Drop in Vaccination Rates to Blame for Europe's Four-Fold Increase In Measles Cases

The number of measles cases in Europe quadrupled in 2017 from the previous year, according to new data released by the World Health Organization (WHO), and health officials say declining vaccination rates are at least partly to blame.

Measles is a highly infectious virus, and the illness typically begins with symptoms including high fever, cough, runny nose, as well as red and watery eyes. White spots called Koplik spots appear in the mouth within 2 or 3 days of infection, and then a rash of flat, red spots often develops along with high fever within 3 to 5 days. The rash typically begins on the face along the hairline and spreads down across the body. Measles is very contagious and spreads through the coughing and sneezing of an infected person, and the virus can linger on surfaces and contaminate airspace for up to 2 hours. According to the Centers for Disease Control and Prevention (CDC), an individual with measles can infect 90% of non-immune individuals who come in close contact.

On February 19, 2018, the WHO Regional Office for Europe announced that there were 21,315 cases of measles resulting in 35 deaths in Europe in 2017, a four-fold increase from the 5,273 cases reported in Europe in 2016. Large outbreaks of 100 or more cases occurred in 15 of 53 countries in the European region last year, including 5,562 cases in Romania, 5,006 cases in Italy, and 4,767 cases in Ukraine. Other countries reporting large outbreaks included Greece, Germany, Serbia, Tajikistan, France, the Russian Federation, Belgium, the United Kingdom, Bulgaria, Spain, Czechia, and Switzerland. Health officials in Europe say that this surge of cases is linked to a drop in overall routine immunization coverage, ongoing low coverage among some marginalized groups, interruptions in vaccine supply, and underperforming disease surveillance systems.

“Every new person affected by measles in Europe reminds us that unvaccinated children and adults, regardless of where they live, remain at risk of catching the disease and spreading it to others who may not be able to get vaccinated. Over 20 000 cases of measles, and 35 lives lost in 2017 alone are a tragedy we simply cannot accept,” said WHO regional director for Europe Zsuzsanna Jakab, PhD, in a recent statement. While measles vaccination rates remain at over 90% across much of Europe, data shows that countries such as Italy, Romania, and Ukraine, which saw a sharp rise in measles cases in 2017, have also reported declining coverage for full measles vaccination over the last decade.

In response to the recent measles outbreaks, the health ministers of 12 European countries met on February 20, 2018, to discuss ways to meet the goals set by the European Vaccine Action Plan (EVAP), including the elimination of measles and rubella in Europe by 2020. “The countries in south-eastern Europe face many common challenges, which intersect and affect progress within and across their borders,” said Dr, Jakab at the meeting. “By establishing and pursuing this tailored roadmap we will contribute to stronger foundations for immunization in the subregion and to the health and well-being of everyone in the European Region as a whole.”

Two doses of the measles, mumps, and rubella (MMR) vaccine are 97% effective at preventing a measles infection, and health officials say 95% vaccination coverage in a community is needed to achieve herd immunity against measles. A 2017 study found that just a 5% drop in the rate of vaccination in the United States would lead to 3 times the number of measles cases. Global increases in measles vaccination rates have resulted in an 84% drop in measles deaths worldwide, according to the WHO.