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Eurosurveillance, Volume 21, Issue 27, 07 July 2016
Monasta and Knowles: Letter to the editor: Outbreak of a new measles B3 variant in the Roma/Sinti population with transmission in the nosocomial setting, Italy, November 2015 to April 2016

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Citation style for this article: Monasta L, Knowles A. Letter to the editor: Outbreak of a new measles B3 variant in the Roma/Sinti population with transmission in the nosocomial setting, Italy, November 2015 to April 2016. Euro Surveill. 2016;21(27):pii=30275. DOI:

Received:15 June 2016; Accepted:30 June 2016

To the editor: The article by Filia et al. [1] has generated a significant echo in the Italian national media with alarming titles on the responsibilities of the Roma and Sinti population [2,3]. Despite this clearly not being the intention of the authors, the article raises a number of issues which in our opinion should not be ignored.

In the introduction, the authors state that “despite a national goal to eliminate measles by 2015, Italy is one of 18 European Region Member States where endemic transmission of measles has not been interrupted”. As long as the vaccine is not compulsory, it will be difficult to interrupt endemic transmission, especially if vaccination coverage is below standard even among healthcare workers.

Secondly, the Roma and Sinti are not a nomadic ethnic group: nomadism is practiced by less than 3% of the population [4], and the term itself is considered to be outdated both linguistically and culturally, even by National Inclusion Strategy [5]. Nomadism has often been used “to provide cultural legitimacy to the marginalisation of Roma and Sinti”. [6] The poor access of Roma and Sinti communities to health services is not caused by mobility, but by marginalisation [5,7-11]. As clearly stated by the authors, the Roma and Sinti accepted to be vaccinated when such a possibility was offered to them. This goes to show that the lack of coverage cannot be solely attributed to the refusal by the Roma and Sinti communities to vaccinate [9].

Finally, the article does not specify whether the communities in which the cases of measles were reported were Roma or Sinti, and whether they were Italian or foreign. This information would be quite relevant because it would imply different degrees of institutional responsibility for the lack of coverage if these were communities of Italian citizens historically present on the territory.

Reports on outbreaks of infectious diseases involving minority or marginalised groups should always take into account socio-cultural dynamics.

Conflict of interest

None declared.

Authors’ contributions

Lorenzo Monasta conceived the letter and wrote the first and the second version. Alessandra Knowles contributed to the discussion about the content and edited both versions.


  1. Filia A, Amendola A, Faccini M, Del Manso M, Senatore S, Bianchi S,  et al.  Outbreak of a new measles B3 variant in the Roma/Sinti population with transmission in the nosocomial setting, Italy, November 2015 to April 2016. Euro Surveill. 2016;21(20):30235. DOI: 10.2807/1560-7917.ES.2016.21.20.30235 PMID: 27240004

  2. Nenzi R. Campi rom, scoppia epidemia morbillo e si diffonde in Italia. [Roma camps, epidemic outbreaks and spread of measles in Italy]. Milan: Il; 3 June, 2016. Italian. Available from:

  3. Bonezzi G. Il morbillo torna a fare paura; Epidemia partita da tre campi rom. [Measles scares again; outbreak originates from three Roma camps]. Rome: QN; 31 May, 2016. Italian. Available from:

  4. Commissione straordinaria per la tutela e la promozione dei diritti umani. [Extraordinary Commission for the protection and promotion of human rights of the Italian Senate]. Rapporto conclusivo dell'indagine sulla condizione di Rom, Sinti e Caminanti in Italia. [Concluding report of the survey on the condition of Roma and Caminanti in Italy]. Rome: Italian Senate; 9 February 2011. Italian. Available from:,%20sinti%20e%20caminanti.pdf

  5. Ufficio Nazionale Antidiscriminazioni Razziali (UNAR). [National Office Against Racial Discrimination]. Strategia nazionale 2012-2020 d’inclusione dei rom, dei sinti e dei caminanti: attuazione comunicazione Commissione Europea N.173/2011. [2012-2020 national strategy for inclusion of Roma, Sinti and Caminanti: implementing the European Commission's Communication 173/2011]. Rome: UNAR; 2011. Italian. Available from:

  6. Sigona N. The governance of Romani people in Italy: discourse, policy and practice.J Mod Ital Stud. 2011;16(5):590-606. DOI: 10.1080/1354571X.2011.622468

  7. Hajioff S, McKee M. The health of the Roma people: a review of the published literature.J Epidemiol Community Health. 2000;54(11):864-9. DOI: 10.1136/jech.54.11.864 PMID: 11027202

  8. Cook B, Wayne GF, Valentine A, Lessios A, Yeh E. Revisiting the evidence on health and health care disparities among the Roma: a systematic review 2003-2012.Int J Public Health. 2013;58(6):885-911. DOI: 10.1007/s00038-013-0518-6 PMID: 24096986

  9. Monasta L, Erenbourg A, Restaino S, Lutje V, Ronfani L. Review of the scientific literature on the health of the Roma and Sinti in Italy.Ethn Dis. 2012;22(3):367-71.PMID: 22870583

  10. European Commission against Racism and Intolerance (ECRI). ECRI report on Italy (fourth monitoring cycle). Strasbourg: ECRI Secretariat; 21 February 2011. Available from:

  11. Committee on the Elimination of Racial Discrimination (CERD). Consideration of reports submitted by states parties under article 9 of the convention: Concluding observations of the Commitee on the Elimination of Racial Discrimination, Italy. Geneva: CERD; 15 March 2008. Available from:

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