Measles Elimination Efforts and 2008–2011 Outbreak, France

Denise Antona

, Daniel Lévy-Bruhl, Claire Baudon, François Freymuth, Mathieu Lamy, Catherine Maine, Daniel Floret, and Isabelle Parent du Chatelet

Author affiliations: Author affiliations: Institut de Veille Sanitaire, Saint-Maurice, France (D. Antona, D. Lévy-Bruhl, C. Baudon, M. Lamy, C. Maine, I. Parent du Chatelet); National Reference Centre for Measles and Respiratory Paramyxoviridae, CHU Caen, France (F. Freymuth); Université Claude Bernard Lyon 1, Lyon, France (D. Floret)

Abstract

Although few measles cases were reported in France during 2006 and 2007, suggesting the country might have been close to eliminating the disease, a dramatic outbreak of >20,000 cases occurred during 2008–2011. Adolescents and young adults accounted for more than half of cases; median patient age increased from 12 to 16 years during the outbreak. The highest incidence rate was observed in children <1 10="" 135="" 1="" 2015="" 27="" 5="" 80="" a="" adults="" age="" almost="" although="" among="" and="" be="" by="" cases="" children="" convincing="" coverage="" critical="" died.="" disease="" during="" eliminate="" encephalitis="" epidemic="" for="" get="" heterogeneous="" hospitalized="" if="" improved="" in="" including="" infants="" is="" issue="" last="" met.="" more="" myelitis="" occurred="" of="" p="" patients="" period="" persons="" pneumonia="" pockets="" reaching="" reflecting="" remain.="" remains="" severe="" still="" susceptible="" target="" than="" the="" this="" to="" unvaccinated="" vaccinated="" vaccination="" vaccine="" wave.="" were="" where="" year="" young="">

In 1983, measles vaccination was introduced into the immunization schedule for toddlers in France; the combined measles-mumps-rubella vaccine (MMR) has been used since 1986. A second MMR dose was added in 1996. Until 2004, recommendation were that the first dose (MMR1) be administered at 12 months of age and the second (MMR2) at 3–6 years of age. A catch-up schedule with 1 dose of MMR was also recommended for unvaccinated children 6–13 years of age.
To meet the World Health Organization (WHO) European Region’s goals for measles elimination, a national plan was implemented in 2005. It included bringing forward the administration of MMR2 to a child’s second year of life in addition to expanding catch-up to include 2 doses for unvaccinated persons born after 1991 and 1 dose for those born during 1980–1991. Other measures implemented included the vaccination of susceptible health professionals and detailed control measures around suspected cases (1,2).
Measles was a notifiable disease from 1945 to 1986 in France. From 1986 to 2004, surveillance of the disease was managed through a national sentinel network of general practitioners (3). Because cases were becoming rare, mandatory reporting was reintroduced in 2005. Laboratory confirmation by serologic or saliva testing and including virus characterization was simultaneously implemented.
Only 40 and 44 cases were notified in 2006 and 2007, respectively, which placed the incidence of reported cases below the WHO threshold for measles elimination (0.1 cases/100,000 inhabitants). However, in 2008, the number of cases started increasing and rose dramatically thereafter (4,5). Here, we describe the 2008–2011 measles epidemic in France and the characteristics of cases reported over that period.