2024-03-02 18:44:00
A recent article from the Eurosurveillance review describes the ongoing measles outbreak in the Federation of Bosnia and Herzegovina (FBiH).
In the Federation of Bosnia and Herzegovina, during the week 52/2023six laboratory-confirmed cases of measles (cases 1-6) were reported in the Canton of Tuzla. Four cases (cases 1-4) were born in 2022 and attended the same preschool, case 5 was born in 2017 and case 6 in 2012. There was no epidemiological link between the cases from the school kindergarten and cases 5 and 6, who came from other municipalities in the same canton. A child attending the nursery school developed symptoms in early December 2023, but the illness was not recognized as measles by healthcare staff. Of the 38 children who attended the same nursery school, 29 were not vaccinated and six were younger than 12 months, therefore younger than the age for the first MMR vaccination. In the days following the appearance of symptoms of the index cases, six new cases of measles associated with the latter were reported.
In week 3/2024three children from a nursery school in canton de Sarajevo were notified. The first of these three cases developed symptoms on January 11 and was initially diagnosed as scarlet fever. A child was notified in a third canton (Canton de Zenica-Doboj). These cases were epidemiologically linked to the cases in the first canton.
In total, between week 52/2023 and week 6/2024, 141 cases of measles were notified, including 52 (36.9%) laboratory confirmed. Cases of measles have been reported in four of the ten cantons of the FBiH (canton of Una-Sana 1 case, Zenica-Doboj canton 3 cases, Sarajevo canton 45 cases, Tuzla canton 92 cases). The index case in a canton had a history of travel to Austria (see news from February 13, 2024) and contact with a measles case there. Overall, the most affected age group was children aged 1 to 4 years, with 76 cases (53.9%). Of the 141 measles cases reported, 130 (92.2%) were not vaccinated, four (2.8%) had incomplete vaccination (one dose of MMR) and for seven (5.0%), this information was not available. During this period, 68 (48.2%) cases were hospitalized. Among the hospitalized cases, six (8.8%) were less than 1 year old, 31 (45.6%) were 1-4 years old, 19 (27.9%) were 5-9 years old, four (5.9% ) were 10-14 years old and eight (11.8%) were aged 20 or older. The most common complications were measles-related pneumonia and diarrhea. No deaths have been reported.
Genotype determination was carried out using four measles RNA-positive samples. All four sequences were identical and belonged to the D8 genotype of the measles virus. The sequence most similar to these was from Moscow, Russia, reported in week 28/2023. The D8 variant currently circulating in FBiH differs from those isolated in Romania in 2023 and in BiH during the two-wave epidemic of 2014-2015.
Comments:
Before 2023, the FBiH experienced two measles epidemics:
- from 2014-2015, 5,103 cases were reported (preschool and school-age children and adolescents 5-19 years old were the most affected age groups, and all sequences belonged to the D8 genotype)
- in 2019, 1,332 cases were reported, most among children 0-5 years old, and all analyzed case sample sequences belonged to the B3 genotype.
The routine vaccination rate of children in the FBiH has been declining steadily since 2014. In 2019, reported vaccination coverage has improved. Coverage of the third dose of diphtheria, tetanus and pertussis-containing vaccine (DTP3) was 80.2% in children under one year of age and that of the first dose of MMR (ROR1) was from 79,0% in children under two years of age, below the 95% target required for measles and rubella elimination.
Good that vaccination of children is compulsory in the FBiH, it is clearly not enforced, meaning that health workers and primary health care centers do not routinely report refusals. According to the FBiH vaccination policy document, verification of vaccination status is required at the time of registration in all preschool programs, at all school levels (from elementary school to high school) and during every medical appointment. Parents who choose not to vaccinate their children may face financial penalties.
With the development of the Covid 19 pandemic, in 2020, DTP3 coverage decreased by 17.6% and that of ROR1 by 26.7%. Similar coverages were recorded in 2021 and 2022. Coverage estimates do not take into account children who delayed vaccination (in 2022, for example, 15% of children were late vaccinated once morest MMR1). Six cases of measles were reported between 2020 and 2022.
In response to the current outbreak, specific control measures include strengthening surveillance, communication with the public and healthcare professionals, and catch-up vaccination activities. Demand for MMR vaccinations has increased since the start of the epidemic (the number of MMR vaccinations increased by 67%, or 1,699 doses, in January 2024 compared to January 2023). To improve accessibility to vaccination services, health authorities in affected cantons have urged primary care centers to offer walk-in vaccination sessions, extend opening hours and dedicate full days to vaccination children of school and preschool age. Given the low vaccination rate recorded in previous years, the risk of the current measles outbreak spreading to other municipalities and cantons in the FBiH is high.
Source : Eurosurveillance
1709406310
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