Measles is back in Spain. After four years with hardly any diagnoses, local infections have occurred again in the country since January due to the slight but constant trickle of imported cases. Toledo and Alicante have been the first two provinces to suffer outbreaks since before the pandemic, although they have been small – five and four cases, respectively – and are already considered closed. Aragón and Catalonia, for their part, are investigating one case each in which the origin of the contagion is currently unknown.
In total, Spain has confirmed 15 cases of measles since January 1, of which seven are imported and eight indigenous, according to data provided by the communities to EL PAÍS. This figure already exceeds the 11 detected in all of 2023 (six imported, four related to one of the above and one of unknown origin), while between 2021 and 2022 in Spain only three cases were diagnosed, according to the annual report of the National Epidemiology Center.
“The incidence of measles is increasing in several European countries and the rest of the world. While this happens, imported cases will continue to arrive in Spain that can lead to outbreaks. The high vaccination coverage that we enjoy is what is slowing the circulation of the virus, but we cannot let our guard down. Typically, non-immunized people tend to be grouped in certain areas or social groups, and form pockets of susceptible populations. If coverage drops and this virus, which is very contagious, reaches one of these pockets, the outbreak could be much larger,” says Quique Bassat, pediatrician and epidemiologist at the Barcelona Institute for Global Health (ISGlobal).
The European Center for Disease Control and Prevention (ECDC) published a risk report on February 16 warning of the increase in cases on the continent, where seven people have already died in recent months (six in Romania and one in Ireland ). “Since 2023, significant increases in the number of measles cases and outbreaks have been observed globally, including 40 of the 53 countries in the European region and at least 10 countries in the European Union (EU) and the European Economic Area ( EEA). It is expected that infections will continue to increase in the EU in the coming months due to suboptimal vaccination coverage,' the agency defends in the document.
The Toledo outbreak began with a case imported from a country that has not been made public. The chain of infections has added another four patients, according to the Junta de Castilla-La Mancha, which has not offered more information, although it considers the outbreak “closed, in principle.”
In the Valencian Community, two children aged eight and 12 acquired the disease during a trip to Russia and, subsequently, two people in their environment were diagnosed with the disease: a younger brother of 22 months and a man of 43 years. All of them live in the province of Alicante, as does a 34-year-old woman with no relation to the previous ones who, during the incubation period, traveled to France, so she was predictably infected in that country. None of these cases were vaccinated.
The Ministry of Health of Aragón, for its part, reported this Monday that it has opened an investigation to clarify the origin of the contagion of “an indigenous case of measles.” This is a 46-year-old man who lives in the province of Zaragoza whose case was confirmed on the 20th. “(This person) had not traveled during the incubation period, he has remained in isolation during the period. of transmission of the disease and is well. Epidemiologists have carried out the study of precise contacts and informed the health network so that professionals are alert in case more cases arise,†states the regional government.
The Generalitat is also investigating the origin of another contagion of “a child residing in Catalonia but who has started symptoms outside of Spain.” The minor is “feeling well,” according to the Catalan Government, which for now has not offered more information about this case.
In January, Catalonia also diagnosed measles in “a young man residing in Catalonia, not vaccinated and with a history of international travel during the incubation period.” This case had no complications. “As public health actions, home isolation of the case and updating of his vaccination status were recommended. The vaccination schedules of family contacts during the trip were reviewed and updated, as well as those of health professionals and patients in the waiting room and emergency room where they treated you,” details the Generalitat, which adds that “every day As of today, there is no news that there have been related secondary cases.
Galicia and Castilla y León have also registered one imported case each, without currently registering related infections.
Vaccine coverage
The measles virus is one of the most contagious known and it is necessary to maintain vaccination coverage of 95% or higher to prevent it from circulating in a population group. In its recent report, with data corresponding to 2022, the ECDC warned that the average coverage in the EU is notably lower and remains at 92.4% for the first dose and 89.7% for the second.
These percentages are higher in Spain, where 97.2% of children born in 2022 received the first dose on their first birthday. Despite this, five communities remained below: Castilla y León (94.8%), the Canary Islands (94.7%), Catalonia (94.4%), La Rioja (91.1%) and Castilla- La Mancha (90.4%). The figures are worse with the second, which is received between four and six years. The percentage for all of Spain remained at 93.7%, with five communities with notably lower levels: Canary Islands and Extremadura (both 90.3%), Castilla-La Mancha (88.8%), La Rioja (88.1%) and the Basque Country (88%).
José Miguel Cisneros, head of the Infectious Diseases service at the Virgen del Rocío Hospital (Seville), insists on an idea: “If all children are vaccinated, measles will disappear. It is a serious disease, which produces serious complications in the form of encephalitis in one in every 1,000 minors who acquire it, which can be fatal or leave serious consequences. There is an extraordinary tool, which is the vaccine, to protect them. “No one should forget it,” concludes this specialist.
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