Outbreaks Open Access
Like 0


In Portugal, measles vaccination coverage and population immunity are high, and no endemic measles cases had been reported since 2004. The World Health Organization classified measles as eliminated in the country in 2015 and 2016, based on data from the previous 3 years. However, in a context of increasing incidence in several European countries in 2016 and 2017, Portugal experienced two simultaneous measles outbreaks with a total of 27 laboratory-confirmed cases (0.3 cases/100,000 population) in two health regions between February and May 2017. Nineteen cases (70.1%) were adults, of whom 12 were healthcare workers. Overall, 17 cases (63.0%) were not vaccinated, of whom five were infants younger than 12 months of age. One unvaccinated teenager died. Genotype B3 was identified in 14 cases from both regions. Measles virus sequencing identified different possible origins of the virus in each region affected. Although measles transmission was stopped in less than 2 months from the first case being notified, these outbreaks represent an opportunity to reinforce awareness of measles diagnosis. We highlight the intensity of the control measures taken and their impact on the rapid control of the outbreaks and also the fact that high vaccination coverage was crucial to stop transmission.


Article metrics loading...

Loading full text...

Full text loading...



  1. O’Connor P, Jankovic D, Muscat M, Ben-Mamou M, Reef S, Papania M, et al. Measles and rubella elimination in the WHO Region for Europe: progress and challenges. Clin Microbiol Infect. 2017;23(8):504-10.  https://doi.org/10.1016/j.cmi.2017.01.003  PMID: 28111293 
  2. World Health Organization (WHO). Global measles and rubella strategic plan: 2012-2020. Geneva: WHO; 2012. Available from: http://apps.who.int/iris/bitstream/10665/44855/1/9789241503396_eng.pdf
  3. World Health Organization Regional Office for Europe (WHO/Europe). European vaccine action plan 2015-2020. Copenhagen: WHO/Europe; 2014. Available from: http://www.euro.who.int/__data/assets/pdf_file/0007/255679/WHO_EVAP_UK_v30_WEBx.pdf?ua=1
  4. Directorate-General of Health (DGS). Programa Nacional de Vacinação 2017. [National Immunisation Programme 2017]. Lisbon: DGS; Dec 2016. Portuguese. Available from: https://www.dgs.pt/documentos-e-publicacoes/programa-nacional-de-vacinacao-2017-pdf.aspx
  5. World Health Organization Regional Office for Europe (WHO/Europe). 4th Meeting of the European Regional Verification Commission for Measles and Rubella Elimination (RVC). Copenhagen: WHO; 2016. Available from: http://www.euro.who.int/__data/assets/pdf_file/0011/304958/4th-RVC-meeting-report.pdf
  6. European Centre for Disease Prevention and Control (ECDC). Measles and rubella monitoring, January 2017 - Disease surveillance data: 1 January 2016 – 31 December 2016. Stockholm: ECDC; 2017. Available from: http://ecdc.europa.eu/en/publications/Publications/measles%20-rubella-monitoring-170424.pdf
  7. European Centre for Disease Prevention and Control (ECDC). Communicable Disease Threats Report. Week 13, 26 March – 1 April 2017. Stockholm: ECDC; Apr 2017. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/communicable-disease-threats-report-1-apr-2017.pdf
  8. George F, Valente J, Augusto GF, Silva AJ, Pereira N, Fernandes T, et al. Measles outbreak after 12 years without endemic transmission, Portugal, February to May 2017. Euro Surveill. 2017;22(23):30548.  https://doi.org/10.2807/1560-7917.ES.2017.22.23.30548  PMID: 28661392 
  9. Republic of Portugal. Despacho N.° 15385-A/2016 [Dispatch No. 15385-A/2016]. In Diário da República. [Government Gazette], Serie II. Lisbon: Government Gazette. 21 Dec 2016. Portuguese. Available from: https://dre.pt/home/-/dre/105574339/details/maximized?serie=II&dreId=105574337
  10. Directorate-General of Health (DGS). Programa Nacional para a Eliminação do Sarampo. [National Measles Elimination Programme]. Lisbon: DGS; Mar 2013. Portuguese. Available from: https://www.dgs.pt/documentos-e-publicacoes/programa-nacional-de-eliminacao-do-sarampo-jpg.aspx
