Measles outbreak in Salento: alarm among paediatricians

Measles in Italy again: an epidemic outbreak the area of Salento (Puglia). Those most affected are adults between 23 and 43 years of age, although infants have also been affected. The phenomenon, recorded in the north of the Salento area since New Year's Eve, has led to the hospitalisation of about thirty young adults, one health worker and four children, two of whom are just a few months old.

Worldwide, measles remains one of the main causes of childhood deaths and in 2018 alone was responsible for over 140,000 deaths, most among children under 5 years of age (half of these cases were recorded in the Democratic Republic of Congo, Liberia, Madagascar, Somalia, Ukraine, the USA, Albania, the Czech Republic, Greece and the United Kingdom).

According to estimates by WHO and the Centers for Disease Control and Prevention (CDC), under the ‘Measles & Rubella Initiative’, in the past 10 years vaccination coverage for measles has been stagnant, creating favourable conditions for the current epidemic outbreaks. The report Progress Toward Regional Measles Elimination - Worldwide, 2000-2017, published in the Morbidity and Mortality Weekly Report (MMWr) in November 2018, describes the progress made towards eliminating this pathology in the WHO Regions ( between 2010 and 2017, over 21 million children worldwide each year did not receive the first dose of the measles vaccine, for an estimated total of 169 million. In 2018, moreover, only 86% of children globally received the first dose of the measles vaccine and just under 70% received the second recommended dose; the increase in the number of non-immunised children has therefore created ideal conditions for the epidemics that are currently spreading. Among the various geographical macro-areas, the European continent together with North America, is still the most affected one with a number of cases registered in the period between 01.01.2016 and 31.03.2019 equal to 44,074 cases, a significantly higher number than the cases recorded in the previous three years (26,382 in 2012-2015).

In Italy, from 01.01.2019 to 31.08.2019 there were 1,571 measles cases with over 50% of these cases recorderd in Lazio and Lombardy (Lazio reported the highest incidence with 128.7 cases per million inhabitants, compared to the national average of 39 cases per million).

In these first weeks of 2020, however, the region of Puglia has been affected by an epidemic outbreak, with more than 30 hospitalisations in just over 20 days, including two children, two babies and a health worker. The intervention measure adopted by the ASL of Lecce to limit infections has seen the implementation of a specific targeted vaccination campaign, aimed primarily at health workers and young adults: the former will be called by occupational health physicians to adhere to the vaccination campaign, while the latter will be advised by their own doctors to undergo vaccination. It is worth remembering that vaccination is strongly recommended in particular for women of childbearing age. The growing incidence of measles cases in our latitudes, confirms the epidemiological evaluation of the ECDC, which state that where the adequate vaccination coverage levels, set at 95% (to restore adequate herd immunity) are not reached, the risk of a persistent and extensive spread of the virus will remain high. wish to take this opportunity to remind users that as a consequence of the decline in vaccination uptake, diseases such as measles have reappeared in Italy and the Government, supported by the opinion of technical bodies and the scientific community, has taken remedial action by introducing, with Law 119/2017 (the details of which are available on our website at the link – Approaching Mandatory Vaccination), the obligation for some vaccinations that had previously been "recommended". Finally, we wish to remind users that the measles vaccine is undeniably safe and effective and any possible adverse reactions are mainly transient and mild, with redness at the injection site in 17-30% of cases, temporary arthralgia in 25% of cases (due to the attenuated rubella virus contained in the vaccine), fever in 2-10% of cases or a mild rash in 5% of cases. In this regard, the recent AIFA report (attached) highlights that 80% of the reports that arose in 2017 were classified as "not serious" (75% for compulsory vaccines alone) in line with previous years. Reports of suspected adverse reactions considered serious have been rare and in most cases of a transitory nature, with complete resolution of the reported event and unrelated to the vaccine. A single dose of the vaccine provides 95% efficacy and this rises to 98-99% at the second dose: maintaining a high level of immunisation in each cohort will enable the eradication of the pathology in our country over time. With this objective, the new National Plan for the Elimination of Measles and Congenital Rubella (PNEMoRC) aims to achieve, by 2023, an incidence <1 case / 1,000,000 population, indicating nine targeted actions to ensure the vaccination coverage of groups considered at risk or "difficult to reach", with an improvement in reporting, epidemiological investigation and surveillance of cases and outbreaks.

The importance of improving the availability of scientific information to be spread among health professionals and the population and the need to guarantee a vaccination service that is inclusive and informative in consultation as well as prompt and efficient in delivering the vaccine is also reiterated.

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