Ongoing measles outbreak in Wallonia,Belgium · Ongoing measles outbreak in Wallonia,Belgium ....

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Ongoing measles outbreak in Wallonia,Belgium December 2016 - May 2017 Cellule de surveillance des maladies infectieuses Nathalie Shodu

Transcript of Ongoing measles outbreak in Wallonia,Belgium · Ongoing measles outbreak in Wallonia,Belgium ....

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Ongoing measles outbreak in

Wallonia,Belgium December 2016 - May 2017

Cellule de surveillance des maladies infectieuses Nathalie Shodu

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Collaboration

WIV-ISP: Ms.Tine Grammens and Dr. Martine Sabbe

AViQ – Cellule de surveillance des maladies infectieuses:

Ms. Sylvie Leenen and Dr. Carole Schirvel

AViQ - Cellule de surveillance des maladies infectieuses Measles Outbreak December 2016 - May 2017

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Summary:

1. Presentation of the disease 2. Start of the Outbreak 3. Epidemiology data 4. Conclusion

AViQ - Cellule de surveillance des maladies infectieuses Measles Outbreak December 2016 - May 2017

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1. Presentation of the disease

AViQ - Cellule de surveillance des maladies infectieuses Measles Outbreak December 2016 - May 2017

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1. Presentation of the disease

maximum: 7-18 Days

Symptoms : Cough Rhinitis, conjuncitivitis, Koplik spots Maculopapular rash

Complications : Otitis Media - bronchiolitis (5-10%) Pneumonitis (2-7%) Keratitis Acute Encephalitis (1/1000) Pregnancy: - risk of miscarriage - premature deliveries - fetal mortality

Slide from presentation by Dr. Sabbe Martine, Pentalfa, KUL, 23 Mar 2017 AViQ - Cellule de surveillance des maladies infectieuses

Measles Outbreak December 2016 - May 2017

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Presenter
Presentation Notes
Measle is a high contagious viral desease . The transmission is mainly by air. In general, it can lead to complications in 20 to 30% of the cases; such as otitis /pneumonitis/ encephalitis and more risk for pregnant women. The symptoms are high fever/ fallowed by oculo-respiratory catarrh (cough, rhinitis, cunjunctivitis) /maculopapular rash /Koplick’s spots Incubation period: +- 10 days The rash can appear till 21days after the exposition! Period of contagiousness: 5 days before to 5 days after the onset of the rash.
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Laboratory diagnosis:

Sample type

Analysis Time sampling Shipment Conser-vation

Serum IgM and IgG 7-28 days after start rash

As soon as possible

At 2-5°C until sending samples

Oral Fluid (OF)

IgM

7-28 days after start rash

As soon as possible (within 7 days in lab)

PCR (virusdetection)

Max. 7 days after start rash

As soon as possible (within 7 days in lab)

Genotyping Max. 5 days after start rash

As soon as possible

Naso

PCR (virusdetection)

Max. 7 days after start rash

As soon as possible

Genotyping Max. 5 days after start rash

As soon as possible

Hutse V et al. 2010, Int J Infect Dis https://nrchm.wiv-isp.be

AViQ - Cellule de surveillance des maladies infectieuses

Measles Outbreak December 2016 - May 2017

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Presenter
Presentation Notes
There is a saliva test possible –This is to avoid to take blood in children to diagnose measles. This test was developed because of the elimination process.
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2. Start of the Outbreak

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2. Start of the Outbreak Time ? Started on 20 December 2016 cluster of 3 cases [ index case = Belgian citizen who travelled to Romania]

Place ? 4/5 Wallonian provinces except province Luxembourg

Person ? - Mainly central and eastern European origin unvaccinated/unknown vacc. Status/ transmission within families; - Spread all over Wallonian citizen (native Belgian,

Italians, Marocco ,etc…) Age of the cases : 0 month to 68 years old

AViQ - Cellule de surveillance des maladies infectieuses Measles Outbreak December 2016 - May 2017

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Presenter
Presentation Notes
The outbreak started end of december 2016. The index case was a Belgian citizen who travelled to Romania during the incubation period. Four out of five provinces in Wallonia were touched by this epidemia. At the beginning the cases were mainly from central and eastern European origin but the virus spread all over Wallonian citizen and other origin were involved.
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3. Epidemiology data

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3.1. Characteristics of the cases Measles outbreak Wallonia Measles cases per province (N=293)

Preliminary data from 20/12/2016 to 08/05/2017

Hainaut

Walloon Brabant

Liège

Namur

130 44,4%

16 5,5% 98

33,4% 40 13,6%

AViQ - Cellule de surveillance des maladies infectieuses Measles Outbreak December 2016 - May 2017

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Presenter
Presentation Notes
As you can see 4 of the 5 provinces of Wallonia were concern by this outbreak: Hainaut (with 130 cases) – Liège (98 cases) – Namur (40 cases)- Walloon Brabant(16 cases). No case was notified in province Luxembourg.
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Measles outbreak Wallonia Measles cases per week of notification and per province (N=293)

Preliminary data from 20/12/2016 to 08/05/2017

AViQ - Cellule de surveillance des maladies infectieuses Measles Outbreak December 2016 - May 2017

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Presenter
Presentation Notes
As said previously,the index case was notified in December 2016; After mid- January 2017 new cases related to December cluster appeared. starting from mid-February (week 8 to 10), the number of case reported increases significantly ( almost 36 new measles cases were reported per week.) After week10, the number of cases notified decreases .We can also see a beautiful Gausse curve that tends to fall.
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Measles outbreak Wallonia Measles cases per age group and vaccination status (N=293)

