A measles outbreak in Plovdiv: Ethnic and age differences

Abstract

Introduction Measles is a highly contagious infectious disease and one of the leading causes of death among young children, although a safe and effective vaccine is available. According to World Health Organization (WHO) in 2017, the incidence of measles in Europe is 11882, with over 35 deaths in the last 12 months. One of the most affected groups at risk for the development and spread of infectious diseases in Bulgaria is the Roma community. According to the National Statistical Institute (2004), 10.33% of the population is defined as Roma. The purpose of the study was to describe the epidemic of measles in the Plovdiv region (the second largest area in Bulgaria). Methods Epidemiological review of cases that have been admitted to the Infectious Diseases Clinic–Plovdiv during the outbreak from March to July 2017 and studied by the Department of Anti-Epidemic control at the Regional Health Inspection - Plovdiv. Results In the spring/summer of 2017, a measles epidemic was observed in Plovdiv region, Central Bulgaria, which affected mainly the Roma ethnic group. A total of 146 cases (44% female, 56% male) were registered, of which 48 cases of measles among young Roma were confirmed. Children under the age of 4 represent the highest number of cases (n = 73) and 16 cases under 6 months. One children at 10 months of age died as a result of a vaccine-preventable illness. All of them have been vaccinated with MRS, according to the age and immunization calendar of the country. Conclusions In children and adolescents below the age of 18 years, a high incidence of morbidity was observed regardless of childhood vaccination. This indicates that other social determinants (such as housing, lifestyle, poverty, education, access to services) affect the health of this ethnic group. More than 90% of cases require hospitalization because of the severity of the disease. Improved access to healthcare and treatment options for patients may have reduced further medical complications and deaths. There is a need of surveys of morbidity among people in the Roma community, identification of risk factors and development of strategies for combating vaccine-preventable diseases.