In the period from 19.10-06.12.2019 two new cases of measles was reported,  According to the negative results obtained from the laboratory tests, the case has been rejected.

In total, since the onset of the epidemic in December 2018 as of December 6, 2019, 2215 cases of measles have been registered in the Republic of North Macedonia with a disease rate of 91.9 per 100,000 inhabitants.

As of 03.12.2019, IPH received a total of 2,215 measles cases.

The total number of cases reported in the Republic of Northern Macedonia from December 2018 as of 06.12.2019, which meet the definition of the case and are counted as the total number of people affected by the epidemic, is 1,901, with a disease rate of 91.9 per 100,000 inhabitants.

 

According to the place of permanent residence, measles cases have been registered in 24 cities, with the highest incidence of 100,000 in Struga 165.1 / 100,000 (112 cases), Kumanovo 162.6 / 100,000 (232) and Skopje 161, 6 / 100,000 (998) (Chart 1).

Chart 1. Geographic distribution of measles cases in the North Macedonia, December 2018 – December 2019

 

In terms of distribution by sex, 977 are male and 924 are female or male – female ratio of 1,1: 1. The specific morbidity by sex in males is 94.3 / 100,000, while in females it is 89.5 / 100,000.

The age of the patients ranges from 1 month to 63 years (median – 27.3 years). Most of the cases are over the age of 30 years – 852 (44.8%), and the highest incidence of 1.399.1 / 100,000 population is registered in children under one year (327 cases, 17.2%), and children aged 1-4 have an incidence of 307.0 per 100,000 population (285 cases, 15.0%) (Chart 1).

Chart 1. Distribution of measles cases in the North Macedonia by age, December 2018 – December 2019 (n = 1.901)

 

According to vaccine status, 1,530 or 80.5% of infected people are unvaccinated, incomplete vaccinated, or with unknown vaccine status. Of these, 327 (21.4%) are under 12 months of age and are not vaccinated according to the Immunization Calendar. (Chart 2)

Chart 2. Distribution of measles cases in the North Macedonia by age and vaccine status, 2018-2019 (n = 1.901)

 

Regarding the date of occurrence of rash, the first case is registered in the 49th week in 2018 in Skopje, and from the 3rd week in 2019 the first cases are registered in the rest of the country. The highest number of patients was reported.During the 16th (n = 123) and 19th (n = 123) weeks.

Since the 22nd week, there has been a continuous decrease in the number of registered cases (Chart 2).

Chart 2. Distribution of measles cases in the North  Macedonia by Week of Rash, 2018-2019 (n = 1.901)

 

 

From the reported cases, 852 or 44.8% were hospitalized, and 302 (15.9%) reported complications. Of these, most complications were in children 0-4 years (n = 137; 45.4%) and 78 (25.9%) – in children up to one year and 59 (19.5%) – in children at age 1-4 years, indicating that this age group is most affected and susceptible to complications. The most common complications were pneumonia – 146 (48.3%) and diarrhea – 140 (46.4%).

In the epidemic there have been four deaths associated with measles, in children aged 5.5 to 13 months, all unvaccinated with the MRP vaccine. Two of the children had comorbidities, and all four children died of bronchopneumonia, a complication of measles disease.

In the measles epidemic there are 187 cases of illness among health professionals / employees in health institutions, which is 9.8% of the total number of registered cases.

Of the total reported cases of measles, 665 or 35.0% are laboratory confirmed, 691 or 36.3% are epidemiologically related, while 545 (28.7%) have clinical picture of measles. Specimens of the genotyped patients were sent to the reference measles laboratory in Luxembourg. The B3 Dublin genotype has been proven to circulate in neighboring countries.

 

 

Implemented vaccination activities with the MRP vaccine

 

The total number of people vaccinated with MRP vaccine up to the age of 14, from the beginning of the epidemic to the end of the analyzed period – in the whole country is 44,497 (the total number of vaccinated persons includes both missed and regularly vaccinated children with MRP vaccine) .

Since the beginning of the epidemic up to now, in the Centers for Public Health, in accordance with the Order of the Minister of Health, and on the recommendation of the Commission for Infectious Diseases, a total of 6,305 doses of vaccine have been additionally applied, of which more than 60% to health professionals, medical students. , dentistry and pharmacy, trainees and high school pupils, while the rest are contacts of patients and persons over 14 years of age.

 

Risk assessment for further spread of the epidemic

No new cases of measles disease have been reported (two suspected cases are epidemiological and laboratory researched and rejected).

After analyzing the data available as of 06/12/2019, it has been concluded that a double incubation period has elapsed since the last reported, laboratory confirmed case of measles, and the Institute of Public Health made a proposal to the Commission for Infectious Diseases. at the MOH for the outbreak of the epidemic to be acknowledged by the Minister of Health.

Due to the fact that the disease is registered throughout the European region, it is possible that individual imported cases and limited spread of the disease among unvaccinated persons may occur.

A larger outbreak in the next period is unlikely, due to an increase in the coverage of susceptible populations up to 14 years over 95% and a decrease in the number of susceptible populations further reduced as a result of vaccination against the rest of the population as an epidemic, provided that the vaccination cohort of the above cohort of more than 95% is maintained in the coming period, in line with WHO recommendations.

 

 

 

Recommendations

The recommended measures and activities undertaken by the Centers for Public Health, the Institute of Public Health, the Ministry of Health, the SOIP and the vaccine services at the Vaccination Points continue to be practiced.

  1. Continuous monitoring of cases of febrile rash (according to the measles elimination program);
  2. Epidemiological investigation of any detected / registered case of measles / suspected measles case;
  3. Compulsory laboratory testing of any detected / registered case of rash / suspected measles case;
  4. Maintain a high coverage with 95% two-dose MDR vaccination;
  5. Targeted vaccine campaigns in identified unvaccinated population groups.