Europe Needs to Get on Top of Its Measles Outbreak – Medscape

"Measles should be a memory, not a present risk," Dr Quique Bassat, director general of the Barcelona Institute of Global Health, told Medscape Medical News.

That is certainly not the case right now in some parts of Europe. The World Health Organization (WHO) says the European Region is experiencing an alarming rise in cases, and urgent action is needed. Healthcare professionals are trying to gain control over measles outbreaks and roll out vaccination catch-up campaigns.

Dr Siddhartha Datta is a European regional advisor on vaccine-preventable diseases and immunization for the WHO. He told Medscape Medical News: "What we are seeing currently is an almost 45-fold rise in measles cases in the WHO European Region. In 2022, there were 940 cases, and in 2023 till November, it was around 42,000 plus. Between 2020 and 2022, we have seen 1.8 million children who have missed their measles vaccine doses."

The overriding reason for the resurgence of measles is a backslide in vaccination coverage during the COVID-19 pandemic.

"During the COVID pandemic, we had a 5% decrease in coverage for most of the vaccines, and we are still seeing the consequences," explained Bassat. "Measles is the perfect example of when you have a small drop of coverage you get outbreaks, as it's extremely infectious and complicated to control."

Reported national coverage with the first dose of measles-containing vaccine in the European Region fell from 96% in 2019 to 93% in 2022. Second-dose coverage fell from 92% in 2019 to 91% in 2022.

"You need to have 95% of the population vaccinated if you want herd immunity," explained Bassat.

The WHO European Region comprises 53 countries, including Russia and some countries in central Asia. Its figures show Kazakhstan had the most recorded cases of measles last year, at more than 13,000, followed by the Russian Federation.

Romania declared a national epidemic in December 2023. Datta said there have also been outbreaks in Austria and France.

The UK Health Security Agency declared a major incident in January 2024 because of a surge in cases. From October 2023 to January 2024, there were 347 lab-confirmed cases of measles in England, with 127 of these confirmed in January. The West Midlands is an area of particular concern.

"It was not as though everything was rosy before COVID," said Datta. "We saw wide variation in the coverage rates before the pandemic. Some countries weren't doing as well. More particularly between some communities or municipalities, there were wide variations, and COVID-19 exacerbated the inequities in coverage. What we are seeing now is a combination of gaps before and after the pandemic, so it's a compound problem."

Belgium has also seen a measles resurgence, but not as many cases as the year before the pandemic. Dr Laura Cornelissen works at the Belgian Public Health Institute, Sciensano, where she leads a team working on vaccine-preventable diseases.

She told Medscape Medical News: "We did observe a significant rise in cases and several clusters in 2023, compared to the very low numbers that were observed during the COVID-19 years. Preliminary figures indicate 85 measles cases for Belgium in 2023, leading to at least 26 hospitalizations. This is compared with eight cases for 2022, seven in 2021, and 47 in 2020; but 480 cases in the pre-pandemic year 2019."

Dr Sabrina Bacci, head of vaccine-preventable diseases and immunization at the European Centre of Disease Control, told Medscape Medical News: "There have been a high number of cases in Romania and smaller outbreaks in other countries. However, there are a number of European countries which haven't seen measles. Even though we have this variation between the different European countries, the tools to respond to outbreaks are the same."

Vaccine hesitance or even refusal is on the rise in Europe and elsewhere in the world.

"We can see from behavioral insights that, during COVID, people's trust on vaccines, healthcare systems, and the government in general has gone down," said Datta. "There had been skepticism before about the MMR jab causing autism, which was proved wrong, but vaccine skepticism shown throughout COVID is now showing its head in routine vaccine systems."

The rise of so-called anti-vaxxers and associated fake conspiracy theories, including a mistrust of Big Pharma, hasn't been helpful for encouraging essential childhood vaccination uptake, like measles, mumps, and rubella (MMR).

But the MMR vaccine backslide does not only originate in the pandemic.

Dr Vanessa Saliba, consultant epidemiologist at the UK Health Security Agency, said: "MMR vaccine coverage has been falling for the last decade, with 1 out of 10 children starting school in England not protected."

It could be that some people have religious concerns about the use of pork gelatin as a stabilizer in MMR vaccines. An alternative vaccine that does not contain pork gelatin can be requested.

Doctors and others in healthcare have a pivotal role to play when it comes to getting on top of the surges and educating patients, according to Bacci. "Healthcare professionals are the most precious resource we have, as they are the ones on the frontline explaining the importance of vaccination to their patients. It's a very important dialogue."

Intensified routine immunization clinics and catch-up campaigns have been established in countries across Europe where they are needed.

Countries with large outbreaks are carrying out case investigations, identifying and vaccinating susceptible contacts, and generally raising awareness and implementing outbreak response immunization.

"Countries are really making good efforts and are systematically catching up the children who have missed their doses in the last 2 years. But the recovery to the 2019 levels has been slow, and more efforts and energy [need] to be put into this. We understand healthcare systems are stretched out from COVID, but this is not the time to lower our guard," Datta said.

"Some countries are more proactive than others," added Bassat. "Measles is an example of a disease where you typically organize catch-up campaigns. Measles has one of the highest reproductive numbers, as in the absence of preventive measures one infected person infects 14-16 others."

All countries, even if they haven't yet experienced measles outbreaks, are being urged by European healthcare authorities to look at potential immunity gaps and address them immediately.

"Measles was a disease that was targeted for elimination, but because of these outbreaks, we are seeing it almost everywhere again. We need to be careful and get on top of this," warned Bassat.

Datta said it's up to member states, decision-makers, healthcare leaders, and parents to come together to raise the immunity profiles of the European population. "Vaccination is a shared responsibility. The tools are effective. We just need to be ahead of the virus, and that is the challenge."

Bacci added, "We have to remember we are entering the spring, which is a season when, traditionally, the disease can spread more easily, and it can find its way when people are susceptible. The vaccine is the tool that can help, and we have to act now and make sure it's offered on time."

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Europe Needs to Get on Top of Its Measles Outbreak - Medscape