Large measles outbreak introduced by asylum seekers and spread among the insufficiently vaccinated resident population, Berlin, October 2014 to August 2015

Abstract

The largest measles outbreak in Berlin since 2001 occurred from October 2014 to August 2015. Overall, 1,344 cases were ascertained, 86% (with available information) unvaccinated, including 146 (12%) asylum seekers. Median age was 17 years (interquartile range: 4–29 years), 26% were hospitalised and a 1-year-old child died. Measles virus genotyping uniformly revealed the variant ‘D8-Rostov-Don’ and descendants. The virus was likely introduced by and initially spread among asylum seekers before affecting Berlin’s resident population. Among Berlin residents, the highest incidence was in children aged < 2 years, yet most cases (52%) were adults. Post-exposure vaccinations in homes for asylum seekers, not always conducted, occurred later (median: 7.5 days) than the recommended 72 hours after onset of the first case and reached only half of potential contacts. Asylum seekers should not only have non-discriminatory, equitable access to vaccination, they also need to be offered measles vaccination in a timely fashion, i.e. immediately upon arrival in the receiving country. Supplementary immunisation activities targeting the resident population, particularly adults, are urgently needed in Berlin.

Toxicity: exploring and expanding the concept

“…The positive reputation attached to antibiotics led to overprescribing for more than a half‐century, creating penicillin‐related allergic reactions and the evolution of medication‐resistant bacteria. In the opposite direction, the negative reputation of childhood vaccinations leads to ‘vaccine hesitancy’ and fewer vaccinations for fear of relatively rare adverse reactions, causing a resurgence of measles outbreaks and associated fatalities .…”

Current course of measles in adults (a literature review)

“…An important feature of the measles outbreaks in recent years is the prevalence among adult patients in the typical clinical picture of measles. In Germany, a percentage of adult patients with measles was 52 % [16], in Italy, 73% of measles patients were older than 15 years [17], in Belgium, 50 % of patients were over 15 years old [18]. The predominance of adults among patients with measles is noted not only in European countries.…”

Masern-Impfung bei Asylsuchenden in der Erstaufnahmeeinrichtung (EAE) Bielefeld: Impfquote 73%, Impfablehnung 21%

“…Verschiedene Studien deuten darauf hin, dass für das Vorliegen einer Herdenimmunität die Masern-Immunität von Asylsuchenden in Einrichtungen in Deutschland zu niedrig ist [5][6][7][8][9]. Trotzdem war es überraschend, dass die Impfquote (bezüglich zumindest einer dokumentierten Masern-Impfdosis) in der EAE Bielefeld nur bei 73 % lag.…”

“…Masern-Impfung bei Asylsuchenden in … Gesundheitswesen 2020; 82: e67-e71 [3,4]. Verschiedene Studien über Masern-Schutz bei Asylsuchenden suggerieren ebenfalls, dass für den Aufbau einer Herdenimmunität die Immunität gegen Masern in dieser Gruppe zu niedrig ist [5][6][7][8][9]. Momentan ist es dennoch unklar, wie hoch die Masern-Impfquoten von Asylsuchenden in den unterschiedlichen Gemeinschaftsunterkünften in Deutschland sind.…”