Abstract
Luxembourg was among the first countries in the World Health Organization (WHO) European Region documenting interruption of endemic measles transmission, but an increased incidence was registered in spring 2019. The outbreak started with an unvaccinated student who had been to a winter sports resort in a neighbouring country, where a measles outbreak was ongoing. Subsequently, 12 secondary and two tertiary cases were confirmed among students from the same school, relatives and healthcare workers, as well as six probably unrelated cases. Only 11 cases initially fulfilled the WHO definition for suspected measles cases. Fourteen of 20 cases with information on country of birth and the majority of unvaccinated cases (10/12) were born outside of Luxembourg. Measles IgM antibody results were available for 16 of the confirmed cases, and five of the eight IgM negative cases had been vaccinated at least once. All 21 cases were PCR positive, but for three previously vaccinated cases with multiple specimen types, at least one of these samples was negative. The outbreak highlighted diagnostic challenges from clinical and laboratory perspectives in a measles elimination setting and showed that people born abroad and commuters may represent important pockets of susceptible people in Luxembourg.
Highlights
Measles is a highly contagious infectious disease caused by measles virus
Luxembourg was among the first countries in the World Health Organization (WHO) European Region documenting interruption of endemic measles transmission [4], and in 2015, measles elimination was declared based on data from 2012 to 2014 [5]
Two additional secondary cases were registered in week 13, one in a vaccinated healthcare worker (LUX19-H-32, Figure 1) who had been in contact with the index case in hospital
Summary
Measles is a highly contagious infectious disease caused by measles virus. A cheap and effective vaccine has been available since the 1960s, but coverage rates of ≥ 95% are required to achieve and maintain measles elimination [2]. In Luxembourg, two doses of measles-mumps-rubella and varicella vaccine are recommended at 12 and 15 to 23 months of age, and coverage rates have been estimated at 99% for the first dose since 2014. Coverage was estimated at 86% between 2014 and 2017, and at 90% in 2018 [3]. Luxembourg was among the first countries in the World Health Organization (WHO) European Region documenting interruption of endemic measles transmission [4], and in 2015, measles elimination was declared based on data from 2012 to 2014 [5]. A few sporadic cases were reported in the years that followed, until an increased disease incidence was noticed in spring 2019, in the context of a concurrent measles resurgence in Europe [6]
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