Abstract
In May 2018, measles was introduced in the Dubrovnik region by an adult who recently travelled to Kosovo*. Control measures and an outbreak investigation were implemented: 15 epidemiologically-linked cases met the outbreak case definition of a visitor/resident of Dubrovnik-Neretva County with laboratory-confirmed measles and symptom onset beginning on May 19. New cases were identified through hospitals and primary care physicians. Throat swabs, urine and/or serum samples were collected from outbreak cases. RT-PCR detection of viral RNA and IgM/IgG was used to confirm infection. The median age of cases was 33 years, with one 8 month-old infant. Vaccination status was unknown for 9 cases, three were unvaccinated, one case had history of one dose and two cases reported receiving two doses of measles-containing vaccine. There were 11 hospitalisations and one person developed pneumonia. Control teams undertook an extensive search of contacts and implemented a range of control measures. Despite the outbreak occurring at the beginning of the summer tourism season, it was contained and did not spread to neighbouring regions. With continuing measles transmission in Europe, even small outbreaks create a burden on the health system in countries which have eliminated measles, and illustrate the importance of maintaining high immunisation coverage.
Highlights
In 2018, there was a large epidemic of measles in Europe with 83,540 cases of measles and 74 related deaths occurring that year [1]
The first dose of measles-mumps-rubella (MMR) vaccine is given at 12 months of age and a second dose is given to first grade school children from 5 to 7 years of age
Suspected measles cases were largely reported by hospital physicians and community practitioners to the Public Health Institute of Dubrovnik-Neretva County (PHIDNC) by email and/or telephone, with PHIDNC immediately forwarding this information to the Croatian Institute of Public Health (CIPH) according to the routine reporting protocol
Summary
In 2018, there was a large epidemic of measles in Europe with 83,540 cases of measles and 74 related deaths occurring that year [1]. Croatia’s neighbouring countries are experiencing ongoing measles outbreaks. Childhood measles vaccination in Croatia is mandatory, free of charge and accessible through primary health care paediatricians for pre-school children and school medical specialists for school-aged children. The first dose of measles-mumps-rubella (MMR) vaccine is given at 12 months of age and a second dose is given to first grade school children from 5 to 7 years of age. The measles vaccine was introduced in Croatia in 1968 as a monovalent vaccine, and the combined MMR vaccine was introduced in 1976 [5]
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