Measles cases hit record high in Europe in 2018

Cases of measles in Europe have hit a record high, according to the World Health Organization (WHO).1 More than 41 000 people have been infected in the first 6 months of 2018, leading to 39 deaths.1,2 The total number for this period far exceeds the 12-month totals reported for every other year this decade. In 2016, there were 23 927 cases whilst in the year before there were only 5273. The number of cases of measles in the UK from January to June of 2018 quadrupled compared with the previous 6 months. Eight countries in the European region have reported over 1000 infections in children and adults between July 2017 and June 2018 (France, Georgia, Greece, Italy, the Russian Federation, Romania, Serbia and Ukraine).2 Ukraine experienced the largest outbreak, with over 23 000 people affected, accounting for over half of the regional total. Measles-related deaths have been reported in all of these countries, with Romania reporting the highest number with 22 deaths as of 1 August 2018. Table 1 summarizes the incidence per 1 million population and the absolute numbers of measles cases in the European region, as extracted from WHO sources.2 Serbia, Ukraine, Georgia and Greece are the countries with the highest measles incidence per 1 million population. Reported cases of measles in the European region from July 2017 to June 2018a aData extracted from http://www.euro.who.int/__data/assets/pdf_file/0008/378602/epi-data-jul2017-jun2018-eng.pdf?ua=1 Reported cases of measles in the European region from July 2017 to June 2018a aData extracted from http://www.euro.who.int/__data/assets/pdf_file/0008/378602/epi-data-jul2017-jun2018-eng.pdf?ua=1 The resurgence of measles in Europe also has implications for travellers and travel medicine providers. Further spread via travellers within and beyond Europe is a major concern. Potential measles transmission risk in mass gatherings is of particular concern, as suggested for the Olympics3 and other large events.4 International adoption, legal and illegal (unauthorized) immigration5 will also be affected by the measles resurgence. Travel medicine providers need to be vigilant in diagnosing measles, as well as intensifying measures to prevent measles. Travel medicine providers should use every pre-travel consultation to check whether the primary measles vaccination schedule was completed. The following recommendations for travellers exist: all individuals ≥12 months of age born in 1957 or later (1970 or later in Canada and the UK; 1966 or later in Australia) without history of disease or of two documented doses of live vaccine at any time during their lives should complete a lifetime total of 2 doses of MMR vaccine (spaced by at least 28 days). All infants aged 6–11 months should receive one dose of MMR vaccine before their travel, if they have not yet received the first dose. Use of pre-travel vaccine-preventable disease serology as a screening tool to identify patients in need of pre-travel vaccination against measles is also recommended.6 Under the Global Vaccine Action Plan, measles is targeted for elimination in five WHO regions by 2020. Travel medicine providers should assist in reaching this target.