Masernausbruch auf den Phillipinen

TEXT WHO
From 1 January to 27 February 2010, a total of 1328 suspect measles cases have been reported nationwide in the Philippines. Of these cases, 742 have been confirmed clinically or by the laboratory, 164 have pending laboratory
results and the remaining cases were discarded as non-measles cases. Compared to the same period last year, the number of confirmed cases has increased by about 200%. Of the confirmed cases, 523 (70%) were positive for measles IgM.

Five of the laboratory or clinically confirmed cases have died (Case Fatality Rate=0.67%) compared to two deaths (CFR=0.90%) in 2009. Four of the fatalities were of infants <12 months of age, and the remaining fatality was 2
years old. 68% of laboratory-confirmed cases were unvaccinated.

Outbreaks have been declared in barangays or villages experiencing at least two laboratory-confirmed cases in the past four weeks. Several outbreaks have been detected in metropolitan Manila as well as in ten other areas of the country.

Authorities have released public health advisories on measles vaccination and disease recognition, and will conduct supplementary immunization activities in areas with outbreaks, targeting children from 6 months to 6 years old.


Masernausbruch in Bulgarien

Ongoing measles outbreak among Roma population in Bulgaria with spread to Member States in the WHO European Region, 2009-2010

Following an eight–year period without indigenous measles transmission, there has been an ongoing measles outbreak since mid-April 2009. The outbreak has spread rapidly through the country affecting all 28 regions with an increasing number of measles cases being registered.The majority of cases are in vulnerable populations who are not immunized against measles or who have received only one dose of a measles-containing vaccine.


The index case was a truck driver returning from Germany to his community in south-eastern Bulgaria, where the outbreak started as a family cluster. The genotype D4 measles virus strain identified showed nucleotide sequence identical to the measles virus strain associated with an outbreak observed in northern Germany in the first half of 2009.

The outbreak continued to spread across Bulgaria primarily in Roma communities, which are inherently mobile, are living in crowded conditions, and for whom access to health care services is a challenge.

Between mid-April 2009 and 14 March 2010, 9,314 confirmed measles cases, including 15 fatal ones (CFR 0.2%) were registered in all 28 regions - Varna, Sliven, Stara Zagora, and Yambol regions accounting for the majority of the cases reported in 2010. Over 70% of the cases were noted since the beginning of 2010, corresponding to an overall crude incidence of 122 per 100,000 population.

Over half (56%) of the cases were reported among individuals less than 15 years of age, with 16% of these cases aged less than one year. Both genders are equally affected. Ninety-percent (90%) of the reported cases are among the Roma population.

Of the 15 fatal cases reported between December 2009 and February 2010, at least five were under one year of age. At least 11 out of the 15 fatal cases were hospitalised and four of them died within 24 hours from admission. At least two cases died at home without seeking medical attention.

Among the reported cases, complications due to measles included 41% with pneumonia, 21% with abdominal disorders with diarrhoea and acute abdominal pain, and three developed encephalitis.

The review of the measles vaccination status of over 2,250 cases indicates that this was known for 75% of the cases. Overall, 25% were unvaccinated, 30% had recorded one dose of measles-containing vaccine, and 8% two doses.

Response efforts implemented by Bulgarian health authorities include:
- Alerting health care workers at all levels;
- Raising awareness targeting the general population and Roma communities through their leaders and non-governmental organizations (NGOs);
- Strengthening of routine immunisation of children aged 13 months (first dose) and 12 years (second dose), including outreach;
- Since May 2009, supplementary immunisation activities (SIAs) were launched in the most affected Regions. SIAs are targeting individuals aged 13 months to 20 years. Resources are being mobilised to extend SIAs to the entire country.

WHO and ECDC conducted a field mission to assist the Ministry of Health in its advocacy efforts for resource mobilisation. The mission also highlighted the risk of spread of other vaccine preventable infections in the Roma communities and spread to other Member States due to the mobility of the affected population.

Heightened level of alertness of health authorities across the Region is warranted considering the low vaccination coverage in the Roma populations, the fact that additional cases of infection might have remained undetected, as well as reports from Roma communities stating that there is ongoing travel to neighbouring countries (e.g. Greece, Turkey, Romania), but also to other countries in the Region because of work opportunities and family connections (e.g. Germany, Spain).

Actions to be considered include:
- Alerting Roma and other vulnerable communities using existing channels, such as NGOs, religious leaders;
- Alerting health care providers to be aware of symptoms of measles disease and to review immunization records and reach out to those who have not received at least two doses of a measles-containing vaccine;
- Offering measles-containing vaccine also in the absence of documentation;
- Stimulating reporting of clinical cases and collection of specimen for laboratory confirmation and further genotypic characterization of the circulating measles virus/es.

Useful links

Ministry of Health of Bulgaria, Epidemic prone diseases, 1-7 March 2010,
http://www.mh.government.bg/Articles.aspx?lang=bg-BG&pageid=458&categoryid=2349
(in Bulgarian, accessed on 10 March 2010)

National Centre for Infectious and Parasitic Diseases (NCIPD), Weekly Epidemiological Bulletin, 1-7 March 2010, available at:
http://www.ncipd.org/?news=disease&id_week=168&y=2010#28
(in Bulgarian, accessed on 10 March 2010)

An ongoing measles outbreak in Bulgaria, 2009. Marinova L, Kojouharova M, Mihneva Z. Euro Surveill. 2009 Jul 2;14(26). pii: 19259. Erratum in: Euro Surveill.2009;14(27). pii: 19262. Available at:
http://www.eurosurveillance.org/viewarticle.aspx?articleid=19259
(accessed on 8 March 2010)

An update on an ongoing measles outbreak in Bulgaria, April-November 2009. Marinova L, Muscat M, Mihneva Z, Kojouharova M. Euro Surveill. 2009 Dec 17;14(50). pii: 19442. Available at:
http://www.eurosurveillance.org/viewarticle.aspx?articleid=19442
(accessed on 8 March 2010)

Public Health Service of Baden-Wuerttemberg, Germany, Weekly Epidemiological Bulletin, 1-7 February 2010, available at: http://www.gesundheitsamtbw.de/servlet/PB/show/1308065/wochenbericht_bw_kw05.pdf(in German, accessed on 18 March 2010)

Ministry of Health of Spain, Vaccination coverage, available at:
http://www.msc.es/profesionales/saludPublica/prevPromocion/vacunaciones/coberturas.htm (in Spanish, accessed on 18 March 2010)

Institute Carlos III, National Epidemiology Centre, National plan for measles and rubella elimination, available at: http://www.isciii.es/htdocs/centros/epidemiologia/epi_sarampion.jsp
(in Spanish, accessed on 18 March 2010)

Regional Office for Europe of the World Health Organization, Vaccine-preventable Diseases and Immunization, European Immunization Week, available at:
http://www.euro.who.int/eiw