Published Date: 2007-03-16 18:00:02
Subject: PRO/EDR> Measles - Serbia (Vojvodina)
Archive Number: 20070316.0932
MEASLES - SERBIA (VOJVODINA)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu 15 Mar 2007
From: ProMED-mail <email@example.com>
Source: Eurosurveillance weekly release 2007; 12(3) [edited]
An outbreak of measles is ongoing in northern Serbia. The 1st cases
were [reported] in January 2007 in the area of Novi Sad, in the
autonomous province of Vojvodina. As of 12 Mar 2007, 121 suspected
cases had been reported to the regional Institute of Public Health,
78 (64.5 percent) of which have been laboratory-confirmed by
detection of measles IgM.
Measles is a notifiable disease in the Republic of Serbia: hospitals,
laboratories, and primary health care physicians should notify all
suspect cases and, if feasible, seek laboratory confirmation. In
2006, 2 cases that were clinically compatible with measles were
notified, but never confirmed by laboratory.
Measles vaccination was introduced in Serbia (then part of the former
Socialist Federal Republic of Yugoslavia) in 1971, as one dose of the
monovalent vaccine at the age of 12 to 15 months. In 1993, the
measles-mumps-rubella (MMR) vaccine was introduced replacing the
monovalent vaccine, and introducing a 2nd dose of the vaccine at the
age of 12. Vaccination is free of charge and obligatory. Previously
unvaccinated children are vaccinated upon school entry and when they
visit health centres. [They are also sent] invitations for regular
vaccinations. Members of the Roma [gypsy] population do not always
receive vaccinations as many move frequently, do not attend school,
or have not registered with health services. There is no reliable
information about the vaccination coverage in the Roma population.
[At this point the original text is supplemented by a figure showing
the epidemic curve of measles cases in Vojvodina, Republic of Serbia,
for cases with known date of onset of symptoms (n=108), for the
period January-March 2007.) [The figure can be seen in the original
report at the link provided above. - CopyEd.MJ]
Confirmed cases have been reported from 3 municipalities in 2 of
Vojvodina's 7 administrative districts (by place of residence). The
median age of the confirmed cases is 13 years. Among them, one was in
an unvaccinated infant and 42 (53.8 percent) were in children aged
1-14 years. For the cases where vaccination records were available,
most were unvaccinated children or children that had received only
one dose of a measles-containing vaccine. The age of the oldest
confirmed case is 33 years.
Of the 78 confirmed cases, 77 occurred among members of the Roma
population. Hospitalization was required in 23 cases (29.5 percent)
but no deaths have occurred.
Measures taken to control the outbreak include
- identification of all contacts of suspect and laboratory-confirmed
cases of measles in the Roma population, following the door-to-door
search for new cases;
- vaccination of contacts of cases aged 6 months to 25 years. In case
of unknown vaccination status, vaccination is performed on site;
- vaccination of all children aged 1 to 15 years, not previously
- campaigns to sensitize physicians around the country to notify
suspected cases of measles.
Although there have been various vaccination coverage activities
targeted to the Roma population, most recently in 2002 and 2006,
their vaccination coverage was still estimated to be low at the
beginning of 2007 (anecdotally no higher than 50 percent in a certain
settlement). Further investigation into settlement-based risk factors
for low vaccine coverage is recommended.
This is the 1st outbreak of measles in Vojvodina since 1998. The last
case of measles was reported in 2000. It is affecting populations
with known low vaccination coverage and people in the age group one
to 33 years.
We would like to thank all the health workers in Vojvodina who took
part in this outbreak investigation.
[Byline: Z Seguliev, P Duric, V Petrovic, et al]
[The autonomous province of Vojvodina in northern Serbia can be
located on the map at
<http://www.un.org/Depts/Cartographic/map/profile/yugoslav.pdf>. - CopyEd.MJ]