Current situation in Macedonia
In the period from 24.12 – 28.12.2018, 3 new cases of measles were registered. One case is related to the epidemic in Radishani, a four-year-old child, in a close family relationship with a previously case. The other two cases are not epidemiologically related, a child of 2.5 years old from Kumanovo and a 32-year-old woman from Skopje, Shuto Orizari. All new cases are laboratory confirmed.
The epidemiological services in Skopje and Kumanovo undertake activities and measures regarding detection of contacts, checking the vaccine status and their vaccination in accordance with the sub-regulation act, Guideline and the Immunization Calendar.
In 2018, up to December 28, 62 cases of measles were registered in the Republic of Macedonia. The largest number (n = 29) is from the territory of Skopje, and 25 persons are from Debar, 4 cases are from Kumanovo, 2 are from Ohrid, and one case is from Tetovo and Struga.
The age varies from 5 months to 59 years, 42% of the diseased are children aged up to 4 years, and 40% are over the age of 30 years.
The majority of the patients (24) were registered in July, when a measles epidemic was reported in the territory of Debar. Individual cases were registered in September and October. In December 9 people were affected. On a weekly basis, the highest number of cases were registered in the 30th week (n = 8), and the increase in the number of cases was registered in the 50th week with 5 cases.
Graph 1. Distribution of measles patients by date and week of disease (n = 62) in Macedonia, 2018
Of the total number of cases, 82% are laboratory confirmed. Out of 51 laboratory-confirmed cases, 84.3% were unvaccinated, incomplete vaccinated or with unknown vaccine status, while 8 people were vaccinated with two doses of vaccine.
In the course of 2018 three cases of measles were reported in the Republic of Macedonia:
- The first epidemic was registered in July on the territory of Debar, and in the epidemic were a total of 27 people.
- The second epidemic is reported by CPH Skopje in November, in the territory of the village Grcec, municipality of Saraj, and only three people have been infected in the epidemic.
- The last, third epidemic was reported by CPH Skopje in December on the territory of the settlement Radishani, the municipality of Butel. There are 7 people in this epidemic.
Epidemic on the territory of CPH Skopje
On December 19, 2018, CPH Skopje reported a new measles epidemic in the settlement of Radishani, the municipality of Butel. In the epidemic, 7 cases were registered, all laboratory confirmed and epidemiologically related. From the diseased, 6 people are aged 3-4 years, unvaccinated and one person at age of 28 years vaccinated with two doses of MRI vaccine. All children attend the same kindergarten “Tashko Karadzha” in the settlement Radishani, and the adult person is in close family contact with one of the diseased children. The team of CPH Skopje made epidemiological insights in the kindergarten and additionally taken sanitary-hygienic and epidemic measures.
Recommended measures
- For the occurrence of a measles epidemic in the settlement of Radishani, the municipality of Butel in Skopje, and on the recommendation of the Commission for Infectious Diseases, epidemiological teams from the Department of Epidemiology at IPH Skopje in the period from 21st to 24th of December, 2018, carried out control of the current vaccination situation with MRI vaccine for children aged 12 months to 14 years on the territory of Skopje.
- The coverage with MRI vaccine was controlled in the 14 Point for immunization of pre-school children and 11 Point for immunization of school children at the Public Health Center Skopje for all 17 municipalities in the area of Skopje. From the conducted analysis of the registered data, it was concluded that out of 39,009 pre-school children in the area of Skopje, 11,256 or 28.85% of children are not vaccinated with MRI vaccine. Regarding the vaccination of school conditions is better compared to pre-school children, out of 65,806 students from the 1st to the 9th grade in the primary schools in the area of Skopje, 3,728 or 5,67% children are not vaccinated with MRI vaccine.
- In the period from 20-25.12.2018, in the Point for immunization of pre-school children “Butel” in which 1,603 children were attached, only 16 children with MRI vaccine were vaccinated out of 486 unvaccinated. In the same period, 12 school children from the Aco Shopov primary school were vaccinated in the settlement Radishani, out of 62 children from the 1st to the 9th grade, at the “Chair” Point for immunization of school children.
- According to the conclusions of the Committee for Infectious Diseases, it is necessary:
At the outbreak of the epidemic – in Radisani, the municipality of Butel, Skopje:
- To be vaccinated with MRI vaccine for all children aged 6 months to 12 months. These children are subject to the administration of one additional dose of MAP vaccine at the age of 15 – 24 months (according to the Guideline). To carry out vaccinations for all children aged from 1 year to 14 years, unvaccinated or missed with MRI vaccine in accordance with the Guideline and the Immunization Calendar;
- To check the vaccine status of all persons aged 15 to 45 years who have been in direct contact (familial or other) with already ill persons, and if they are unvaccinated or incompletely vaccinated against measles or have not had the disease, they should be called in Skopje and immediately vaccinated.
On the territory of the whole country:
- Vaccine teams from all vaccine sites in the country, in collaboration with patronage nurses, to make the vaccine cards for childbearing to be eligible for vaccination for children under 14 years of age, and vaccinated and incomplete immunizations should be immediately called and vaccinated in accordance with the Guideline and the Calendar for immunization;
- CPH / RO Epidemiological Services in collaboration with State Sanitary and Health Inspectorate to continue to strengthen the control of the vaccine sites, check the vaccine status of the subjects of the MRP (for the first and second dose), from 12 months to 14 years, finding unvaccinated and incompletely vaccinated persons;
- All primary doctors should check the vaccine status of all children under 14 years of age and all vaccinated and unvaccinated for vaccination;
- The CPH, in cooperation with the IPH, to conduct educational and promotional activities related to the prevention of measles, ie emphasizing the vaccination as the only preventive measure for the protection of the health of children.
