28 Nov 2017

Measles in Europe

A reminder for seasonal travellers to ensure they are up to date with measles vaccine Measles in Europe

Measles outbreaks continue to be reported in a number of European countries [1]. Measles cases and localised outbreaks have been reported in England and Wales in 2017 that have been linked to importations from Europe [2-3].

Measles increasingly affects all age groups in Europe: 47% of measles cases with known age were aged 15 years or older in 2017. Of the cases reported in Europe from October 2016 to September 2017 with known vaccination status, 86% were unvaccinated [1].

The four European countries with the highest number of measles cases in 2017 were Romania (7,759), Italy (4,775), Germany (898) and Greece (368). Of the 33 deaths in Europe from measles to date in 2017, the majority (23) occurred in Romania [4].

Measles is a highly infectious illness spread by airborne/droplet transmission. Symptoms include fever, runny nose, conjunctivitis and cough. A rash then usually develops, starting at the head, then spreading to the trunk and limbs over three to four days. Individuals are infectious from their first symptoms to four days after the rash appears, and the incubation period is about ten days. Complications can occur and in the UK, the death rate is approximately one in 5,000 cases. Risk of death from measles is age-related: high in children under one year of age, lower in children aged one to nine years, rising again in teenagers and adults [5]. 

Advice for travellers

If you are planning a seasonal break, as part of your travel preparation, make sure you are up-to-date with all currently recommended UK vaccines, including measles, mumps and rubella (MMR) vaccine. This is especially important if you are travelling to Romania, Italy, Germany or Greece, but is advised for all travellers, as increases in measles cases are being reported internationally [6]. Two doses of MMR in a life time are needed for a person to be considered fully protected.

MMR vaccine can be given to babies from six months of age before travel to a risk country and/or where an outbreak is occurring [5].

If you have not had measles (the illness) or if you have not had two doses of MMR vaccine in your lifetime, you may be at risk if visiting countries reporting cases. This is especially a concern if staying with friends or family, mixing with the local population or going to mass gatherings like festivals, sports events or pilgrimages. Measles is easily passed from person to person and can be a serious illness in adults (as well as children). It is never too late to have the vaccine.

You may wish to consider carrying a record documenting vaccination against MMR when travelling abroad.

Advice for health professionals

Guidance on measles vaccination is available in Immunisation against infectious disease Chapter 21. Advice on immunisation against measles is also available for those whose immunisation status is uncertain. In the UK, measles is a notifiable disease. Any case of suspected measles should be notified to the local Health Protection Team.

Resources

Nigeria: yellow fever outbreaks

Suspected and confirmed cases of yellow fever reported to the World Health Organization Read more

Diphtheria in the Caribbean and South America

A reminder for travellers to be up to date with diphtheria vaccine Read more

Polio: Public Health Emergency of International Concern

An update on the polio Public Health Emergency of International Concern (PHEIC) Read more

Hepatitis B vaccine shortage and vaccine prioritisation: advising the traveller

Public Health England and NaTHNaC update the temporary recommendations for hepatitis B containing vaccine use in children and adults travelling to countries of intermediate/high prevalence Read more
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