Preliminary data from 20/12/2016 to 08/05/2017

Not vaccinated 31.1% 1 Dose 6.5% 2 Doses 2.0% Unknown nb of Doses 2.7% Unknown vacci status 57.7%

<5y: 28% >=15y: 52% +/- 12% of the cases are HCW

AViQ - Cellule de surveillance des maladies infectieuses Measles Outbreak December 2016 - May 2017

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Presenter
Presentation Notes
This graph represente the measles cases per age group and their vaccination status. What is important to remember here is that nearly 57% of the subjects reported have no knowledge about their immunization status. And 31% of the cases are not vaccinated. Note that 28% are under 5 years of age and 52% are 15 years of age or older. During this epidemic, we detected 37 cases of measles among health care worker which represent 12% of the total cases.
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3.2. Clinical aspects Measles outbreak Wallonia - Hospitalisations and complications

Complications in hospitalised patients Period 20/12/2016 – 12/03/2016 (N=177) * Hospitalised: 76/177= 43%

< 5y 5-14y >= 15y

Dehydration: 6 Febrile convulsions: 1

Pneumonia: 3

Dehydration: 4 Hepatic disorder: 1

Otitis media: 1

Dehydration: 6 Acute encephalitis: 1 Hepatic disorder: 9

Pneumonia: 5 Pancreatitis: 1

Update (08/05/2017): 39% hospitalised (115/293) Complications: • 2 acute encephalitis • 5 pregnant women with hospitalisation (1 preterm delivery)

* Grammens T, Schirvel C, Leenen S, Shodu N, Hutse V, Mendes da Costa E, Sabbe M. Rapid Communication. Ongoing measles outbreak in Wallonia, Belgium, December 2016 to March 2017: characteristics and challenges. Eurosurveillance. 2017 Apr 27;22 (17). Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22787

AViQ - Cellule de surveillance des maladies infectieuses Measles Outbreak December 2016 - May 2017

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Presenter
Presentation Notes
From the beginning of the epidemic to the present; we had out of a total of 293 declarations, 115cases of measles hospitalized (39%). The main reasons for hospitalizations are related to complications such as dehydration/ otitis/pneumonia or hapatic disorder.
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3.3. Laboratory confirmation From December 2016 to May 2017:

169 cases were laboratory-confirmed * (58 %) (the majority by the NRC for measles, mumps and rubella at the WIV-ISP) 82 were probable cases (= with an epidemiological link to a confirmed measles case) 42 were possible cases (= based on clinical symptoms)

Genotyping:

Performed by the NRC Classified as B3 :

- same strain as the one identified in the index case - same strain circulating in Romania / Italy/ Austria at the end of 2016 [cfr. WHO MeaNS database]** *Case definition ECDC 2012: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2012:262:0001:0057:EN:PDF

*World Health Organization (WHO). Measles Nucleotide Surveillance (MeaNS) Database. Geneva: WHO. Available from: http://www.hpa-bioinformatics.org.uk/Measles/Public/Web_Front/main.php

Preliminary data from 20/12/2016 to 08/05/2017 AViQ - Cellule de surveillance des maladies infectieuses

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Presenter
Presentation Notes
Since december to now, we had 169 confirmed cases by the NRC for measles, mumps and rubella. 82 were probable cases and 42 were possible cases . The genotyping is performed by the NRC for measles, mumps and rubella. The virus was classified as B3; which is the same strain ast the index case and also the same strain as the one circulating in Romania/ Italy and Austria et the end of 2016.
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3.4. Control measures Guidelines:

- Contact tracing + source investigation /for each case - Isolation - Vaccination proposed to all susceptible contacts [verified based on

the vaccination status + date of birth ( born< 1970* = considered immunized against measles)]

- Information letters sent to hospitals/ asylum centres/GP’s/Parents of the students attending school or nursery where measles cases had been reported / etc.

Aim: to raise awareness/ to inform/ to prevent by vaccination

Large scale communication methods: press release, public website, emails, newsflash, etc.

*CSS : « Vaccination de rattrapage, révision 2013. » Chapitre 3.2. Schémas de vaccination de rattrapage chez l’adulte. Available from : https://www.health.belgium.be/sites/default/files/uploads/fields/fpshealth_theme_file/19087449/Vaccination%20de%20rattrapage%20%282013%29%20.pdf

AViQ - Cellule de surveillance des maladies infectieuses Measles Outbreak December 2016 - May 2017

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Presenter
Presentation Notes
During this outbreak, we have foollowed and put in place various tools to help us control this epidemic such as : Contact tracing and source investigation for each case/ isolation of the case/ vaccination was proposed to all susceptible contacts. Information letters were sent to hospitals/ GP’s/parents of the students attending school or nursery where measle case had been reported. Our aim was to raise awareness; to inform and to prevent by vaccination when it was possible. We also used larger scale communication methods as press releasing, public website, etc.
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4. Conclusion

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4. Conclusion

Measles is a highly contagious disease

Effectiveness of the vaccination as a preventive measure

Affecting all age groups [52% >15years & 28%< 5years old]

Specificity of this outbreak : +/- 12% of the cases are HCW

Leads to non-negligible complications and hospitalisation in 39% of the cases

Belgium= Endemic country

Status of vaccination of the cases : +- 73% are unknown status or unvaccinated!!

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Special thanks for your cooperation and support during this outbreak to:

Service Epidemiology of Infectious Diseases, WIV-ISP NRC for measles, mumps and rubella CoCom PROVAC - ONE Private and hospital laboratories Hospital doctors and nursing hygienists General practitioners and clinical physicians Etc…

AViQ - Cellule de surveillance des maladies infectieuses Measles Outbreak December 2016 - May 2017

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Presenter
Presentation Notes
Do not read this out loud > timing!