The measles outbreak in Bulgaria, 2009–2011: An epidemiological assessment and lessons learnt

Abstract

Measles re-emerged in a nationwide outbreak in Bulgaria from 2009 to 2011 despite reported high vaccination coverage at national level. This followed an eight-year period since the last indigenous cases of measles were detected. The Bulgarian National Centre of Infectious and Parasitic Diseases collated measles surveillance data for 2009–2011. We analysed data for age group, sex, ethnicity, diagnosis confirmation, vaccination, hospitalisation, disease complications, and death and describe the outbreak control measures taken. The outbreak started in April 2009 following an importation of measles virus and affected 24,364 persons, predominantly Roma. Most cases (73%) were among children < 15 years old. Vaccination status was available for 52% (n = 12,630) of cases. Of children 1–14 years old, 22% (n = 1,769) were unvaccinated and 70% (n = 5,518) had received one dose of a measles-containing vaccine. Twenty-four measles-related deaths were reported. The Roma ethnic group was particularly susceptible to measles. The magnitude of the outbreak resulted primarily from the accumulation of susceptible children over time. This outbreak serves as a reminder that both high vaccination coverage and closing of immunity gaps across all sections of the population are crucial to reach the goal of measles elimination.

Ongoing measles outbreak in Greece related to the recent European-wide epidemic

“…This finding is consistent with reported measles cases in Italy, where adults were the most affected age group, with 68% of reported cases aged above 20 years [16–17]. In addition, a number of measles cases in fully vaccinated individuals were also reported in Greece, as well as in outbreaks in other countries [18–19] which might be attributed to vaccine failure.…”

Indirect costs associated with deaths of children aged 0–14 years from measles in a weak health system and conflict and fragile zone: the case of Somalia

“…The present study estimation of a significant indirect cost associated with measles-related deaths may be a clear pointer that the disease continues to affect Somalia, especially among children 14 years and younger, robbing off their future productivity and contributions to society. The findings support outcomes of previous studies which reported that measles complications and deaths were disproportionately borne by underage children [37, 38]. The results also relate to the continued global burden of measles in terms of incidence even in developed countries in the European and Western Pacific Regions [39, 40] and in the United States [40, 41].…”

Impact of infectious diseases on population health using incidence-based disability-adjusted life years (DALYs): results from the Burden of Communicable Diseases in Europe study, European Union and European Economic Area countries, 2009 to 2013

“…However, it could still be valuable to show the effect of an outbreak given that such can cause rankings to substantially change from the baseline. For example, the burden of disease was 35.5 DALYs per 100,000 Bulgarian population per year considering the 2010 measles outbreak of just under 22,000 cases [ 34 ]. This burden would have led to this outbreak ranking fourth in our results, between HIV/AIDS and IPD.…”