in Europe and United States - information for travellers

Published: March 18, 2008

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.

Further information:

• Further details on measles vaccination can be found in the Immunisation Guidelines for Ireland. 
• Further information on measles is available on the Measles section of the HPSC website.
• For further information on the European outbreaks please refer to the EUVAC website at http://www.euvac.net/graphics/euvac/index.html and Eurosurveillance reports