  11. European Commission. Commission Implementing Decision of 8 August 2012 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council. Luxembourg: Publications Office of the European Union. L262. 27 Sep 2012. Available from: http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=OJ%3AL%3A2012%3A262%3ATOC
  12. World Health Organization (WHO). Manual for the laboratory diagnosis of measles and rubella virus infection. (2nd Ed). Geneva: WHO; 2007. Available from: http://www.who.int/ihr/elibrary/manual_diagn_lab_mea_rub_en.pdf
  13. Grammens T, Schirvel C, Leenen S, Shodu N, Hutse V, Mendes da Costa E, et al. Ongoing measles outbreak in Wallonia, Belgium, December 2016 to March 2017: characteristics and challenges. Euro Surveill. 2017;22(17):30524.  https://doi.org/10.2807/1560-7917.ES.2017.22.17.30524  PMID: 28488998 
  14. Amendola A, Bianchi S, Frati ER, Ciceri G, Faccini M, Senatore S, et al. Ongoing large measles outbreak with nosocomial transmission in Milan, northern Italy, March-August 2017. Euro Surveill. 2017;22(33):30596.  https://doi.org/10.2807/1560-7917.ES.2017.22.33.30596  PMID: 28840825 
  15. Republic of Portugal. Despacho N.° 3668-A/2017 [Dispatch No. 3668-A/2017]. In Diário da República [Government Gazette], II Serie. Lisbon: Government Gazette; 28 Apr 2017. Portuguese. Available from: https://dre.pt/application/file/a/106955144
  16. Directorate-General of Health (DGS). Norma N.° 4/2017 – Sarampo: Procedimentos em Unidades de Saúde. [Normative Document No. 4/2017 – Measles: Procedures in Healthcare Units]. Lisbon: DGS; Apr 2017. Portuguese. Available from: https://www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/norma-n-0042017-de-12042017.aspx
  17. Directorate-General of Health (DGS). Orientação N.° 7/2017 – Sarampo. Medidas Especiais. [Guideline No. 7/2017 – Measles. Special Measures]. Lisbon: DGS; Apr 2017. Portuguese. Available from: www.dgs.pt/directrizes-da-dgs/orientacoes-e-circulares-informativas/orientacao-n0072017-de-20042017-pdf.aspx
  18. Directorate-General of Health (DGS). Norma N.° 8/2017 – Campanha de vacinação de repescagem contra o sarampo – crianças e adultos. [Normative Document No. 8/2017 – Measles vaccination catch-up campaign: children and adults]. Lisbon: DGS; Jul 2017. Portuguese. Available from: https://www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/norma-n-0082017-de-05072017-pdf.aspx
  19. Directorate-General of Health (DGS). Programa Nacional de Vacinação – Boletim de Vacinação N.° 11 [National immunisation programme – Vaccination Bulletin No. 11]. Lisbon: DGS; Apr 2017. Portuguese. Available from: https://www.dgs.pt/documentos-e-publicacoes/boletim-vacinacao-n-11-abril-de-2017.aspx
  20. National Institute of Health Dr Ricardo Jorge (INSA). Inquérito Serológico Nacional 2015-16. [National Serological Survey 2015-16]. Lisbon: INSA; 2017. Portuguese. Available from: http://repositorio.insa.pt/handle/10400.18/5401
  21. Directorate-General of Health (DGS). Avaliação do programa nacional de vacinação e melhoria do seu custo-efetividade: 2.° inquérito serológico nacional: Portugal Continental 2001-2002. [Evaluation of the National Immunisation Programme and improvement of its cost-efectiveness: 2nd National Serological Survey – Continental Portugal 2001-2002]. Lisbon: DGS; 2004. Portuguese. Available from: www.dgs.pt/ficheiros-de-upload-1/2-inquerito-serologico-nacional-livro-pdf.aspx
  22. Biellik RJ, Clements CJ. Strategies for minimizing nosocomial measles transmission. Bull World Health Organ. 1997;75(4):367-75. PMID: 9342896 
  23. Bowen AC, Ferson MJ, Palasanthiran P. Consequences of an unrecognized measles exposure in an emergency department. Emerg Med Australas. 2009;21(6):491-6.  https://doi.org/10.1111/j.1742-6723.2009.01230.x  PMID: 20002720 

Data & Media loading...

Comment has been disabled for this content
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