Ongoing measles outbreak in Greece related to the recent European-wide epidemic

Abstract

We report an ongoing measles outbreak in Greece. The first cases were notified through the mandatory notification system on May 2017 in Northern Greece and concerned a cluster of three imported cases in unvaccinated Roma siblings. So far, 3150 cases have been reported in all 13 Regions. Initially, the outbreak mainly affected Greek Roma but as it progressed it spread to non-minority Greek nationals. The outbreak reached its ultimate peak on week 10/2018 but from week 15/2018 has been gradually declining. Most cases (60.6%) were Roma (especially children <10 year-old) followed by non-minority Greek nationals (29.3%; mostly young adults). The majority (80.4%) were unvaccinated. Interestingly, 129 (4.1%) cases were healthcare workers (HCWs). Genotype B3 was identified by molecular methods in all 87 cases tested. Overall, 61.3% of the cases were hospitalised. Complications were reported in 17.1% of the cases among which four deaths. The outbreak occurred after 3 years without local endemic measles transmission. Extensive vaccination implemented as the major public health measure managed to prevent the emergence of a large number of cases in refugee/migrant hosting sites. Mitigation efforts currently focus on raising awareness among HCWs and closing the immunisation gap in populations with suboptimal vaccination coverage.

Spatiotemporal Distribution and Genetic Characterization of Measles Strains Circulating in Greece during the 2017–2018 Outbreak

“…Greece had successfully prevented measles since 2014–2015 [ 8 , 9 ]. However, a measles outbreak started in May 2017, with a total of 3258 cases up until November 2018, according to the National Public Health Organization (NPHO) [ 10 , 11 ]. The purpose of this study is to identify the genetic identity of the measles strains that circulated in Greece during this outbreak, as well as to present their spatial and geographical distribution, in order to identify the sources of importation and transmission patterns of the virus in the country.…”

Viral ecosystem: An epidemiological hypothesis

“…According to recent reports from World Health Organization (WHO), measles outbreak in Europe reaches more than 41 000 cases and 37 measles‐related deaths . According to our hypothesis, suppression of the outer zone can cause measles outbreak.…”

Roma Health: An Overview of Communicable Diseases in Eastern and Central Europe

“…Secondly, and perhaps more concerning to many, there is the fact that as long as segregated Roma continue to exhibit a higher prevalence of disease, they remain a reservoir for neglected and immunisable diseases which could easily spill over into the general population. This has happened several times already in the case of measles [ 37 , 38 ]. Lastly, Roma communities that do not have a high disease burden also need attention.…”