Introduction

CPH Skopje registered an epidemic in the territory of the settlement Radishani, municipality of Butel with 7 measles cases in December. Due to the occurrence of an increased number of sick people from different parts of the city of Skopje during the 52nd week of 2018, on 02.01.2019, CPH Skopje reported an epidemic in the territory of the city of Skopje.

Here is a smallpox epidemic on the territory of the city of Skopje, including the 7 cases of Radishani in 2018.

As of 18.01.2019, 75 suspected measles cases have been reported in the epidemic. After epidemiological research and laboratory results, 65 were classified as measles.

The epidemic started with reported cases of measles in children attending the same preschool institution “Tashko Karadzha” in the settlement Radishani, the municipality of Butel. The epidemic has spread to the territory of all municipalities of the city of Skopje, so far (32.3%) of cases have been registered by the Municipality of Aerodrom (Chart 1).

Chart 1. Distribution of measles patients by municipalities in Skopje, 2018-2019 (n = 65)

 

The age of the patients varies from 8 months to 42 years (median – 3 years). The highest number and percentage of patients (n = 42; 64.6%) belong to the age group of 1-4 years, five children are up to one year old. In the age group above 20 years, 18 persons or 27.7% were diagnosed (Chart 2). Regarding gender, 34 cases or 52.3% are female.

According to the vaccine status, 55 or 84.6% of diseased persons are unvaccinated (49) or with unknown vaccine status (6). From non-vaccinated children (47), 5 children are under 12 months of age and are not subject to vaccination, according to the Immunization Calendar (Chart 2).

Chart 2. Vaccine status and age group of measles patients in epidemic Skopje 2018-2019 (n = 65)

The first case has been reported in 49 week in 2018, and an increase in the number of cases has been reported since 52 weeks in 2018. During the first week of 2019, measles symptoms occurred in 12 cases, with the largest number of cases being recorded during the second week – 27 cases. In the third week of 2019, there were 8 cases.

In terms of hospitalization, 42 cases or 64.6% of the patients were hospitalized at the Clinic for Infectious Diseases and Febrile Conditions in Skopje, of which 73.8% were aged 1-4. In 15 (23.1%) of the patients, complications were registered, of which the largest number is 12 or 80% in children up to 4 years of age (Chart 3).

From the total number of patients (n = 65), 47 or 72.3% were laboratory confirmed in the Laboratory for Virology and Molecular Diagnostics in IPH, 11 or 16.9% are epidemiologically related, while 7 cases are only with a clinical manifestation of small measles.

Chart 3. Number of hospitalized by age, epidemic in  Skopje 2018-2019 (n = 65)

 

Vaccination activities with MRP vaccine conducted on the territory of the City of Skopje and in the country

Skopje – Number of unvaccinated people aged 14 years and implemented vaccination activities with MRP vaccine

After proclaiming an epidemic on the territory of the city of Skopje, teams of CPH Skopje and the Health Center inspected all vaccination points. According to the latest data submitted by the Health Center – Skopje, it was found that out of 41,189 children aged 1-5 years, 12,437 or 30% of the vaccine vaccinated were unvaccinated.

From the 63,815 school children aged 14 years in the City of Skopje, 3,924 children or 6.1% of the underwriters have been unvaccinated. The largest number of unvaccinated children are from the first grade, ie 1,532 or 20% of the subjects.

A total of 2721 children have been vaccinated from the beginning of the epidemic in Radishani, until 13.01.2019.

Macedonia (without Skopje) – Number of unvaccinated persons aged up to 14 years and implemented vaccination activities with MRP vaccine

From the 62,752 preschool children missing from CPH Centers (missing for CPH Tetovo and PE Radovish), 7,145 or 11.4%. During the second week of 2019, 205 children were vaccinated, making the total number of vaccinated pre-school children in 2019, 378.

From the 84,071 school children subjected to two doses of MRP vaccine, only 469 (0.5%) were not vaccinated with no single dose of MRP, and 2.397 (2.8%) were vaccinated with only one dose of MRP. During the second week of 2019, 136 children with a second dose of MRP vaccine were vaccinated, making the total number of vaccinated schoolchildren in 2019, 188.

In the course of 2019, only one child was vaccinated with a first dose.

Recommended measures and activities

The implementation of the previously recommended measures on the entire territory of the City of Skopje continues:

  • In pre-school institutions on the territory of Skopje not to accept children who are not immunized with MRP vaccine during the epidemic of measles and SSHI will control the implementation of this measure.
  • Vaccination on the territory of the city of Skopje with MRP vaccine for all non-vaccinated or incomplete vaccinated children under the age of 14, in accordance with the Rulebook and the Immunization Calendar;
  • Checking the vaccine status of all persons aged 15 to 45 who have been in direct contact (familial or other) with already ill persons, and if they are unvaccinated or incompletely vaccinated against measles or who have not undergone the disease, they should be called CPH Skopje and be immediately vaccinated;

 

To Continue to implement measures and activities throughout the country:

 

  • Enhanced epidemiological surveillance of febrile rashes;
  • The vaccine teams from all vaccine sites in the country, in collaboration with patronage nurses, will make the vaccination card for children under 14 years of age subject to MRI vaccination, and vaccinated and incompletely vaccinated immediately to be vaccinate, in accordance with the Rulebook and Immunization calendar;
  • Epidemiological services in collaboration with SSHI to continue to strengthen the control of the vaccine sites, check the vaccine status of the subjects of MRI (for the first and second dose), from 12 months to 14 years, finding unvaccinated and incompletely vaccinated persons;
  • Keep a regular record of the number of vaccinated individuals from the eligible MRI vaccine (unvaccinated and incomplete vaccinated) and to inform the CPH / IPH on a weekly basis.

 

For all novelties and the current situation, IPH will provide information on a weekly basis (every Friday) to all /relevant institutions.