Measles is back: what’s happening in Italy

“Dying from measles in 2024 in Europe”, we headlined yesterday, reporting the news of a man who died in Ireland after contracting the infectious disease which often affects children between 1 and 3 years old …

Measles is back: what's happening in Italy

“Dying from measles in 2024 in Europe”, we headlined yesterday, reporting the news of a man who died in Ireland after contracting the infectious disease which often affects children between 1 and 3 years old (and for this reason is called infantile, like rubella, chickenpox, whooping cough and mumps). According to the World Health Organization (WHO), last year measles cases in Europe increased almost 45 times: 42,200 people, compared to 941 in 2022. The WHO believes that the increase in infections is the result of fewer children vaccinated against the disease during the covid years.

How are things going in Italy? In 2023, measles cases also increased in our country, and the trend is continuing in 2024. This is stated by the new bulletins published by the Higher Institute of Health (ISS), according to which last year the surveillance system recorded 43 cases of measles, a clear increase compared to the 15 in 2022, while in the month of January 2024 alone 27 were reported. According to data released by the ISS, in the period between 1 January and 31 December 2023 there were 43 cases of measles reported: in particular, an increase was observed in the last four months of the year, with 32 cases recorded between September and December 2023, compared to three cases in the same period of 2022. 42% of the cases reported were cases imported.

93% of total cases are not vaccinated

The national incidence is one case per million inhabitants. At a regional level, the highest incidence was observed in the Campania region. The median age of cases is 27 years, but the highest incidence has been observed in children under 5 years of age. 93% of total cases were unvaccinated. Furthermore, 26% of cases reported a complication: the most frequently reported was diarrhea, found in six cases, followed by pneumonia (four cases), respiratory failure (three cases), keratoconjunctivitis (three cases) and from hepatitis or increased transaminases (three cases).

And let’s look at the numbers for the current year, which began with a less than encouraging trend. From 1 January to 31 January 2024, 27 cases of measles were reported to the surveillance system, of which 26 were laboratory confirmed, from seven regions. The national incidence was 0.5 cases per million inhabitants. Over half of the cases were reported from three regions: Lombardy, Tuscany and Lazio. The highest incidence was reported in Tuscany (2.4 cases per million inhabitants), followed by Lazio and Campania. Nine of the reported cases (33%) are imported cases.

The median age of cases registered in 2024 is 35 years (range: 1-47 years) and over half of the cases (6 out of 11) are aged between 15 and 39 years. One case has also been reported in a child less than one year of age (therefore not eligible for vaccination). The highest incidence was observed in the 15-39 age group (1.08 per million), followed by the 0-4 age group (0.46 per million).

High contagiousness and risk of complications

In recent days, family doctors in Lazio have spoken of a boom in cases registered among adults, particularly those in their thirties. “Measles is a disease that should not be underestimated because it is a ‘bad’ virus that brings high fever and enathema, a skin rash in the mucous membranes of the pharynx, then comes the rash with blisters”, said Pierluigi Bartoletti, secretary of the Italian federation of family doctors (Fimmg) of Rome and its province. In Lazio, the expert explained, “there is an alarm in adults, we see cases again in young people, unvaccinated thirty-year-olds. A situation that we family doctors have not witnessed for decades. What we advise our clients is to check whether you have had the measles vaccination and if not, do it”.

“It is not a disease that should be underestimated, it is extremely contagious due to its spread by air, one case generates 16, much more than the first Sars-CoV-2. The only weapon is the vaccine because there are no effective drugs” , warns Massimo Andreoni, scientific director of Simit, the Italian society of infectious and tropical diseases. “The vaccine is given at the 13th month of life and then the booster at 5-6 years. Now those who know they have never had it can do it in their local health authority and those who have not had the booster can still do it”, recalls Andreoni.

The ISS table on complications among reported measles cases

The increase in cases and the safe and effective vaccine

“The increase in cases recorded in Italy is smaller than that of other European countries about which the WHO recently raised an alarm, but it should not be underestimated”, explained Anna Teresa Palamara, director of the disease department infectious diseases of the ISS. Measles can be potentially very dangerous, especially for the little ones, as demonstrated by the WHO data for Europe, which report 21 thousand hospitalizations and 5 deaths in 2023. “The vaccine, which is safe and effective, remains the main tool to provision to combat this disease”, concluded Palamara.

In the 1960s, immediately preceding the introduction of vaccination, around 74 thousand cases per year were recorded in Italy, corresponding to an incidence of around 150 cases per one hundred thousand inhabitants. Since the introduction of vaccination, the number has progressively decreased, with an average incidence of 81 cases per hundred thousand inhabitants in the 1980s and 41 cases per 100 thousand inhabitants in the 1990s. The last “epidemic” year was 1997, with approximately 41 thousand notifications, 95% of which were in the age group between 0 and 14 years. In 1998, notifications dropped sharply to four thousand, and have continued to decline ever since.

The measles vaccination campaign is struggling

The explosive growth of measles cases in countries not too far from ours, such as Romania, is bringing attention back to participation in the vaccination offer. The increase in cases around the world, in fact, may be related to the sharp decline in vaccinations. Suffice it to say that in Europe and Central Asia the first dose vaccination rate decreased from 96% in 2019 to 93% in 2022 and that approximately 931 thousand children did not receive all or part of routine vaccines between 2019 and 2021.

“There is no clearer sign of the collapse of vaccination coverage than an increase in measles cases – says Regina De Dominicis, UNICEF regional director for Europe and Central Asia -. Such a marked increase requires careful attention urgent public health measures to protect children from this dangerous and deadly disease. Measles – recalls the expert – has a devastating effect on a child’s health, sometimes with lethal consequences. It causes a lasting weakening of children’s immune systems, making them more vulnerable to other infectious diseases, including pneumonia.”

Demand for vaccines decreased during the covid pandemic, but now that the worst seems to be over, European healthcare systems, including Italy, are still struggling to resume routine activities. In 2021, vaccination coverage in our country was 92% of the population for the first dose and 86% for the second, down 1% and 3% respectively compared to 2018. We should reach at least 95% with two doses, recommends the ECDC (the European Center for Disease Prevention and Control), with “homogeneous coverage throughout the territory, because the virus can find a way to spread in unprotected pockets of the population, leading to outbreaks even in the countries that have eradicated it”.