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:: Home > Archives : Eurosurveillance weekly releases 2007 > Volume 12 / Issue 5
Surveillance Report
volume 12
issue 5
date 24 May 2007
An outbreak of measles among a travelling community from England in
Norway: a preliminary reportØ Løvoll (Oistein.Lovoll@fhi.no) 1, L Vonen 2, T Vevatne 3, E Sagvik 4,
K Vainio 1, S Sandbu 1 and P Aavitsland 1
1. Folkehelseinstituttet (Norwegian Institute of Public Health, NIPH),
Oslo, Norway
2. Malvik Municipality, Norway
3. Sola Municipality, Norway
4. Trondheim Municipality, Norway
Between 7 and 14 May 2007, Nasjonalt Folkehelseinstitutt (the Norwegian
Institute of Public Health, NIPH) was notified of six cases of measles,
all occurring in a group of families from England staying at camping sites
in Norway.
Epidemiology of measles in Norway
Measles is no longer considered an endemic disease in Norway [1]. Except
for one imported case earlier this year, there have been no cases of
measles reported in Norway since 2004 when seven cases, also imported,
were notified. The last cases of measles of probably endemic origin in
Norway were in 1999. Measles is a notifiable disease in Norway and every
case is to be reported individually by both clinicians and laboratories.
In addition, the disease is subject to immediate early warning to local
and health authorities and the 24/7 doctor on call at the NIPH.
MMR vaccine is included in the national vaccination programme and children
are vaccinated at 15 months and 12 years of age. The vaccination coverage
for the first dose of MMR was 86% in 2003, but has increased to 91% for
2006. The coverage for the second dose was 91% in both 2003 and 2006.
Vaccination is also recommended for non-immune persons within 72 hours of
being been exposed to measles.
Outbreak description
On 7 May, the NIPH received a laboratory report indicating measles in a
seven-month-old girl (case no. 1) admitted to Stavanger University
Hospital in the south-western part of the country. Following up this
report, we learnt that the child had onset of fever on 27 April and was
examined at the hospital outpatient department the following day. Due to
worsening of her condition she was admitted to the paediatric department
on 1 May and then developed a rash and was isolated. The measles diagnosis
was confirmed by a positive IgM test in serum.
The patient was the child of an English family staying in a caravan at a
camping site in the municipality of Sola neighbouring Stavanger. According
to the mother
the child had been in contact with a child with measles
in England shortly before they came to Norway. The Municipal Medical
Officer in Sola was notified by the hospital and the NIPH. He visited the
camping site and found three to four English families staying there on
vacation.
Two children of these families, aged five (case no. 3)
and nine years (case no. 4), had fallen ill on 8 May and had been
to an out-patient clinic. They were later confirmed as having measles on
the basis of serology test of serum. They were unvaccinated. The remaining seven children of the English families at the camping site
had been vaccinated, according to their parents.
On 10 May, the NIPH was notified by St. Olav University Hospital in
Trondheim, a city in central Norway (at least 16 hours drive from
Stavanger), of a
case of measles in a child 15 months of age (case
no. 2).
The child fell ill on 4 May with fever and diarrhoea and a rash developed
on 7 May. The child was admitted to the paediatric ward on the 8 May and
isolated the following day.
The child was a cousin of the first case in
Stavanger, and had been staying at the same camping site in Sola at
the time when the first patient fell ill. The family had later gone
with their caravan to a camping site in the municipality of Malvik near
Trondheim.
The child had not been vaccinated against measles.
According to her father, who also was not vaccinated, the girl and her
brother of four years had not been vaccinated because the parents feared
serious side effects.On 12 May, the father (case no. 5) of the child in Trondheim (case no. 2)
also came down with fever. He became so affected that he was admitted to
St. Olavs Hospital on 15 May. The brother of case no. 2 also fell ill with
fever on 13 May and had developed a rash when he was seen by a doctor on
17 May. He was also admitted to St. Olav Hospital on 18 May. The diagnoses
for all three cases of this family were confirmed by PCR in throat swab
and serology in serum.
Public health measures
NIPH informed general practitioners and public health officers through our
biweekly newsletter MSIS-rapport on 8 May, and gave more comprehensive
information on the web site from 11 May. An early warning was also issued
through EWRS on 11 May. On 15 May, further information was sent to all
hospitals in the country.
Both the index patient in Stavanger and the first patient in Trondheim had
visited outpatient clinics and paediatric wards during their infectious
period. The hospitals could therefore not rule out the possibility that
they might have infected other children. Stavanger University Hospital
posted information to 30-40 families with children who might have been in
contact with the patient. St. Olav Hospital and the municipal Medical
Officer in Trondheim traced patient contacts and offered vaccine and
gammaglobulin. Three unvaccinated children aged 9-15 months received MMR
vaccine and one child below nine months of age received gammaglobulin.
Also three adult contacts and six health workers received vaccination. So
far, no secondary cases due to contact in the health services have been
reported.
The Senior Medical Officers in Malvik, in Sola and in the city of
Trondheim were involved in contact tracing. The patients in Trondheim were
staying at a camping site in Malvik together with approximately 24 other
English families with a total of approximately 75 persons. MMR vaccine was
offered to all members of these families. So far, 15 have accepted and
received vaccine, and two infants below the age of nine months have been
given gammaglobulin.
International investigation
It is not common to see English families with school-aged children on
camping holidays in Norway at this time of the year, and there were also
indications that the families were reluctant to vaccinate children. As
this suggested that the families were from the travelling community, we
sought more information from the Health Protection Agency in the United
Kingdom (UK).
Around 20 cases have been confirmed so far this year among travellers from
several sites in the UK, most arising after a large gathering that
occurred in south-east London on 3 April. On further interviewing, it
appears likely that the index patient in Stavanger attended this event
early in April. The mother reported hearing that someone with measles had
been at that event, but as the index patient fell ill on 27 April,
however, it is likely that she contracted measles following contact in
the UK with other travelling children. These details of the intermediate
cases remain to be investigated.
Travelling communities in the UK report poorer health than comparable
groups of residents from socially deprived inner city areas, other ethnic
minorities and rural residents [2]. Outbreaks of measles have indicated
that they have lower vaccination coverage than the stable population.
Conclusion
Norwegian health authorities are investigating an outbreak of measles
among English nomadic travellers in Norway. The infection is most likely
imported from England and linked to other current clusters in the UK. So
far, no cases in the Norwegian population can be linked to the outbreak.
The investigation of the outbreaks continues and intensified surveillance
during the coming weeks will show if the outbreak will continue or not.
Due to low vaccination coverage and wide travels, the travelling
communities in Europe represent a particular challenge for the measles
elimination campaign [4].
References:EUVAC.NET.
http://www.euvac.net/graphics/euvac/index.html Parry G, Van Cleemput P, Peters J, Walters S, Thomas K, Cooper C. Health
status of Gypsies and Travellers in England. J Epidemiol Community Health.
2007 Mar;61(3):198-204. Available from:
http://jech.bmj.com/cgi/content/full/61/3/198 Laboratory confirmed cases of measles, mumps, and rubella, England and
Wales: April to June 2006. Communicable Disease Report Weekly. 28
September 2006; 16;39. Available from:
http://www.hpa.org.uk/cdr/archives/2006/cdr3906.pdf Filia A, Curtale F, Kreidl P, Morosetti G, Nicoletti L, Perrelli F, et al.
Cluster of measles cases in the Roma/Sinti population, Italy,
June-September 2006. Euro Surveill 2006;11(10):E061012.2. Available from:
http://www.eurosurveillance.org/ew/2006/061012.asp#2 --------------------------------------------------------------------------
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