Albania mounts rapid and comprehensive response to measles outbreak
Albania is one of the countries in the WHO European Region that have successfully interrupted endemic transmission of measles and rubella. Since achieving measles elimination in 2015, the country has reported sporadic imported cases of measles. This includes cases in the second half of 2017 that were followed by a few separate outbreaks with a small number of cases and limited period of transmission. A recent and much larger outbreak has been a greater test of the Albanian health system. However, due to sustained high immunization coverage through the country’s well performing national immunization programme, along with a prompt and comprehensive outbreak response, it is anticipated that the outbreak will be controlled and that the country will maintain its measles elimination status.
Outbreak response activities implemented to help limit spread of measles
In December 2017, 4 imported measles cases and 5 additional linked cases due to local transmission were reported in the city of Pogreadec. Another imported measles case in December sparked a measles outbreak in Tirana, which is still ongoing and has potentially spread to other cities. On 13−15 February 2018, a team of WHO technical experts visited the country to meet with national technical counterparts. The purpose of their visit was to discuss the situation and to provide support for the outbreak response activities. During the visit, the WHO team observed that the national immunization programme response has followed WHO recommendations and that a variety of important measures have been implemented to help limit the spread of disease. The National Institute of Public Health continues to monitor the epidemiological situation and report back to WHO on developments.
The first measles case was confirmed on 10 January 2018, and by 13 February 115 cases had been confirmed – with the highest number of cases reported in Tirana (84) and Lezhe (10). Preliminary findings from epidemiological investigations show possible measles transmission at the emergency unit and other units of the paediatric department of a national hospital. The majority of cases in Tirana are unimmunized (56 of 84) or do not have information available about immunization status (11 of 84). Of 56 unimmunized cases, 43 are children aged 3–12 months, the age group that is not covered by the routine immunization programme. The small number of cases in age groups that have been targeted with routine immunization, as well as the absence of cases among health-care workers, confirms high coverage with routine and supplemental immunization activities in Albania.
In response to the outbreak, health authorities traced and followed up with contacts of all cases, and any of those susceptible to measles were immunized. Furthermore, immunization registries were reviewed and a catch-up immunization was provided to all children that had a delay in receiving the first or second dose of measles- and rubella-containing vaccines. More than 10 000 doses of measles, mumps and rubella (MMR) vaccine were administered in January through routine immunization and catch-up activities targeting children, supplemental activities targeting adults and vulnerable subgroups, and through immunization of contacts as part of the outbreak response.
Due to a significant number of cases affecting children younger than 1 year old, and with approval from the National Immunization Technical Advisory Group, the schedule of the national immunization programme has been temporarily modified to allow the use of the MMR vaccine for children aged 9–12 months. In such instances, it will be administered as a “zero” dose.
The Albanian health system still faces challenges in ensuring compliance with infection prevention and control practices in health-care settings, and this was observed in the management of measles cases. The current influenza season and ongoing measles outbreak have caused an increase in numbers of outpatient visits and hospitalizations, which increases the risk of disease transmission in health-care institutions. Health authorities at national, subnational and facility levels are taking steps to strengthen the implementation of infection prevention and control measures, including triage and isolation of patients.
Measles is an ongoing threat
Measles is a highly contagious disease and as long as the measles virus is circulating anywhere in the world, the risk of cross-border transmission and importation to countries that have achieved elimination remains high. Recently released data show that the European Region experienced a 4-fold increase in measles cases in 2017, compared to the previous year, indicating that much work remains to be done in order to reach the regional goal of measles elimination.