Measles in R. Macedonia in 2018
In 2018, 95 cases of measles have been reported in Macedonia. After the epidemiological investigations and laboratory results, 68 suspected cases have been classified as measles, of which:
- 57 are laboratory confirmed,
- 10 cases are likely (have an epidemiological link), and
- only one case is possible with a clinical picture of measles and is not laboratory tested
- 27 cases were rejected after receiving negative laboratory results.
In the course of 2018 three epidemic of measles were reported in the Republic of Macedonia:
- The first epidemic was registered in July in the territory of Debar, with a total of 27 infected people.
- The second epidemic is reported by CPH Skopje in November, on the territory of the village Grcec, municipality of Saraj, and in the epidemic there are three people.
- The third epidemic, reported from CPH Skopje in December and is still ongoing.
Geographic distribution of cases
The highest number (n = 35) of registered cases of measles are from the territory of CPH Skopje, and 25 persons are from the territory of RO Debar. Individual cases have been reported in 4 cities in the Republic of Macedonia. (Table 1).
Cumulative incidence in R. Macedonia in 2018 is 3.3 / 100.000 inhabitants. The highest incidence is registered in the territory of Debar (90.1 / 100.000). In other cities, the incidence ranges from 0.5 / 100.000 in Tetovo to 5.8 / 100.000 inhabitants in Skopje (Table 1).
Table 1. Number of cases of measles and incidence / 100.000 per CPH / PE in R. Macedonia
Distribution by age and gender
The age of the diseased varies from 5 months to 59 years. Regarding the distribution by age group, most of the cases, ie 26 persons (38.2%) belong to the age group above 30 years (Chart 1).
The highest incidence is recorded in the age group of up to 1 year and is 34.2 / 100.000 inhabitants.
According to the distribution by sex, the two sexes are equally represented (Chart 1).
Chart 1. Distribution of measles patients by sex and age in R. Macedonia, 2018 (n = 68)
According to the date of the rash, the highest number of cases – 24 people were registered in July. A further increase in the number of cases was registered in December – 15 persons. On a weekly basis, the highest number of cases were registered in the 30th week (n = 8), and the increase in the number of cases was registered in 52 weeks – 7 new cases. (Chart 2)
Chart 2. Distribution of diseases of measles by date and week of disease (n = 68) in R. Macedonia, 2018
According to the vaccine status, 80.9% (n = 56) of cases are unvaccinated, incomplete vaccinated or with unknown vaccine status. Of non-vaccinated persons, 8 people are under 12 months old and are not subject to vaccination, according to the Immunization Calendar. 13 people have been vaccinated With two doses of vaccine, more than half of whom are over the age of 30 years (Table 2).
Table 2. Vaccinal status and age group of patients (n = 68) of measles in R. Macedonia, 2018
Classification of cases
Of the total number of cases (n = 68), 83.8% (n = 57) were laboratory confirmed. Out of 57 laboratory-confirmed cases, 86% are unvaccinated, incomplete vaccinated or with unknown vaccine status (Table 3).
Table 3. Distribution of cases of measles by laboratory diagnosis and laboratory confirmation
53 patients have been hospitalized, and the most common complications are diarrhea and pneumonia.
- Enhanced epidemiological surveillance of rashes, hospitalization and isolation of patients with severe clinical manifestation, and for insured patients with mild clinical picture, isolation is recommended at home.
- Mandatory reporting of each suspected case of measles and its laboratory examination.
- For each case of measles, an epidemiological study was conducted by local epidemiologists and an epidemiological survey was prepared.
- The vaccine status of all affected persons and their contacts has been checked.
- All found close contacts that have not had the disease/, have not been vaccinated/ or are incomplete vaccinated with MRP, have been called for vaccination in the CPH.
- Enhanced control of vaccine sites by CPH / RO epidemiological services, checking vaccine status for MRI (first and second dose), finding unvaccinated and incomplete vaccinees.
- Strengthened activities of the vaccine teams for finding children who are eligible for vaccination with MRI up to 14 years of age and vaccination of unvaccinated or incomplete immunizations.
- Health education activities aimed at promoting MRP vaccination have been implemented as the most effective preventive measure against measles.
- Conducted media presentations in order to inform the population about the condition of measles in the Republic of Macedonia and the neighboring countries as well as protection from this disease with a special emphasis on MRI vaccination.