1724. Characteristics of the Ongoing Measles Outbreak in Greece in the Context of the Recent European-wide Epidemic and Public Health Measures

Abstract

BackgroundMeasles is a highly contagious disease which still remains a cause of severe complications, including deaths worldwide, despite the existence of safe and effective vaccines. In the last 3 decades, the incidence of measles in Greece has constantly declined with only sporadic clusters or outbreaks (last outbreak in 2010–2011). We describe the characteristics of the ongoing measles outbreak and the Public Health response.MethodsAll measles cases are reported through the mandatory notification system (EU case definition 2012) to the Department of Surveillance and Intervention of the Hellenic Centre for Disease Control and Prevention. For laboratory confirmation patient sera were tested for IgM antibodies and pharyngeal swabs for the presence of measles virus RNA with RT-PCR. Sequencing of the measles nucleoprotein gene was applied in positively tested serological samples.ResultsFrom 9 May 2017 to 26 April 2018, 2,659 cases were reported in all 13 regions in Greece; 1,605 (60.4%) were laboratory confirmed. Most cases (n = 1,595; 60%) were Roma (73% children <10 years) followed by nonminority Greek nationals (n = 781; 29.4%, of whom 57% young adults 25–44 years), highlighting the immunity gap in Roma population. The vast majority of cases (80.5%) were unvaccinated. Ninety-four (3.5%) cases were healthcare workers (HCW); all were partially or not vaccinated. Genotype B3 was identified by molecular testing in all 88 cases tested. Severe complications were reported in 429 (16.1%) patients, most frequently pneumonia (43.8%) and hepatitis (21.2%). Three deaths were recorded in an 11-month-old immunocompromised Roma infant, a 17-year-old unvaccinated Roma, and a 35 year olds partially vaccinated individual from the general population. Extensive vaccination in refugee/migrant hosting sites prevented the emergence of a large number of cases. Mitigation efforts focused on closing the immunization gap in Roma population through emergency vaccination and raising awareness among HCWs to prevent further spread.ConclusionThe current outbreak highlights the need to achieve high vaccination coverage with 2 doses of MMR vaccine in the general population (children, adolescents, and young adults) and in hard-to-reach vulnerable populations like Roma and refugees.Disclosures All authors: No reported disclosures.

Migration and Outbreaks of Vaccine-Preventable Disease in Europe: A Systematic Review

“…Germany (n=9) (16, 29, 32, 34, 37, 52, 56, 59, 62), Spain (n=8) (43-45, 48, 61, 63-65), Italy (n=6) (33, 36, 40, 46, 47, 58, 60) and Greece (n=5) (28, 42, 50, 51, 54, 55) were the countries that most frequently reported outbreaks involving migrants between 2000 and 2020. Two thirds (n=6) of included outbreaks in Germany affected refugee or asylum-seeking populations, mostly in temporary camps, 78% (n=7) were measles outbreaks and all but one were reported in 2010 or later.…”

“…21 reports discussing measles outbreaks were included, reporting on 24 distinct outbreaks and one report that presented all outbreak-related cases in asylum seekers in Germany from 2004 to 2014. Seven reports originated from Germany (16, 24, 29, 37, 52, 56, 59), four from Greece (50, 51, 54, 55), three from Italy (46, 47, 58), two from Spain (45, 48) and one each from Croatia (53), France (26), Ireland (49), Norway (57) and Poland (35). A large proportion of outbreaks were associated with Eastern European migrants, particularly of Roma nationality, including nine outbreaks with an Eastern European index case (16, 37, 46, 47, 51, 52, 58, 62, 67, 68).…”

“…Post-2015, which saw a major influx of migrants to Europe (69), four measles outbreaks involving migrants were reported, two of which took place in hosting facilities for asylum seekers and refugees (16, 26). Another took place in Greece across 2017 and 2018 and was responsible for 3150 cases, of whom the majority (80.4%) were unvaccinated, with three Romanian Roma siblings reported as the index cases (51). Over half (61.3%) of the cases were hospitalised, with complications reported in 17.1% of cases and four deaths.…”

“…Seven reports originated from Germany (16,24,29,37,52,56,59), four from Greece (50,51,54,55), three from Italy (46,47,58), two from Spain (45, 48) and one each from Croatia (53), France (26), Ireland (49), Norway (57) and Poland (35). A large proportion of outbreaks were associated with Eastern European migrants, particularly of Roma nationality, including nine outbreaks with an Eastern European index case (16,37,46,47,51,52,58,62,67,68). Measles outbreaks were frequently observed in refugee camps, residences or shelters, with a high burden in children and adolescents in both Roma communities and refugee camps.…”

Διερεύνηση μηχανισμών αντοχής στα αντιβιοτικά κλινικών στελεχών streptococcus pneumoniae

“…Σημαντική μείωση των δηλωθέντων περιστατικών διεισδυτικής νόσου από τους 6 επιπρόσθετους ορότυπους του εμβολίου καταγράφηκε επίσης από το Health Protection Agency της Μεγάλης Βρετανίας στα παιδιά κάτω των 2 ετών και ειδικά από τους ορότυπους 19Α και 7F255,256 .Στη Γερμανία τρία χρόνια μετά την ένταξη των συζευγμένων εμβολίων 2ης γενιάς καταγράφονται λιγότερα περιστατικά διεισδυτικής νόσου από τους ορότυπους 1, 3, 7F και 19A σε παιδιά κάτω των 2 ετών257 . Στη χώρα μας, μέσα στο πρώτο χρόνο κυκλοφορίας του PCV-13 καταγράφηκε μείωση 23,3% των περιστατικών πνευμονιοκοκκικής μηνιγγίτιδας σε παιδιά κάτω των 5 ετών258 Επιπλέον, μειώθηκε κατά 55% και η εμφάνιση νόσου σε ενήλικες άνω των 50 ετών που δεν είχαν εμβολιαστεί [76][77][78][79]. Είναι σημαντικό να αναφερθεί η σημαντική μείωση της εμφάνισης των διεισδυτικών πνευμονιοκοκκικών λοιμώξεων από τους ορότυπους του εμβολίου που διαπιστώθηκε σε πολλά ευρωπαϊκά κράτη, όπως μείωση κατά 39% στις πνευμονιοκοκκικές μηνιγγίτιδες και 29% στις βακτηριαιμίες σε παιδιά κάτω των 2 ετών στη Γαλλία242 , μείωση κατά 50% της διεισδυτικής πνευμονιοκοκκικής νόσου σε παιδιά κάτω των 2 ετών στη Γερμανία243 και κατά 40% στην Ισπανία244 ,κατά 95% ελάττωση των διεισδυτικών λοιμώξεων από ορότυπους του PCV-7 σε παιδιά κάτω των 5 ετών στην Νορβηγία245 , κατά 89% σε παιδιά <2 ετών στη Δανία246 και κατά 98% στην Massachusetts), η επίπτωση της διεισδυτικής πνευμονιοκοκκικής νόσου ελαττώθηκε από 20.2/100000 σε 14/100000 παιδιά κάτω των 5 ετών, αν και το ποσοστό των περιστατικών που προκλήθηκαν από οροτύπους του PCV13 δεν ελαττώθηκε σημαντικά (από 66.7% σε 59.2%) 81.…”