Global Alert and Response (GAR)

Measles outbreaks: Regions of the Americas, Europe and Africa

7 OCTOBER 2011 - In 2011 several large measles outbreaks have been reported from Member States in the European and African regions, with several reported outbreaks in the Americas linked to Europe or Africa.

Europe: As of 20 September 2011, 40 of 53 Member States in the WHO European Region have reported 26 025 confirmed measles cases for the period January – July 2011 to the WHO European Regional Office through routine surveillance and outbreak reports. The highest number of cases was reported from France with 14 025 cases for the first six months of the year. In addition, eleven of all cases in the Region were lethal (6 in France and one in each of Germany, Kyrgyzstan, Romania, the Former Yugoslav Republic of Macedonia and the United Kingdom). The predominant genotype currently circulating in the European Region is D4, the same endemic genotype from the United Kingdom in 2008. The most recent outbreak was reported from Israel in September, with 12 cases. Member States have responded to the outbreak by modifying the vaccination schedule, like France, or by offering vaccination free of charge or in schools, to increase accessibility to and availability of vaccines.

Africa: The Regional Office reports that as of September 2011 large measles outbreaks are being reported by the Democratic Republic of the Congo, with over 103 000 cases, Nigeria, with 17 428 cases, and Zambia, with 5 397 cases, and Ethiopia, with 2 902 cases. Even though deaths are not routinely reported to the Regional Office, the WHO Country Office in the Democratic Republic of the Congo reports over 1100 measles-associated deaths in the country during 2011.

Americas: The last case of endemic measles was reported from the region in 2002. In 2011 the Region has received reports of several outbreaks linked to importation of measles virus from other regions. The largest, in Quebec, Canada, involves 742 reported cases, 89 requiring hospitalization, but no measles-associated deaths. Other outbreaks have been reported from the United States (213 cases), Ecuador (41 cases), Brazil (18 cases), Columbia (7 cases), Mexico (3 cases), and Chile (6 cases). Most of these outbreaks are linked to importations from Europe, except for outbreaks in the United States and Chile linked to cases from Malaysia and the outbreak in Ecuador, linked to Kenya.

Measles is a highly infectious disease that causes complications and deaths, even in previously-healthy individuals, but is fully preventable by vaccination. Countries need to ensure that they reach 95% coverage with two doses of measles vaccine across all age groups up to 15 years of age. Otherwise the country will experience measles outbreaks with large numbers of cases, associated hospitalizations and deaths. The recent outbreaks in countries with high volumes of international travellers can lead to measles exportation to regions previously free of measles, such as the Region of the Americas or certain African countries. These exportations can lead to large outbreaks and associated deaths.

These outbreaks should remind travellers that they should ensure that they have had two doses of measles-containing vaccine before their trip.

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