In which region of Greece is there a measles outbreak? The measures to come

measles

An informal meeting is scheduled today at the Hellenic National Public Health Organization (EODY) to define the operational plan for measles immunisation

The health authorities of Greece are on standby, in the wake of the measles outbreak in Europe. Strengthening vaccination coverage in children and adults who have not received the second dose, shielding vulnerable populations, and training younger health personnel to recognise the clinical picture of measles are at the heart of EODY's strategy.

In this context, an informal meeting at EODY, at an operational level, is scheduled for today, in which the establishment of a working group with the role of organising interventions that will prevent a wave of measles, such as the last one in 2017-2018, will be discussed.

EODY's mobilisation is directed by the remarkable increase in measles cases in Europe in 2023. In addition, there is a local outbreak of cases in Crete.

The... laxity in vaccination brings an increase in measles cases. In Greece, the exact rates of vaccination coverage are not known because the child vaccination register that has been put in place is not updated – pediatricians face difficulties as it is a time-consuming process, they say.

The EODY, to define the roadmap for any epidemic of the disease, requested accurate information from social security services on the prescription of vaccines in all previous years.

The problem, it seems, is with citizens born after 1970 and especially after 1990, as they are likely not to have had both doses of the vaccine. Health authorities consider it extremely important that these citizens check their measles vaccination status.

At the same time, the pandemic proved to be a limiting factor for vaccination, with EODY experts estimating that several young children whose vaccination program coincided with the coronavirus pandemic have an immunity gap.

17 out of 100 children are unvaccinated

According to the latest available data from the European Center for Disease Control and Prevention (ECDC), in 2021, vaccination coverage with the measles vaccine in Greece was at 97% for the first dose (given to children around one year old) and 83% for the second dose (performed in children around 2-3 years old).

The percentage of 83% is considered small, according to experts, since for measles to continue to be considered an "extinct" disease, vaccination rates must exceed 90%. From this data, the coverage rate of adults is unknown, although the most significant volume of data concerns minors.

The official recommendation, however, is for people born from 1970 onwards who have not had measles to get the vaccine.

Another issue that Public Health officials have to manage is young doctors' recognition of the disease. Given that measles is not often found in Greece due to vaccination, many doctors have yet to be called upon to manage it.

As pediatricians point out at Ygeiamou.gr, measles infection begins with respiratory symptoms and continues with fever, and the characteristic rash appears 3-4 days after the onset of symptoms.

Therefore, training health personnel in diagnosing the disease and its treatment is one of the measures included in the EODY strategy.

In addition, because special populations are particularly vulnerable, such as immigrants and Roma, groups in which transmission is high and due to living conditions, mass vaccinations cannot be ruled out, as they have been done in the past.

Warning from the World Health Organization

The warning for vigilance was rung by the World Health Organization (WHO), according to which measles cases increased last year in Europe by 30 times. In particular, more than 30,000 people were infected in 2023, compared to 941 in 2022.

WHO experts believe the vaccination outbreak results from a vaccination gap during the coronavirus pandemic.

“Vaccination is the only way to protect children from this potentially dangerous disease. Urgent vaccination efforts are needed to halt transmission and prevent further spread,” explained Dr Hans Henri P. Kluge, WHO Regional Director for Europe.

“Urgent vaccination efforts are needed to halt transmission and prevent further spread. It is vital that all countries are prepared to rapidly detect and timely respond to measles outbreaks, which could endanger progress towards measles elimination,” he added.

According to the ECDC, there is an outbreak in the UK and other countries emphasising communities and closed populations with low vaccination coverage.

The latest epidemic outbreak of measles

During the period 2004-2022, three measles epidemics occurred in our country: The years 2005-2006, 2010-2011 and 2017-2018. A total of 4,151 cases were reported, with an average annual reported incidence throughout the country of 2.02/100,000 population.

The majority of cases concerned Greek Roma (56.9%) but also young adults from the general population who were unvaccinated or incompletely vaccinated.

The disease showed the highest incidence in the age group 0-4 years. A total of four deaths were reported, with an average annual mortality of 0.02%.

The latter was also the largest epidemic and was connected to the anti-vaccination movement that was at its "top". The epidemic started in 2017 with 968 reported cases and an average annual reported incidence of 8.99/100,000 population. It peaked the following year with 2,291 reported cases and an average annual reported incidence of 21.33/100,000 population. The disease most often affected Southern Greece.

In the year 2022, as in 2021, no measles cases were reported. EODY highlights the possibility of under-declaration due to the ongoing Covid-19 pandemic. Overall, the average annual reported incidence for the period 2004-2022 in the whole country was 2.02/100,000 population (mean number of cases per year: 218.5, total number of cases: 4,151).

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