14.06 and 1.64 per 100,000 inhabitants respectively. Thirteen countries reported no indigenous cases (Table 1 and Figure). As expected, the majority of measles cases were unvaccinated (87%) where vaccination status was known (92%). Although no deaths have yet been reported for 2007 cases, four countries reported 19 deaths for 2005-2006 cases (Table 2), 15 of which (80%) were in children under 5 years of age. Pneumonitis was the established cause of death in 13 cases and acute encephalitis in four cases. <strong>In</strong> the remaining two cases the cause was unknown or not reported. Overall, for the period 2005-2007, acute encephalitis was reported in 21 cases and distributed in the following agegroups:
Special issue: European Immunization Week 2008 - time for reflection Rapid communications A n o n g o i n g m u lt i - s t A t e o u t b r e A k o f m e A s l e s l i n k e d t o n o n - i m m u n e A n t h r o p o s o p h i c c o m m u n i t i e s in Au s t r i A, g e r m A n y , A n d no r w A y , mA r c h -Ap r i l 2008 D Schmid 1 , H Holzmann 2 , S Abele 2 , S Kasper 1 , S König 3 , S Meusburger 3 , H Hrabcik 3 , A Luckner-Hornischer 3 , E Bechter 3 , A DeMartin 3 , Jana Stirling 3 , A Heißenhuber 4 , A Siedler 4 , H Bernard 4 , G Pfaff 4 , D Schorr 5 , M S Ludwig 5 , HP Zimmerman 5 , Ø Løvoll 6 , P Aavitsland 6 , F Allerberger (franz.allerberger@ages.at) 1 1.Österreichische Agentur für Gesundheit und Ernährungssicherheit (Austrian Agency for Health and Food Safety, AGES), Vienna, Austria 2. National Measles Reference Centre, Medical University of Vienna, Vienna, Austria 3. Austrian Public Health Authorities, Salzburg/Linz/<strong>In</strong>nsbruck/Vienna, Austria 4. German Public Health Authorities and Robert-Koch institute, Oberschleißheim/Stuttgart/Berlin, Germany 5. Swiss Public Health Authorities, Liestal/Bern, Switzerland 6. Folkehelseinstituttet (Norwegian National <strong>In</strong>stitute of Health, FHI), Oslo, Norway From the second week of March 2008, public health authorities in the province of Salzburg observed an increased number of measles cases compared to previous years. Twenty cases of measles had been were notified Austria-wide in 2007, 24 in 2006, 10 in 2005, and 14 in 2004. The current outbreak has affected, as of 14 April, 202 people in Austria, 53 in Germany, and four in Norway, bringing the total number of cases related to <strong>this</strong> outbreak to 259. The initial case series investigation revealed that the common link was attendance of an anthroposophic school and day care centre in Salzburg city. The majority of the pupils were not vaccinated against measles. An outbreak case was defined as a person who a) became ill with measles after 1 March, fulfilling the clinical criteria of measles regardless of laboratory confirmation, and b) was epidemiologically linked to Salzburg city in the period 7 to 18 days prior to clinical onset. Outbreak investigation As of 14 April, 183 cases of measles restricted to four public health districts in the province Salzburg, 16 cases from the neighboring province Upper Austria, and one case each in the Austrian provinces Tyrol, Vorarlberg and Vienna fulfilled the preliminary outbreak case definition. <strong>In</strong> addition, 50 outbreak cases, most of them with residence in Bavaria, three cases of measles in the state Baden-Württemberg in Germany, and four outbreak cases resident in Norway were identified. Figure 1 illustrates the epidemic curve by onset of rash of 256 notified cases for whom data on clinical onset were available. <strong>In</strong> 78.5% (201) of these cases a link to the particular school and day care centre in Salzburg city has been identified so far. Questioning of the cases is still ongoing. Figure 2 summarises age and sex distribution of 259 cases. Since the third week of March 2008, the Austrian health authority has put in place a range of outbreak control measures: • raising awareness in the overall population and encouraging measles, mumps, rubella (MMR) vaccine uptake, supported by proactive media releases; • dissemination of information to schools and nurseries; Figure 1 Outbreak cases with date of onset of rash available (Ntotal = 256). CasesAustria : N=202; Cases : N=47 in German province I and N=3 in German Germany province II; CasesNorway : N=4; and the possible source case by date of onset of rash 30 25 20 15 10 5 Mar 1 Mar 2 Mar 3 Mar 4 Mar 5 Mar 6 Mar 7 Mar 8 Mar 9 Mar 10 Mar 11 Mar 12 Mar 13 Mar 14 Mar 15 Mar 16 Mar 17 Mar 18 Mar 19 Mar 20 Mar 21 Mar 22 Mar 23 Mar 24 Mar 25 Mar 26 Mar 27 Mar 28 Mar 29 Mar 30 Mar 31 Apr-01 Apr-02 Apr-03 Apr-04 Apr-05 Apr-06 Apr-07 Apr-08 Apr-09 Apr-10 Apr-11 Apr-12 Apr-13 Apr-14 Apr-15 Apr-16 Possible Source Case Case, Austria Time (Day of Month) Case, Germany Province 1 Case, Germany Province 2 Case, Norway EUROSURVEILLANCE Vol. 13 · Issues 14–26 · Apr–Jun 2008 · www.eurosurveillance.org 155
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References 1. American Public Healt
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Telephone calls are handled by a tw
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At that time, the daily monitoring
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Research articles S u r v e i l l a
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Virological data collection Stool s
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Discussion Our combined epidemiolog
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Acknowledgements We are grateful to
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The total study sample consisted of
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Table Multivariate model of associa
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event. The survey included question
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protected vaccinees annually) [6].
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single case of the disease while in
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UNITED KINGDOM England and Wales He