Headlines - Measles Outbreak in France: Surveillance Data Update as of August 3, 2017

From 2008 to 2016, more than 24,000 cases of measles were reported in France (including nearly 15,000 cases reported in 2011 alone). Nearly 1,500 cases developed severe pneumonia, 34 had neurological complications (31 cases of encephalitis, 1 case of myelitis, and 2 cases of Guillain-Barré syndrome), and 10 died.The number of cases dropped sharply in 2012, then remained stable in 2013 and 2014 (859, 259, and 267 reported cases, respectively) (Figure). In 2015, the number of cases rose again (364 cases), linked to a major outbreak in Alsace (230 cases). In 2016, 79 cases were reported, indicating reduced circulation of the measles virus. However, even though circulation had slowed, the virus persisted in several departments, notably in Dordogne and Jura (incidence ranging from 1 to 5 per 100,000 inhabitants in these departments). From January 1 to July 31, 2017, 387 cases were reported (with an epidemic peak in May, when 113 cases were reported). Of these, 154 cases (40%) required hospitalization, and one case resulted in death.The median age of reported cases over the past twelve months was 13 years (range: 1 month–75 years). The highest incidence rate is observed among children under 1 year of age (6.3/100,000), a population not targeted by vaccination and which can only be protected if those around them are immune to the disease. This situation is very concerning because complications (particularly neurological or pulmonary) are more frequent and severe in this age group as well as among young adults. The current epidemiology of measles shows that France remains endemic for the infection and is not immune to a new large-scale epidemic. The existence of reported cases in nearly all regions does not protect departments currently free of measles from an expansion of viral circulation in the near future: this is all the more concerning given that no department currently achieves the 95% vaccination coverage rate by age 2 for the two doses of vaccine—the rate required to eliminate the disease. In the BFC region, this two-dose vaccination coverage in 2015 ranged from a minimum of 67.6% in the Jura to a maximum of 85.8% in Haute-Saône.Clinicians must therefore systematically verify, and if necessary update, the measles vaccination status of anyone aged 12 months or older and born after 1980. According to the current vaccination schedule, all such individuals should have received two doses of the trivalent vaccine (measles-mumps-rubella). Furthermore, for close contacts of a patient with measles, the implementation of post-exposure prophylaxis measures (vaccination or polyvalent immunoglobulins) is essential.