Dataset Information

Spatiotemporal distribution and determinants of measles incidence during a large outbreak, Italy, September 2016 to July 2018.

ABSTRACT: BackgroundMeasles is still endemic in Italy and outbreaks are frequent. From 2016 to 2018, more than 7,000 measles cases were reported to the national integrated measles and rubella surveillance system, the largest outbreak since implementation of this system.AimWe aimed to describe the characteristics and spatiotemporal distribution of measles cases in Italy and explore determinants of incidence at municipality level.MethodsWe performed a retrospective observational study, mapping by municipalityall measles cases reported to the national surveillance system with symptom onset between 1 September 2016 and 31 July 2018. We also analysed measles-mumps-rubella (MMR) vaccination coverage (VC) data (2000-2017) for the first and second dose, collected from the Ministry of Health. We used regression analysis to explore factors associated with measles incidence at municipality level.ResultsWe analysed 7,854 cases, 3,927 (50%) female. Median age was 26 years; 475 cases (6%) were?younger than 1?year. The outbreak occurred in two epidemic waves. The first started in central/northern regions (end of 2016), the second (mostly within 2018) was concentrated in southern regions. In 2016 and 2017, national VC was below 95% for both MMR doses. In 2017, only one region reported VC above 95% for the first dose. At municipality level, incidence was associated with higher urbanisation, less deprivation and fewer adults.ConclusionThe spread of measles between September 2016 and July 2018 in Italy indicates the need to improve VC and to explore further how societal and other parameters might be linked to incidence.

SUBMITTER: Andrianou XD

PROVIDER: S-EPMC6628759 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Spatiotemporal distribution and determinants of measles incidence during a large outbreak, Italy, September 2016 to July 2018.

Andrianou Xanthi D XD Del Manso Martina M Bella Antonino A Vescio Maria Fenicia MF Baggieri Melissa M Rota Maria Cristina MC Pezzotti Patrizio P Filia Antonietta A

Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin 20190401 17

BackgroundMeasles is still endemic in Italy and outbreaks are frequent. From 2016 to 2018, more than 7,000 measles cases were reported to the national integrated measles and rubella surveillance system, the largest outbreak since implementation of this system.AimWe aimed to describe the characteristics and spatiotemporal distribution of measles cases in Italy and explore determinants of incidence at municipality level.MethodsWe performed a retrospective observational study, mapping by municipali ...[more]

PMID: 31039836

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Project description:BackgroundOn 12 October, 2016 a measles outbreak was reported in Mayuge District, eastern Uganda. We investigated the outbreak to determine its scope, identify risk factors for transmission, evaluate vaccination coverage and vaccine effectiveness, and recommend evidence-based control measures.MethodsWe defined a probable case as onset of fever (≥3 days) and generalized rash, plus ≥1 of the following: conjunctivitis, cough, and/or runny nose in a Mayuge District resident. A confirmed case was a probable case with measles-specific IgM (+) not explained by vaccination. We reviewed medical records and conducted active community case-finding. In a case-control investigation involving probable case-persons and controls matched by age and village, we evaluated risk factors for transmission for both cases and controls during the case-person's likely exposure period (i.e., 7-21 days prior to rash onset). We estimated vaccine effectiveness (VE) using the formula: VE ≈ (1-ORprotective) × 100. We calculated vaccination coverage using the percentage of controls vaccinated.ResultsWe identified 62 probable case-persons (attack rate [AR] = 4.0/10,000), including 3 confirmed. Of all age groups, children < 5 years were the most affected (AR = 14/10,000). The epidemic curve showed a propagated outbreak. Thirty-two percent (13/41) of case-persons and 13% (21/161) of control-persons visited water-collection sites (by themselves or with parents) during the case-persons' likely exposure period (ORM-H = 5.0; 95% CI = 1.5-17). Among children aged 9-59 months, the effectiveness of the single-dose measles vaccine was 75% (95% CI = 25-92); vaccination coverage was 68% (95% CI = 61-76).ConclusionsLow vaccine effectiveness, inadequate vaccination coverage and congregation at water collection points facilitated measles transmission in this outbreak. We recommended increasing measles vaccination coverage and restriction of children with signs and symptoms of measles from accessing public gatherings.

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Spatiotemporal distribution and determinants of measles incidence during a large outbreak, Italy, September 2016 to July 2018.

Publications

Spatiotemporal distribution and determinants of measles incidence during a large outbreak, Italy, September 2016 to July 2018.

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