Surveillance and outbreak report Open Access
Like 0


The largest measles outbreak in Berlin since 2001 occurred from October 2014 to August 2015. Overall, 1,344 cases were ascertained, 86% (with available information) unvaccinated, including 146 (12%) asylum seekers. Median age was 17 years (interquartile range: 4–29 years), 26% were hospitalised and a 1-year-old child died. Measles virus genotyping uniformly revealed the variant ‘D8-Rostov-Don’ and descendants. The virus was likely introduced by and initially spread among asylum seekers before affecting Berlin’s resident population. Among Berlin residents, the highest incidence was in children aged < 2 years, yet most cases (52%) were adults. Post-exposure vaccinations in homes for asylum seekers, not always conducted, occurred later (median: 7.5 days) than the recommended 72 hours after onset of the first case and reached only half of potential contacts. Asylum seekers should not only have non-discriminatory, equitable access to vaccination, they also need to be offered measles vaccination in a timely fashion, i.e. immediately upon arrival in the receiving country. Supplementary immunisation activities targeting the resident population, particularly adults, are urgently needed in Berlin.


Article metrics loading...

Loading full text...

Full text loading...



  1. Perry RT, Murray JS, Gacic-Dobo M, Dabbagh A, Mulders MN, Strebel PM, et al. Progress toward regional measles elimination - worldwide, 2000-2014. MMWR Morb Mortal Wkly Rep. 2015;64(44):1246-51.  https://doi.org/10.15585/mmwr.6444a4  PMID: 26562349 
  2. Mina MJ, Metcalf CJE, de Swart RL, Osterhaus ADME, Grenfell BT. Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality. Science. 2015;348(6235):694-9.  https://doi.org/10.1126/science.aaa3662  PMID: 25954009 
  3. Bundesministerium für Gesundheit. [Federal Ministry of Health]. Nationaler Aktionsplan 2015-2020 zur Elimination der Masern und Röteln in Deutschland: Hintergründe, Ziele und Strategien. [National action plan 2015-2020 for the elimination of measles and rubella in Germany: Background, goals and strategies]. Berlin: Federal Ministry of Health; [Accessed 13 Feb 2017]. German. Available from: https://www.gmkonline.de/documents/Aktionsplan_Masern_Roeteln_2.pdf
  4. World Health Organization Regional Office for Europe (WHO Europe). Eliminating measles and rubella and preventing congenital rubella infection: WHO European Region strategic plan 2005-2010. Copenhagen: WHO Europe; 2005. [Accessed 9 Feb 2017]. Available from: http://www.euro.who.int/__data/assets/pdf_file/0008/79028/E87772.pdf
  5. World Health Organization Regional Office for Europe (WHO Europe). Eliminating measles and rubella: Framework for the verification process in the WHO European Region. Copenhagen: WHO Europe; 2014. [Accessed 23 Nov 2015]. Available from: http://www.euro.who.int/__data/assets/pdf_file/0009/247356/Eliminating-measles-and-rubella-Framework-for-the-verification-process-in-the-WHO-European-Region.pdf
  6. Clemmons NS, Gastanaduy PA, Fiebelkorn AP, Redd SB, Wallace GS. Measles - United States, January 4-April 2, 2015. MMWR Morb Mortal Wkly Rep. 2015;64(14):373-6. PMID: 25879894 
  7. Papania MJ, Wallace GS, Rota PA, Icenogle JP, Fiebelkorn AP, Armstrong GL, et al. Elimination of endemic measles, rubella, and congenital rubella syndrome from the Western hemisphere: the US experience. JAMA Pediatr. 2014;168(2):148-55.  https://doi.org/10.1001/jamapediatrics.2013.4342  PMID: 24311021 
