Measles outbreak after 12 years without endemic transmission, Portugal, February to May 2017

Abstract

We report a measles outbreak in two Portuguese health regions (Algarve and Lisbon and the Tagus Valley) since February 2017, and which by 31 May resulted in 28 confirmed cases, of which 16 were unvaccinated. Thirteen cases were healthcare workers. One unvaccinated teenager died. Genotype B3 was identified in 14 cases from both regions. This outbreak occurs after 12 years without endemic measles transmission, and in a context of high measles vaccination coverage and immunity.

Measles outbreak in a tertiary level hospital, Porto, Portugal, 2018: challenges in the post-elimination era

“…Prior to this, Portugal had 12 years without endemic measles transmission [11]. In the current outbreak, transmission of measles has occurred mainly in the healthcare setting.…”

“…Portugal had its last measles outbreak in 2017 following an imported case [11]. Prior to this, Portugal had 12 years without endemic measles transmission [11].…”

Fever and Rash: Revisiting Measles

“…10 To summarize, our unvaccinated immunocompetent patient presented typical symptoms of measles that evolved rapidly to a rare complication, highlighting the need to promptly diagnose measles in adults even in low incidence regions and to collect a thorough vaccination history.…”

“…8,9 Remarkably, our patient was In Portugal, no endemic transmission had been reported since 2005 and the rate of immune individuals is estimated at 93.4%. 10 The latter can be explained by the fact that measles vaccine was introduced in the Portuguese mandatory immunisation schedule for all children aged 12 -15 months in 1974. 10 Therefore, the high levels of vaccination coverage and immunity in Portugal led us to initially pursue other diagnostic hypotheses, including DRESS syndrome, given the recent drug exposure, eosinophilia, lymphadenopathy, rash, and hepatic and pulmonary involvement, even prompting us to start corticosteroids.…”

“…10 The latter can be explained by the fact that measles vaccine was introduced in the Portuguese mandatory immunisation schedule for all children aged 12 -15 months in 1974. 10 Therefore, the high levels of vaccination coverage and immunity in Portugal led us to initially pursue other diagnostic hypotheses, including DRESS syndrome, given the recent drug exposure, eosinophilia, lymphadenopathy, rash, and hepatic and pulmonary involvement, even prompting us to start corticosteroids. However, our patient was not vaccinated for measles, as she was born in 1972 and was not a candidate for mandatory vaccination at the time.…”