Obstacles in measles elimination: an in-depth description of a measles outbreak in Ghent, Belgium, spring 2011

BACKGROUND: From Mid-February to April 2011 one of the largest measles-outbreak in Flanders, since the start of the 2-dose vaccination scheme in 1995, took place in Ghent, Belgium. The outbreak started in a day care center, infecting children too young to be vaccinated, after which it spread to anthroposophic schools with a low measles, mumps and rubella vaccination coverage. This report describes the outbreak and evaluates the control measures and interventions. METHODS: Data collection was done through the system of mandatory notification of the public health authority. Vaccination coverage in the schools was assessed by a questionnaire and the electronic immunization database ‘Vaccinnet’. A case was defined as anyone with laboratory confirmed measles or with clinical symptoms and an epidemiological link to a laboratory confirmed case. Towards the end of the outbreak we only sought laboratory confirmation for persons with an atypical clinical presentation or without an epidemiological link. In search for an index patient we determined the measles IgG level of infants from the day care center. RESULTS: A total of 65 cases were reported of which 31 were laboratory confirmed. Twenty-five were confirmed by PCR and/or IgM. In 6 infants, too young to be vaccinated, only elevated measles IgG levels were found. Most cases (72%) were young children (0–9 years old). All but two cases were completely unimmunized. In the day care center all the infants who were too young to be vaccinated (N=14) were included as cases. Thirteen of them were laboratory confirmed. Eight of these infants were hospitalized with symptoms suspicious for measles. Vaccination coverage in the affected anthroposophic schools was low, 45-49% of the pupils were unvaccinated. We organized vaccination campaigns in the schools and vaccinated 79 persons (25% of those unvaccinated or incompletely vaccinated). CONCLUSIONS: Clustering of unvaccinated persons, in a day care center and in anthroposophic schools, allows for measles outbreaks and is an important obstacle for the elimination of measles. Isolation measures, a vacation period and an immunization campaign limited the spread of measles within the schools but could not prevent further spread among unvaccinated family members. It was necessary to raise clinicians' awareness of measles since it had become a rare, less known disease and went undiagnosed

Immunisation of migrants in EU/EEA countries: Policies and practices

In recent years various EU/EEA countries have experienced an influx of migrants from low and middle-income countries. In 2018, the “Vaccine European New Integrated Collaboration Effort (VENICE)” survey group conducted a survey among 30 EU/EEA countries to investigate immunisation policies and practices targeting irregular migrants, refugees and asylum seekers (later called “migrants” in this report). Twenty-nine countries participated in the survey. Twenty-eight countries reported having national policies targeting children/adolescent and adult migrants, however vaccinations offered to adult migrants are limited to specific conditions in seven countries. All the vaccinations included in the National Immunisation Programme (NIP) are offered to children/adolescents in 27/28 countries and to adults in 13/28 countries. In the 15 countries offering only certain vaccinations to adults, priority is given to diphtheria-tetanus, measles-mumps-rubella and polio vaccinations. Information about the vaccines given to child/adolescent migrants is recorded in 22 countries and to adult migrants in 19 countries with a large variation in recording methods found across countries. Individual and aggregated data are reportedly not shared with other centres/institutions in 13 and 15 countries, respectively. Twenty countries reported not collecting data on vaccination uptake among migrants; only three countries have these data at the national level. Procedures to guarantee migrants’ access to vaccinations at the community level are available in 13 countries. In conclusion, although diversified, strategies for migrant vaccination are in place in all countries except for one, and the strategies are generally in line with international recommendations. Efforts are needed to strengthen partnerships and implement initiatives across countries of origin, transit and destination to develop and better share documentation in order to guarantee a completion of vaccination series and to avoid unnecessary re-vaccination. Development of migrant-friendly strategies to facilitate migrants' access to vaccination and collection of vaccination uptake data among migrants is needed to meet existing gaps

Eliminatie van Mazelen en Rubella in 2010 : halen we de doelstelling ?

Mazelen is één van de meest besmettelijke infectieziekten waarbij tot in 30% van de gevallen complicaties optreden. Het congenitaal rubellasyndroom is een verzamelnaam voor de afwijkingen die kunnen optreden bij een kind waarvan de moeder tijdens de zwangerschap besmet werd met rubella. Het Regionaal Bureau voor Europa van de Wereldgezondheidsorganisatie gaf in 2010 prioriteit aan de eliminatie van mazelen en het congenitaal rubellasyndroom. Dit artikel beschrijft de belangrijkste klinische en diagnostische aspecten van mazelen en van het congenitaal rubellasyndroom. Vervolgens wordt een overzicht gegeven van de surveillance van mazelen en rubella in België. Hieruit blijkt dat ook in 2009 er nog verschillende gevallen van mazelen voorkwamen. De eliminatiedoelstelling kan bereikt worden maar vraagt een blijvende inspanning van alle gezondheidswerkers

Mazelenepidemie in België. Stand van zaken januari to midden mei 2011.

In België werd tussen 1 januari en 15 mei 2011 melding gemaakt van minstens 231 gevallen van mazelen, terwijl er in het jaar 2010 slechts sprake was van 40 gevallen. Van de 142 gevallen waarvan de vaccinatiestatus gekend was, waren 119 (84%) gevallen niet gevaccineerd. Deze toename in 2011 kan verklaard worden door het nog altijd bestaan van subgroepen met een lage vaccinatiegraad en door de onvoldoende hoge vaccinatiegraad met het mazelen-bof-rubellavaccin in het verleden, waardoor een accumulatie van vatbare personen mogelijk werd. In meerdere Europese landen worden gelijkaardige uitbraken vastgesteld in 2010 en 2011. Naar aanleiding van de Europese vaccinatieweek van 23-30 april 2011 ondernam de Vlaamse Gemeenschap verscheidene sensibilisatieacties. Vanuit het Comité voor de Eliminatie van Mazelen en Rubella gebeurde er een actieve communicatie naar de ziekenhuizen en naar het algemene publiek