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Istituto Superiore di Sanità
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Istituto Superiore di Sanità - EpiCentro


Epidemic of Measles in Campania:  An Update

Marta Ciofi degli Atti (1), Stefania Salmaso (1) for the coordinating group of the SPES, Renato Pizzuti (2), Paola D’Agnese (2), Crescenzo Bove (3), Domenico Protano (3), Angelo D’Argenzio (4), and Maria Luigia Trabucco (4)

(1)   Laboratory of Epidemiology and Biostatistics, ISS

(2)   Regional Health Services Agency, Campania Region

(3)   Local Health Unit Caserta 1

(4)   Local Health Unit Caserta 2

 

In the April 2002 BEN, an increase in measles notifications in the Campania region was detected by the Pediatric Epidemiologic Surveillance Network (SPES) (1). This article provides an update of the epidemic and data on hospitalizations and complications obtained through a special study currently being conducted in the region.

 

During the first four months of 2002, an average of 50 pediatricians in Campania participated in the SPES system. These pediatricians follow an estimated 41,000 children between 0-14 years of age (4% of the total pediatric population of the region). Between January and April, the number of measles cases notified by the SPES pediatricians progressively increased; in total 662 cases were reported compared with 18 during the previous two years. The estimated measles incidence for January-April based on the SPES data was 1600 cases per 100,000 children under 14 years; applying this rate to the overall pediatric population of the region yields an estimated total number of measles cases of 17,000. The highest incidence was observed in the children between 5-9 years, followed by those 10-14 years of age.

 

The distribution by province of new cases is reported in the table, as is the province-specific vaccine coverage for those born in 1998, estimated in as part of a 2000-01 survey (2). The incidence by province corresponds closely with the vaccine coverage; the incidence rate is highest in the two provinces with the lowest coverage (Caserta and Naples), while the provinces with the highest coverage (Benevento and Avellino) have had fewer cases. It should be noted, however, than only two pediatricians from Avellino contribute data to the SPES system, and the results for this province should be interpreted with caution.

 

The analysis of hospitalizations was conducted in the major hospitals in the region that have infectious disease units (Cotugno Hospital in Naples and the regional hospitals of Caserta, Benevento, Avellino, and Salerno) and includes data through the 5th of June 2002. In the first 5 months of the year, 368 persons were hospitalized with measles. Of these 63, had pulmonary complications, 13 had encephalitis, and 3 died. The three deaths occurred in children ages 6 months, 4 years, and 10 years. Most of the hospitalizations (258/368) occurred in Cotugno hospital in Naples; in this hospital the age of patients with measles ranged from 15 days to 68 years, with 17% of the admissions occurring in persons 14 years and over.

 

Incidence in other regions of Italy was significantly lower than that observed in Campania. Excluding this region, the incidence of measles between January and April 2000 averaged 33 cases/100,000.

 

The epidemic in Campania has the characteristics of an epidemic in a population with intermediate levels of vaccine coverage—levels are high enough to alter the epidemiology of the spread but low enough to permit widespread circulation of the virus. Indeed, in this region, the last epidemic occurred in 1996, and the inter-epidemic interval was much longer than that observed in the absence of vaccination (6 years versus 3 years).

 

The key to preventing epidemics of this type is to prevent the accumulation of susceptibles in all age groups as quickly as possible. The regional health authorities have thus recommended: 1) intensification of active vaccination of those exposed in family and school settings; b) vaccination starting at 6 months of age, with subsequent revaccination after one year of those children vaccinated between 6 and 12 months; c) offering vaccine to all persons that who have not been vaccinated or who do not have a history of measles disease.

 

The situation in Campania is not unique in Italy because there are other regions with low levels of vaccine coverage. To prevent new epidemics it is therefore essential that there be a strong political and technical commitment that guarantees high levels of coverage in all the regions, both during the second year of life and in older children as well.

 

References

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