An interregional measles outbreak in Spain with nosocomial transmission, November 2017 to July 2018

Abstract

Given sustained high vaccination coverage and enhanced surveillance for measles, Spain has been free of endemic measles transmission since 2014, achieving elimination certification from the World Health Organization in 2017. In November 2017, measles was introduced through an imported case travelling to the Valencian Community, causing an interregional outbreak. Here, we describe the outbreak using data reported to the national epidemiological surveillance network. The outbreak involved 154 cases (67 males, 87 females) notified in four regions; 148 were laboratory-confirmed and six epidemiologically linked. Most cases were adults aged 30–39 (n = 62, 40.3%) years. Sixty-two cases were hospitalised (40.3%) and 35 presented complications (22.7%). Two thirds of the cases (n = 102) were unvaccinated including 11 infants (≤ 1 year) not yet eligible for vaccination. The main route of transmission was nosocomial; at least six healthcare facilities and 41 healthcare workers and support personnel were affected. Sequencing of the viral nucleoprotein C-terminus (N450) identified genotype B3, belonging to the circulating MVs/Dublin.IRL/8.16-variant. Control measures were implemented, and the outbreak was contained in July 2018. The outbreak highlighted that raising awareness about measles and improving the vaccination coverage in under-vaccinated subgroups and personnel of healthcare facilities are key measures for prevention of future outbreaks.

Utility of MF-non coding region for measles molecular surveillance during post-elimination phase, Spain, 2017–2020

“…The questionnaire includes items on demographic and clinical characteristics, complications, risk factors and laboratory results for diagnosis. For each confirmed case, we collected the following epidemiological information: date of rash onset, outbreak and chain of transmission identifier (as reported to WHO), contacts with other cases, importation status (case exposed outside of the country in the 7–21 days before symptom onset), type of exposure and molecular data including the WHO name and N450 variant or “named strain.” For our analyses of chains of transmission, we focused on three national outbreaks: (i) B3-Dublin in the region of Navarra in 2017; (ii) B3-Dublin in the region of Valencia in 2017–2018 ( Pampaka et al, 2023 ); and (iii) D8-Gir Somnath in the regions of Madrid and Castilla-La-Mancha in 2019 ( González-Praetorius et al, 2021 ). Table 1 presents the epidemiological characteristics of each of these outbreaks.…”

An Outbreak of Measles in Iraq

“…Despite great efforts from all countries in collaboration with the WHO to prevent measles epidemics, outbreaks of measles occurred in different nations, including developing and developed countries [8][9][10]. The most important risk factor for the measles outbreak is the reduction in vaccination coverage rate [8].…”

“…[12]. As a consequence, the reported cases of measles have increased in number, reaching 11595 on March 12, 2024 and Iraq is considered the 5 th country among the top 10 countries in the world, as indicated in Certain measures should be taken by the Republic of Iraq (Ministry of Health) to prevent measles in the country, these include increasing the awareness of the parents regarding the national timely immunization program, a proper way of identifying and immunizing infants and children, finding a rapid way of distribution of measles vaccines to all regions including distal and rural areas, perform frequent health campaigns to facilitates immunization of larger number of children, increasing the number of primary health care centers to accommodate the increment of the population, specific precautions should be undertaken at the hospital level to prevent the transmission of the virus from an infected individual to healthcare workers, visitors, and other patients (this is considered the main way of transmission of measles virus by a recent study from Spain [9]), and great care is needed for vaccinated the children of the immigrant families from neighboring countries like Syria.…”