December 11, 2017

Measles transmission is continuing to decline across the region, though risk of infection remains highest in Romania. Greece is currently experiencing a measles outbreak, primarily in southern areas. Regardless of country of destination, health experts recommend that expatriates, students, and business travelers ensure they receive a booster immunization against measles, which remains a significant risk in the region.

Measles cases per 1 million  in Europe 2016-2017Measles Epidemic Slows

All countries in the European Union and European Economic Area (EU/EEA) have reported measles infections during 2017, except for Latvia, Liechtenstein, and Malta. During the period of October 2016 through September 2017, more than 12,740 measles cases were reported by EU/EEA countries, of which 8,028 were laboratory confirmed. Three countries accounted for more than 70 percent of all reported cases: Italy (4,925 cases), Romania (4,854 cases), and Germany (956 cases). However, cases per 1 million residents – a better indicator of risk – was highest in Belgium, Bulgaria, Italy, and Romania.

Monthly reported cases in the Romanian measles epidemic are continuing to decline, since a peak in transmission during March. Countries reporting similar declines in measles activity include France, Germany, and Italy, all of which have successfully addressed their previously elevated measles activity. Conversely, Greek health officials have reported increasing numbers of monthly cases since July, as well as disease activity in new areas, primarily in southern parts of the country, including Attica, Crete, and the Peloponnese (map).

Measles Vaccinations

Measles Vaccination Coverage in Europe MapInternational health officials assert that a measles, mumps, and rubella (MMR) vaccination rate of at least 92-95 percent is needed to prevent wider community transmission of measles; however, vaccination standards and requirements vary by country. Therefore, sporadic outbreaks of vaccine preventable diseases – including measles – are not uncommon. However, the population of unvaccinated individuals (those who have not received any doses of MMR vaccine) and under-vaccinated individuals (those who received only one of two doses of MMR vaccine) in the European Union (EU) and European Economic Area (EEA) have increased in recent years (map). This reduced vaccination coverage increases the risk of large, widespread outbreaks. The trend is thought to be due, at least in part, to declining childhood vaccination rates in response to perceived risks, fear, and speculation regarding an incorrect and disproven association between vaccines and autism – a conclusion that has since been thoroughly discredited by multiple international studies about vaccines and child development.

Measles vaccination can be obtained at any age. If an individual was not vaccinated as a child, they can still be effectively vaccinated as an adult. The measles vaccine requires multiple doses to achieve full immunity; widely-used formulations require 28 days between each dose, depending on age and vaccination history. Attempt to obtain these vaccines well in advance of international travel.

Measles is a very contagious viral disease spread by respiratory droplets created when an infected person coughs, sneezes, or speaks. Employers can help mitigate these risks for traveling employees by encouraging individuals to consider a measles booster vaccination prior to departure for countries in the EU and EEA, as well as promoting basic health precautions and proper hygiene, thereby reducing the risk of contracting the disease. The US CDC maintains “Watch-Level 1” travel health notices due to elevated measles activity in Romania, Italy, and Ukraine. International health officials strongly recommend a booster measles vaccination for travelers to Romania, Italy, Germany, and Greece.

Keep the Workplace Clean

Measles can be spread through contact with contaminated surfaces or objects, it is extremely important that employers develop procedures and policies that ensure all commonly touched work surfaces, work areas, and equipment - for example, telephones, doorknobs, lunch areas, copy machines, etc. - are cleaned frequently. Routine cleaning agents are sufficient to disinfect surfaces, but employers should provide easy access to cleaning supplies. Keep the following etiquette tips in mind to minimize the spread of measles in the workplace.

Hand hiegiene image


The WHO and other international health organizations continue to work closely with governments to strengthen immunization programs and provide enhanced disease surveillance. Officials will likely continue reporting new measles infections across Europe throughout the remainder of 2017, primarily in Romania and Greece.

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