May 01, 2017

Romania, Italy, and Germany Report Widespread Outbreaks in 2017

Introduction: Vaccines in the EU

Vaccination standards and requirements vary by country in Europe. Therefore, sporadic outbreaks of vaccine-preventable diseases - including measles - are not uncommon. However, the potential for large outbreaks occurs when immunization coverage drops below 95 percent, and the population of unvaccinated individuals in the European Union (EU) has increased in recent years. This 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.

During the first two months of 2017, the European Centre for Disease Prevention and Control (ECDC) reported significantly elevated measles activity among 14 European countries, 10 of which – including Austria, Belgium, Croatia, France, Germany, Italy, Poland, Romania, Spain and Sweden – reported nearly double the measles activity when compared to the same period of 2016. Since then, Romania, Italy, and Germany have reported widespread and, in some cases, record-setting measles transmission.

Romania: Bearing the Brunt of Measles Outbreaks in Europe

Since health officials first detected elevated measles activity in March 2016, Romanian authorities have reported at least 5,119 cases of the disease nationwide as of April 28, 2017. The counties most affected by this outbreak are in the western part of the country, including Arad, Caraș-Severin, and Timis (map). Caraș-Severin County, on the Serbian border, has reported at least 965 cases since the outbreak began – the highest number of cases reported in any Romanian district. In response to elevated measles activity, the US CDC has maintained a “Watch-Level 1” travel health advisory for Romania since November 2016.

Despite multiple vaccination campaigns, measles activity has continued in Romania and is likely related to several factors. First, the vaccination rate for measles in Romania has declined since 2002, and was reportedly at only 86 percent in 2015, per the World Bank. A vaccination rate of 92-95 percent is needed to prevent wider community transmission.

Although Romanian health officials continue efforts to increase public awareness of the benefits of vaccination, it will take several years of consistent, timely, and complete vaccination of those living in Romania to increase the MMR vaccine coverage to an acceptable 92 percent nationwide. Secondly, it takes 2-4 weeks for immunity to be established in the human body following vaccination, leaving the individual susceptible to infection during that period. Lastly, a single dose of the MMR vaccination provides 93-percent effectiveness in preventing measles infection, which still leaves a margin of potential susceptibility.


Measles activity in Italy remains high during 2017 following elevated disease activity throughout 2016. Since Jan. 1, Italian health officials have reported more than 1,730 cases nationwide as of April 23; over 90 percent of these cases were reported among seven Italian regions: Abruzzo, Lazio, Lombardy, Piedmont, Sicily, Tuscany, and Veneto (map). Approximately 88 percent of cases were either never vaccinated against measles or incompletely vaccinated (meaning they received fewer than the necessary number of doses to attain immunity), highlighting the importance of receiving timely booster vaccinations, as appropriate.

International health officials state that a vaccination rate of at least 92 percent is needed to prevent wider community transmission; the nationwide measles, mumps, and rubella (MMR) vaccination rate among Italian children was highest in 2010 at 91 percent. Since 2012, the controversy regarding vaccines and autism took hold in Italy and, consequently, immunization rates have since fallen below 90 percent: it was last reported at just 85 percent in 2015. The US CDC issued a “Watch-Level 1” travel health advisory for Italy on April 17 due to elevated measles activity.


German health officials continue to report significantly elevated measles activity during 2017 – since Jan. 1, at least 462 cases have been reported nationwide, compared to just 30 cases reported during the same period of 2016. North Rhine-Westphalia Region has reported nearly half of all cases identified in Germany (227 cases) (map). Germany has maintained a nationwide average vaccination rate of 97 percent for the measles, mumps, and rubella vaccination; this rate is high enough to prevent widespread disease activity, but not high enough to prevent sporadic outbreaks. Sensitization campaigns are ongoing in order to promote the importance of routine immunization against preventable diseases to reduce the likelihood of another outbreak occurring.


The measles outbreaks in Europe threaten progress toward measles elimination in the European region – the European Vaccine Action Plan was adopted by all member states in 2015, with the goal of eliminating measles and rubella in the European region by 2020. The WHO continues to work closely with governments to strengthen immunization programs and provide enhanced disease surveillance. European Immunization Week took place April 24-30 and coincided with World Immunization Week, with the intention of raising awareness about the importance of timely vaccination in all stages of life.

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 Romania, Italy, or Germany, as well as promoting basic health precautions and proper hygiene, thereby reducing the risk of contracting the disease.

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