Of the 26,000 reported measles cases in 36 European countries from January to October 2011, 83% have occurred in Western Europe, which is supposed to have world-leading public health services. WHO (World Health Organization) Europe has issued a stern warning to European nations, explaining that the ever-growing measles outbreaks pose a “serious public health (threat) with economic implications”. In a new report, WHO Europe says that European nations should take effective and prompt preventive action to combat measles transmission during the approaching high season and beyond.

Europe’s high season for measles is generally from February until the end of May.

14,000 of the reported cases in Europe during that period have occurred in France. So far, there have been 7,288 hospitalizations due to measles, and nine deaths in Europe; six of the deaths in France.

Ms Zsuzsanna Jakab, WHO Regional Director for Europe, said:

“The increase in measles in European countries reveals a serious challenge to achieving the regional measles elimination goal by 2015. Every country in the European Region must take the opportunity now to raise coverage amongst susceptible populations, improve surveillance and severely reduce measles virus circulation before the approaching measles high season.”

Director of the European CDC (Centre for Disease Control), Dr. Marc Sprenger, said:

“A substantial commitment is needed and should involve all stakeholders, especially health professionals who have a decisive role to play in helping parents make informative decisions regarding vaccination.”

A European child with day-4 measles rash

Western Europe has now become one of the three measles hotspots worldwide, together with the Democratic Republic of Congo, which has over 100,000 reported cases so far this year, Nigeria with over 15,000 and Somalia with at least another 15,000.

In the world today, where air travel is commonplace, a regional outbreak of a very contagious disease affects other regions. The European outbreak has been the cause of reported measles cases in the USA, Canada, Australia, Brazil and South-East Asia. The USA says that 2011 has had more reported cases than in any year since 1996.

Nine in every ten measles cases in Europe have occurred in adolescent and adult individuals who had either not been vaccinated, or their vaccination status was unknown.

The Measles Initiative emphasizes that countries have a collective responsibility to control and eliminate the disease – what occurs in one country, can have a knock-on effect in others. The Measles Initiative aims to reduce measles deaths by 95% worldwide compared to 2000 figures.

On behalf of the Measles Initiative, Dr. Stephen Cochi, Senior Advisor for immunization at the U.S. CDC (Centers for Disease Control and Prevention), said:

“Measles elimination requires focused attention on every country with measles and support to the developing countries which still carry the highest burden of measles cases and deaths.”

French health authorities have responded with a France-wide communications campaign aimed at raising awareness and the urgent need for measles vaccination. The campaign is being directed at the most relevant age-groups, asking people to check their vaccination status, and to take action if necessary.

The French Ministry of Health is urging everybody born after 1980 to make sure they receive two doses of the MMR (mumps, measles and rubella) vaccine. The majority of infections in France have occurred in young people over the age of 10. Children in daycare centers should be vaccinated when they are 9 months old, instead of the usual 12 months. A second dose should be administered before they are 24 months old.

Director-General for Health in France, Mr. Jean-Yves Grall, said:

“France can simply not afford to have deaths, painful and costly hospitalizations, disruptions to work and school from a completely vaccine-preventable disease. France is now actively encouraging two doses of measles vaccine for everyone born since 1980. High vaccination coverage in France and every European country is essential to stop this measles outbreak for good.”

In 2008 there was a measles outbreak in Arizona, USA, involving 7 infections. It was eventually traced to one person who had come into the state from Switzerland. Two hospitals were affected, there was considerable disruption. A well-documented report showed that responding and containing just that outbreak, involving just 7 people, cost $800,000. For $800,000 approximately 2.5 million measles vaccine doses can be purchased for developing nations.

The Measles Initiative managed to bring down total global measles deaths by 78% over an eight-year period ending in 2008. Unfortunately, measles is making a global comeback and is estimated to be causing the deaths of over 164,000 children annually – 450 per day. The Initiative says there is a $43 million funding gap for its 2012 campaign.

According to WHO, the measles vaccine (or MMR, which covers measles) protects over 99% of vaccinated people. If 95% of a population is vaccinated, the likelihood of complete elimination of the disease is extremely high.

The Measles Initiative is a worldwide collaboration between WHO, UNICEF, US CDC, and the American Red Cross. It has dedicated over $875 million in activities to control the disease, and has managed to vaccinate over 1 billion children in over 80 nations. The Initiative has probably saved about 4.3 million lives.

Measles is caused by the rubeola virus and is a highly infectious disease. It is continually present in the community, where a sizeable proportion of the population develops resistance – it is an endemic disease.

If the virus enters an area where nobody has been exposed or vaccinated, the consequences can be devastating. In 1592, about two-thirds of the native population of the island of Cuba perished because of measles; two years later, half of the native population of Honduras died from similar causes.

WHO estimates that measles has killed at least 200 million people worldwide over the last 150 years. In the 1850s approximately 20% of the population of Hawaii died from measles.

Measles complications are fairly common, especially among those with weakened immune systems, such as patients with leukemia or HIV/AIDS, very young children, and individuals with vitamin deficiency. An adult has a higher risk of complications compared to a healthy child over 5 years of age.

1 in every 5 measles patients has some kind of complication, which can include:

    The more common complications

  • Diarrhea
  • Eye infection
  • Febrile convulsion
  • Laryngitis and bronchitis
  • Pneumonia
  • Vomiting
  • Less common complications

  • Encephalitis (affects about 1/1000 measles patients)
  • Hepatitis
  • Squint
  • Thrombocytopenia
  • Extremely rare, but possible complications

  • Neuritis
  • Heart complications
  • Subacute sclerosing panencephalitis (SSPE)
  • Ascending myelitis
  • Retrobulbar neuritis
  • Toxic encephalopathy
  • Transverse myelitis
  • Complications during pregnancy

  • Low birth weight
  • Miscarriage
  • Premature labor

Written by Christian Nordqvist