Resurgence of measles in Serbia 2010–2011 highlights the need for supplementary immunization activities

Abstract

Between December 2010 and August 2011 an outbreak of measles occurred in Serbia with 363 reported cases. Sera and/or nose/throat swabs were collected from 193 patients and tested for measles-specific IgM antibodies by ELISA and viral RNA by RT-PCR, respectively. Epidemiological data were obtained from the surveillance database of the Institute of Public Health of Serbia. Of the 363 cases involved in the outbreak, 113 were laboratory confirmed. More than one third of the patients were hospitalized (n = 130, 35·8%) and for 15 (4·1% of the reported outbreak cases) the infection was complicated by pneumonia. Mostly pre-school children aged ⩽4 years (37·8%) and adults aged ⩾30 years (27·3%) were affected. The majority of patients belonged to the Roma population with a preponderance of female cases (57·0%). Nearly 94% of the patients were either unvaccinated or of unknown vaccination status. The main outbreak virus was the D4-Hamburg strain. The outbreak in Serbia occurred after several years of very low measles incidence despite a high routine immunization coverage in the general population, suggesting that special efforts to identify and vaccinate susceptible population groups are required even in countries with apparently good disease control.

The Roma vaccination gap: Evidence from twelve countries in Central and South-East Europe

“…This paper explores one of many issues affecting Roma, immunisation against common childhood diseases. Several outbreaks of measles among Roma have been linked to low levels of immunisation 10 12 and this has assumed a wider importance as Europe moves towards eradication of measles.…”

Correlation between measles vaccine doses: implications for the maintenance of elimination

“…A high correlation may result from routinely missed populations (e.g. [ 21 , 36 – 38 ]) and heterogeneities in healthcare access that result in positive feedback mechanisms, e.g. poverty traps [ 39 ].…”

Targeted Measles Outbreak Response Vaccination In The Context of Measles Control and Elimination: Experiences From South Sudan

“…Similar trends have been observed in many difficult settings in Africa and South America were follow-up campaigns and intervals of resurgence of multiple outbreaks occurred in less than 2 years. 10,11 Implementation of high quality follow-up campaigns in low resourced settings therefore remains a challenge.…”

“…In recent times, similar factors have accounted for the occurrence of outbreaks in both developing and underdeveloped countries. 10,11,[16][17][18][19] Comparing the risk of measles among vaccinated population over time was limited by possible recall bias since vaccination status of cases was not evidenced by card and detailed history of vaccine handling. Therefore, the extent of variation of trends that could be attributed to vaccine failure may be deficient but possibly cannot be discounted considering the weak health system.…”