The National Institute of Health has released data regarding an epidemic that, like never before in 2024, is spreading on a large scale. The portion of the population most affected is those between the ages of 15 and 40, but especially those who are not vaccinated or only have received one dose. According to some epidemiologists, the worst is yet to come and could coincide with the summer.
The cases
In the first quarter of 2024, Italy reported 213 cases of measles. The national incidence was 14.5 cases per million inhabitants, and the highest incidence was observed in the age group 0-4 years (63.3 per million), followed by the 15-39 years age group (28.3 per million). This emerges from the bulletin of the integrated measles-rubella surveillance of the National Institute of Health for the period January 1 - March 31, 2024. The average age of the cases is 31 years, and three-quarters of the cases (74.2%) are aged between 15 and 64 years. Eleven cases were reported in children under one year of age. In the first quarter of 2024, no cases of rubella were reported in Italy. Of the 213 measles cases, 181 were confirmed in the laboratory, 9 probable, and 23 possible cases. Eighteen of the reported cases (8.4%) were imported cases.
The vaccinations
The vaccination status is known for 187 out of 213 cases (87.8%), of which 165 cases (88.2%) were not vaccinated at the time of infection, 11 cases were vaccinated with one dose, nine cases with two doses, and for two cases the number of doses administered was unknown. Fifty-six cases (26.3%) reported at least one complication. The most frequently reported complications were hepatitis/increased transaminases and pneumonia. A case of encephalitis was reported in a young adult, unvaccinated. 48.8% of the cases were hospitalized (104/213) and an additional 38 cases sought emergency room care.
The transmission
The mode of transmission of the disease is known for half of the reported cases. Transmission mainly occurred within the family. Twenty cases occurred as a result of transmission in a hospital setting, 19 in the workplace, 13 cases during international travel, and six cases in a school setting. Eleven of the reported cases are healthcare workers, of whom six are not vaccinated.
Matteo Bassetti: «Epidemic increase in summer»
Matteo Bassetti, regarding the measles data released by the National Institute of Health, reiterated the importance of vaccinations during this period as they develop antibodies capable of protecting you. According to the professor of infectious diseases, the phase in which the epidemic risks developing even more is likely to be in the summer: «The measles data published today by the ISS confirm that unfortunately, in this 2024, an epidemic has started: we have significant numbers, 213 cases in 3 months, compared to 2023 with few cases. It's just the beginning, the worst is yet to come, and I fear it will be around summer. The affected population is not vaccinated or with only one dose, between 15 and 40 years, a range already highlighted by the report of the ECDC, which had recorded 30,000 cases in 2023. It strikes me that no one is concerned about the complications: it is not a mild and manageable disease, if you get it in adulthood it can be serious and cause complications. Vaccination is the protection tool that the National Health Service must implement. It is no longer an initiative of the individual, but the intervention of the State is needed to protect itself with vaccinations.»
Massimo Ciccozzi: «Concern about the incidence in 0-4 years»
The epidemiologist Massimo Ciccozzi has commented on the data released by the National Institute of Health stating he is concerned about this increase in the first three months of 2024 but especially about the incidence in children between 0 and 4 years: «There is a 0-4 years age group in which a clear peak of measles incidence in the first three months of 2024 is evident. I wonder how this can be since there has been a mandatory vaccination since 2017. One hypothesis is that not all are Italian children, that is, the information on vaccinations may not have reached some ethnic groups. And perhaps on this point, we should question ourselves and act accordingly by improving communication. It worries me that the trend of measles cases in the first three months of 2024 is increasing and this does not leave us calm for the coming months.»
Fabrizio Pregliasco: «Vaccination campaigns are needed»
Fabrizio Pregliasco, a virologist at the University of Milan, believes that it is essential to promote vaccination campaigns to try to decrease the epidemic: «It is necessary to promote campaigns to restore vaccination protection. Information is needed and a proactive commitment on the part of the Prevention Departments is required. Recovering the missed second doses for young people while among adults we need to target the most exposed subjects, such as teachers and healthcare workers. We certainly see a situation linked to the decline in vaccination coverage. Being measles a disease with a very high R0 transmissibility index and occurring contagion through breathing, the only strategy is vaccination.»
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