  8. World Health Organization (WHO). Global measles and rubella strategic plan: 2012-2020. Geneva: WHO; [Accessed 9 Feb 2017]. Available from: http://apps.who.int/iris/bitstream/10665/44855/1/9789241503396_eng.pdf.
  9. Robert Koch-Institut (RKI). Empfehlungen der Ständigen Impfkommission (STIKO) am RKI. [Recommendations of the German Standing Committee on Vaccination (STIKO) at the RKI]. Epidemiologisches Bulletin. Berlin: RKI; 29 Aug 2016. German. Available from: https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2016/Ausgaben/34_16.pdf?__blob=publicationFile
  10. Robert Koch-Institut (RKI). Impfquoten bei der Schuleingangsuntersuchung in Deutschland 2014. [Vaccine coverage at school entry examination in Germany in 2014]. Berlin: RKI; 25 Apr 2016. German. Available from: https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2016/Ausgaben/16_16.pdf?__blob=publicationFile
  11. Robert Koch-Institut (RKI). Mitteilung der Ständigen Impfkommission (STIKO) am Robert Koch-Institut (RKI). [Information of the German Standing Committee on Vaccination (STIKO) at the RKI]. Berlin: RKI; 16 Aug 2010. German. Available from: https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2010/Ausgaben/32_10.pdf?__blob=publicationFile.
  12. Eurostat. Database: Asylum and managed migration (migr). Luxembourg: Eurostat; [Accessed 1 Aug 2017]. Available from: http://ec.europa.eu/eurostat/data/database?node_code=migr
  13. Amt für Statistik Berlin-Brandenburg. [Office for Statistics Berlin-Brandenburg]. Statistiken. [Statistics]. Berlin: Office for Statistics Berlin Brandenburg; [Accessed 13 Feb 2017]. German. Available from: https://www.statistik-berlin-brandenburg.de/Statistiken/inhalt-statistiken.asp
  14. World Health Organization Regional Office for Europe (WHO Europe). Health2020: A European policy framework and strategy for the 21st century. Copenhagen: WHO Europe; 2013. [Accessed 9 Feb 2017]. Available from: http://www.euro.who.int/__data/assets/pdf_file/0011/199532/Health2020-Long.pdf?ua=1
  15. Weis P. The Convention Relating to the Status of Stateless Persons. Int Comp Law Q. 1961;10(10(2)):255-64.  https://doi.org/10.1093/iclqaj/10.2.255 
  16. Declaration of Alma-Ata. Lancet. 1979;1(8109):217-8.  PMID: 84242 
  17. World Health Organization (WHO). Sixty-First World Health Assembly. Geneva, 19-24 May 2008. Geneva: WHO; [Accessed 9 Feb 2017]. Available from: http://apps.who.int/gb/ebwha/pdf_files/WHA61-REC1/A61_REC1-en.pdf
  18. Federal Ministry of Justice. Asylbewerberleistungsgesetz. [Asylum Seekers’ Benefit Act]. Bonn: Bundesgesetzblatt (BGBI). I S. 2541. 17 Jul 2017. [Accessed 31 Jul 2017]. Available from: http://www.gesetze-im-internet.de/bundesrecht/asylblg/gesamt.pdf
  19. Rota PA, Brown K, Mankertz A, Santibanez S, Shulga S, Muller CP, et al. Global distribution of measles genotypes and measles molecular epidemiology. J Infect Dis. 2011;204(Suppl 1):S514-23.  https://doi.org/10.1093/infdis/jir118  PMID: 21666208 
  20. Kumar S, Stecher G, Tamura K. MEGA7: Molecular Evolutionary Genetics Analysis Version 7.0 for Bigger Datasets. Mol Biol Evol. 2016;33(7):1870-4.  https://doi.org/10.1093/molbev/msw054  PMID: 27004904 
  21. World Health Organization (WHO). Measles virus nomenclature update: 2012. Wkly Epidemiol Rec. 2012;87(9):73-81. PMID: 22462199 
  22. Salimović-Bešić I, Šeremet M, Hübschen JM, Hukić M, Tihić N, Ahmetagić S, et al. Epidemiologic and laboratory surveillance of the measles outbreak in the Federation of Bosnia and Herzegovina, February 2014-April 2015. Clin Microbiol Infect. 2016;22(6):563.e1-7.  https://doi.org/10.1016/j.cmi.2016.02.005  PMID: 26928202 
