Limits...
Obstacles in measles elimination: an in-depth description of a measles outbreak in Ghent, Belgium, spring 2011.

Braeye T, Sabbe M, Hutse V, Flipse W, Godderis L, Top G - Arch Public Health (2013)

Bottom Line: Twenty-five were confirmed by PCR and/or IgM.In 6 infants, too young to be vaccinated, only elevated measles IgG levels were found.Thirteen of them were laboratory confirmed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Scientific Institute of Public Health, Brussels, Belgium. Toon.Braeye@wiv-isp.be.

ABSTRACT

Background: From Mid-February to April 2011 one of the largest measles-outbreak in Flanders, since the start of the 2-dose vaccination scheme in 1995, took place in Ghent, Belgium. The outbreak started in a day care center, infecting children too young to be vaccinated, after which it spread to anthroposophic schools with a low measles, mumps and rubella vaccination coverage. This report describes the outbreak and evaluates the control measures and interventions.

Methods: Data collection was done through the system of mandatory notification of the public health authority. Vaccination coverage in the schools was assessed by a questionnaire and the electronic immunization database 'Vaccinnet'. A case was defined as anyone with laboratory confirmed measles or with clinical symptoms and an epidemiological link to a laboratory confirmed case. Towards the end of the outbreak we only sought laboratory confirmation for persons with an atypical clinical presentation or without an epidemiological link. In search for an index patient we determined the measles IgG level of infants from the day care center.

Results: A total of 65 cases were reported of which 31 were laboratory confirmed. Twenty-five were confirmed by PCR and/or IgM. In 6 infants, too young to be vaccinated, only elevated measles IgG levels were found. Most cases (72%) were young children (0-9 years old). All but two cases were completely unimmunized. In the day care center all the infants who were too young to be vaccinated (N=14) were included as cases. Thirteen of them were laboratory confirmed. Eight of these infants were hospitalized with symptoms suspicious for measles. Vaccination coverage in the affected anthroposophic schools was low, 45-49% of the pupils were unvaccinated. We organized vaccination campaigns in the schools and vaccinated 79 persons (25% of those unvaccinated or incompletely vaccinated).

Conclusions: Clustering of unvaccinated persons, in a day care center and in anthroposophic schools, allows for measles outbreaks and is an important obstacle for the elimination of measles. Isolation measures, a vacation period and an immunization campaign limited the spread of measles within the schools but could not prevent further spread among unvaccinated family members. It was necessary to raise clinicians' awareness of measles since it had become a rare, less known disease and went undiagnosed.

No MeSH data available.


Related in: MedlinePlus

Epidemic curve, measles outbreak Ghent, Belgium 2011. Epidemic curve of measles cases, 10/02/2011 to 18/04/2011 Ghent, Belgium (N=65), sorted by starting date of symptoms. Epidemiological linked cases (=blue) had a known contact with another case.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3716678&req=5

Figure 2: Epidemic curve, measles outbreak Ghent, Belgium 2011. Epidemic curve of measles cases, 10/02/2011 to 18/04/2011 Ghent, Belgium (N=65), sorted by starting date of symptoms. Epidemiological linked cases (=blue) had a known contact with another case.

Mentions: From mid-April on, only a three new cases were reported. These cases were laboratory confirmed but without a clear link to the outbreak. This outbreak consisted of a total of 65 cases (FigureĀ 2).


Obstacles in measles elimination: an in-depth description of a measles outbreak in Ghent, Belgium, spring 2011.

Braeye T, Sabbe M, Hutse V, Flipse W, Godderis L, Top G - Arch Public Health (2013)

Epidemic curve, measles outbreak Ghent, Belgium 2011. Epidemic curve of measles cases, 10/02/2011 to 18/04/2011 Ghent, Belgium (N=65), sorted by starting date of symptoms. Epidemiological linked cases (=blue) had a known contact with another case.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3716678&req=5

Figure 2: Epidemic curve, measles outbreak Ghent, Belgium 2011. Epidemic curve of measles cases, 10/02/2011 to 18/04/2011 Ghent, Belgium (N=65), sorted by starting date of symptoms. Epidemiological linked cases (=blue) had a known contact with another case.
Mentions: From mid-April on, only a three new cases were reported. These cases were laboratory confirmed but without a clear link to the outbreak. This outbreak consisted of a total of 65 cases (FigureĀ 2).

Bottom Line: Twenty-five were confirmed by PCR and/or IgM.In 6 infants, too young to be vaccinated, only elevated measles IgG levels were found.Thirteen of them were laboratory confirmed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Scientific Institute of Public Health, Brussels, Belgium. Toon.Braeye@wiv-isp.be.

ABSTRACT

Background: From Mid-February to April 2011 one of the largest measles-outbreak in Flanders, since the start of the 2-dose vaccination scheme in 1995, took place in Ghent, Belgium. The outbreak started in a day care center, infecting children too young to be vaccinated, after which it spread to anthroposophic schools with a low measles, mumps and rubella vaccination coverage. This report describes the outbreak and evaluates the control measures and interventions.

Methods: Data collection was done through the system of mandatory notification of the public health authority. Vaccination coverage in the schools was assessed by a questionnaire and the electronic immunization database 'Vaccinnet'. A case was defined as anyone with laboratory confirmed measles or with clinical symptoms and an epidemiological link to a laboratory confirmed case. Towards the end of the outbreak we only sought laboratory confirmation for persons with an atypical clinical presentation or without an epidemiological link. In search for an index patient we determined the measles IgG level of infants from the day care center.

Results: A total of 65 cases were reported of which 31 were laboratory confirmed. Twenty-five were confirmed by PCR and/or IgM. In 6 infants, too young to be vaccinated, only elevated measles IgG levels were found. Most cases (72%) were young children (0-9 years old). All but two cases were completely unimmunized. In the day care center all the infants who were too young to be vaccinated (N=14) were included as cases. Thirteen of them were laboratory confirmed. Eight of these infants were hospitalized with symptoms suspicious for measles. Vaccination coverage in the affected anthroposophic schools was low, 45-49% of the pupils were unvaccinated. We organized vaccination campaigns in the schools and vaccinated 79 persons (25% of those unvaccinated or incompletely vaccinated).

Conclusions: Clustering of unvaccinated persons, in a day care center and in anthroposophic schools, allows for measles outbreaks and is an important obstacle for the elimination of measles. Isolation measures, a vacation period and an immunization campaign limited the spread of measles within the schools but could not prevent further spread among unvaccinated family members. It was necessary to raise clinicians' awareness of measles since it had become a rare, less known disease and went undiagnosed.

No MeSH data available.


Related in: MedlinePlus