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Current measles epidemiology in Central and Eastern Europe – can we do better? (CROSBI ID 634123)

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Tešović, Goran Current measles epidemiology in Central and Eastern Europe – can we do better? // 1st Croatian Congress on Travel, Tropical, Migration Medicine & HIV with International Participation - Book of Abstract. 2015

Podaci o odgovornosti

Tešović, Goran

engleski

Current measles epidemiology in Central and Eastern Europe – can we do better?

Measles is a serious and highly contagious infectious disease that can easily spread through airborne respiratory droplets or by direct contact with nasal and throat secretions of infected individuals. Although the majority of patients recover without complications, approximately 30% of cases are complicated by diarrhoea, pneumonia, otitis media, encephalitis and even death. Preschool age children and adults older than 20 years of age are more prone to complications. Measles vaccines are available as live, attenuated, monovalent vaccines or in combination with mumps and rubella (MMR) and/or varicella (MMRV) vaccines. In 2011, about 84% of the world’s children received one dose of the vaccine by their first birthday through routine health services – up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity and prevent outbreaks, as about 15% of vaccinated children fail to develop immunity from the first dose. Despite the widespread availability of safe and effective vaccines, measles remains a global public concern, especially in countries where infection is still endemic. During 2000–2011, annual measles incidence decreased by 65% worldwide, from 146 to 52 cases per 1 million population and the estimated number of measles deaths decreased by 71%, from 548, 000 to 158, 000. However, widespread transmission of MV began in late 2009, with large outbreaks being reported in various countries. Outbreaks in Europe contributed to a rise in the global number of reported cases from 7, 499 in 2009 to 30, 625 in 2010, mostly occurring in Western European countries. Between March 2012 and February 2013, a total of 8, 127 cases of measles were reported across 30 European countries (29 European Union/European Economic Area [EU/EEA] countries, plus Croatia), mostly in the unvaccinated population. Furthermore, Romania and four developed countries (France, Italy, Spain and the United Kingdom) accounted for 94% of cases. Immunisation against measles is recommended for all susceptible children and adults for whom measles vaccination is not contraindicated. The attenuated, live measles vaccines that are internationally available are safe and effective, and provide long-lasting protection. Reaching all children with two doses of measles vaccines should be the standard for all national immunisation programmes. To limit the impact of measles outbreaks, the WHO encourages surveillance for early detection, through assessment of the risk of spread and of severe disease outcomes, and rapid responses, including expanded use of the measles vaccine. It is recommended that vaccination is administered within 2 days of exposure to protect high-risk patients during an outbreak as this may modify the clinical course of the disease and may even prevent symptoms. Routine measles vaccination programmes have been in place for more than four decades across all Central/Eastern European countries. Slovenia was the first country to introduce a two-dose MMR vaccine schedule in 1976, but currently, all countries in the region have adopted a two-dose MMR vaccine schedule. Currently, measles vaccination for children is mandatory in most countries. Data regarding measles vaccine coverage are not consistent across the region. According to the most recent data collected in 2011, only the Czech Republic, Croatia, Hungary and Slovakia achieved and sustained the ≥95% two-dose MMR vaccine coverage recommended by the WHO in order to eliminate measles by 2015. In Lithuania, vaccine coverage dropped from 97.9% to 93.7% in 2002–2011. In Turkey, a measles elimination programme has existed since 2002 and in 2003–2005, 18.5 million doses were distributed among children aged <15 years. In Bulgaria, although the measles vaccine has been part of the immunisation programme since 2002, two-dose MMR vaccine coverage (local and national) has remained below the 95% coverage rate targeted by the WHO, which can explain, at least in part, the large number of cases reported during the 2009–2010 outbreak. Vaccination coverage is especially low among the Roma population who represent an important ethnic minority in many Central and Eastern European countries and are at increased risk for measles infection. Although measles vaccines are strongly recommended for high-risk groups (i.e. those in contact with immunocompromised or measles infected patients, those who plan to travel to high-risk countries, and those who work in healthcare facilities), no official recommendations exist for high-risk groups in Croatia, Estonia, Latvia and Slovakia and for specific age groups in Latvia and the Czech Republic. Control measures for measles outbreaks are implemented in most CEVAG countries. In Bulgaria, vaccine initiatives such as social welfare, financial support, and social mediators are provided to address measles outbreaks. There is also a national programme for eradication of measles and congenital rubella in Bulgaria, which unfortunately has not been very successful. Croatia conducts contact tracing and vaccination of susceptible contacts, including healthcare workers without evidence of immunity, and recommends voluntary quarantine of susceptible contacts that cannot be vaccinated due to contraindications. In the Czech Republic, outbreak control measures include reporting of all cases, laboratory confirmation, case isolation, active sourcing and contact investigation, mass vaccination, including unprotected individuals within 3 days of contact and the unprotected population 3 days after contact, immunoglobulin administration to unvaccinated children up to 15 months of age, and medical supervision of unvaccinated individuals for 21 days. In Poland, control of measles outbreaks involves local immunisation campaigns among the Roma population. In Romania, control measures for outbreaks include vaccination campaigns in affected areas, free vaccination and regular meetings with local public health representatives to increase awareness in the general population. In Slovenia, measures include tracking of contacts, strict isolation of patients, vaccination of all susceptible contacts (i.e. contacts who have not completed the two-dose vaccination schedule or have no evidence of previous natural infection). In Turkey, MMR is given within 3 days after exposure to contacts aged >6 months, while intravenous immunoglobulin is given to those <6 months. One dose of MMR vaccine is given to unvaccinated children aged 1–4 years and to vaccinated healthcare workers, or two doses within 1 month interval, if they were previously unvaccinated. The recent epidemiology of measles in Central/Eastern European countries highlights the importance of continued vaccination as disease rates decline, and the need to reduce the threats posed by unsubstantiated claims about the vaccine that undermine the success of vaccination programmes. In conclusion, despite the remarkable impact that measles immunisation has on disease transmission, there are still obstacles that need to be overcome to eradicate measles in the Central/Eastern European region. Maintaining high immunisation coverage and strengthening surveillance are essential in order to meet and to maintain the 2015 WHO measles elimination target of <1 case per million population.

Measles; epidemiology; Central Europe; Eastern Europe

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Podaci o prilogu

2015.

objavljeno

Podaci o matičnoj publikaciji

1st Croatian Congress on Travel, Tropical, Migration Medicine & HIV with International Participation - Book of Abstract

Podaci o skupu

1st Croatian Congress on Travel, Tropical, Migration Medicine & HIV with international participation

predavanje

01.10.2015-04.10.2015

Dubrovnik, Hrvatska

Povezanost rada

Kliničke medicinske znanosti