  23. Robert Koch-Institut (RKI). Impfraten deutscher Kinder bei der Schuleingangsuntersuchung im Jahr 2002. [Vaccine coverage of German children at school entry examination in the year 2002]. Epidemiologisches Bulletin. Berlin: RKI; 30 Apr 2003. German. Available from: http://edoc.rki.de/documents/rki_fv/rePoSwYQt9oyc/PDF/24xN0iiVGsOc.pdf
  24. Poethko-Müller C, Schmitz R. Impfstatus von Erwachsenen in Deutschland: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). [Vaccination coverage in German adults: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56(5-6):845-57.  https://doi.org/10.1007/s00103-013-1693-6  PMID: 23703506 
  25. Robert Koch-Institut (RKI). SurvStat@RKI 2.0. Berlin: RKI; [Accessed 9 Feb 2017]. Available from: https://survstat.rki.de/Content/Query/Create.aspx
  26. Takla A, Wichmann O, Rieck T, Matysiak-Klose D. Measles incidence and reporting trends in Germany, 2007-2011. Bull World Health Organ. 2014;92(10):742-9.  https://doi.org/10.2471/BLT.13.135145  PMID: 25378728 
  27. Hoffmann A, Sagebiel D, Hentschel K, Werber D. Large measles outbreak in Berlin 2014/2015 - Many cases not opposed to vaccination, yet unvaccinated (reference number 3048). In: European Scientific Conference on Applied Infectious Disease Epidemiology (ESCAIDE). Abstract Book; 1-13 Nov 2015; Stockholm, Sweden. Stockholm: ESCAIDE;2015. [Accessed 12 Dec 2016]. p. 58. Available from: http://www.escaide.eu/sites/escaide/files/documents/escaide-2015-abstract-book.pdf
  28. Barnett ED, Christiansen D, Figueira M. Seroprevalence of measles, rubella, and varicella in refugees. Clin Infect Dis. 2002;35(4):403-8.  https://doi.org/10.1086/341772  PMID: 12145723 
  29. Greenaway C, Dongier P, Boivin J-F, Tapiero B, Miller M, Schwartzman K. Susceptibility to measles, mumps, and rubella in newly arrived adult immigrants and refugees. Ann Intern Med. 2007;146(1):20-4.  https://doi.org/10.7326/0003-4819-146-1-200701020-00005  PMID: 17200218 
  30. Mankertz A, Mihneva Z, Gold H, Baumgarte S, Baillot A, Helble R, et al. Spread of measles virus D4-Hamburg, Europe, 2008-2011. Emerg Infect Dis. 2011;17(8):1396-401.  https://doi.org/10.3201/eid1708.101994  PMID: 21801615 
  31. World Health Organization Regional Office for Europe (WHO Europe). WHO-UNHCR-UNICEF joint technical guidance: general principles of vaccination of refugees, asylum-seekers and migrants in the WHO European Region. Copenhagen: WHO Europe; 23 Nov 2015. Available from: http://www.euro.who.int/en/health-topics/health-determinants/migration-and-health/news/news/2015/11/who,-unicef-and-unhcr-call-for-equitable-access-to-vaccines-for-refugees-and-migrants/who-unhcr-unicef-joint-technical-guidance-general-principles-of-vaccination-of-refugees,-asylum-seekers-and-migrants-in-the-who-european-region
  32. European Centre for Disease Prevention and Control (ECDC). Rapid Risk Assessment. Communicable disease risks associated with the movement of refugees in Europe during the winter season. Stockholm: ECDC; 10 Nov 2015. Available from: http://ecdc.europa.eu/en/publications/Publications/refugee-migrant-health-in-european-winter-rapid-risk-assessment.pdf
  33. Amt für Statistik Berlin-Brandenburg. [Office for Statistics Berlin-Brandenburg]. Tourismus Basisdaten. [Tourism. Basic data]. Berlin: Office for Statistics Berlin-Brandenburg; [Accessed 9 Feb 2017]. Available from: https://www.statistik-berlin-brandenburg.de/BasisZeitreiheGrafik/Bas-Tourismus.asp?Ptyp=300&Sageb=45005&creg=BBB&anzwer=7

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error