Appendix. The situation in the seven affected countries

Bosnia and Herzegovina

A nationwide outbreak of measles is underway in Bosnia and Herzegovina, with 5340 cases reported since February 2014. All age groups are affected, particularly adolescents and young adults, including those who were born in the period 1990–2000.

In response to the outbreak, measles, mumps and rubella (MMR) vaccine is provided to children, adolescents and young adults in contact with ill people, and surveillance has been strengthened to detect every case. Parents are encouraged to get their children vaccinated.

Georgia

Georgia reported 3191 measles cases in 2014, in addition to the 7872 reported in 2013. Approximately 100 new cases have been reported in 2015, as of 23 February. The Government initiated supplementary immunization activities in 2013, targeting children aged under 5, health care workers, un- and undervaccinated groups aged under 29 years and all high-school students. Supplementary activities are continuing in 2015, expanded to adults aged under 40.

Germany

 As of 23 February 2015, 1091 measles cases have been reported to the national public health authority in Germany since the beginning of 2014. There have been several outbreaks.
 
Most cases can be attributed to an ongoing outbreak of measles in Berlin; the disease is likely to have been imported. Between October 2014 and 23 February 2015, a total of 540 cases have been reported to the national public health authority in Germany, mostly since the beginning of 2015. Of these cases, 144 (27%) were hospitalized and unfortunately one toddler died. The health authorities are providing post-exposure vaccinations in affected institutions, and are strongly encouraging the population to receive catch-up immunizations as soon as possible.

Italy

Italy reported 1674 measles cases in 2014, in addition to the 2251 reported in 2013. Of this total, 80.8% were found in six regions (Emilia-Romagna, Lazio, Liguria, Lombardy, Piedmont and Sardinia). Most cases were in the group aged 15–39 years. One in three measles patients was hospitalized.

The newly established national system of integrated measles and rubella surveillance was able rapidly to detect these cases. Follow-up efforts include using supplemental immunization activities to increase measles-vaccine coverage in children and susceptible groups.

Kazakhstan

Kazakhstan started supplemental immunization against measles on 26 January 2015, in response to an increased number of cases reported in 2014 (317); 220 more were reported in January 2015. One million doses of monovalent measles vaccines were procured for the campaign, which intends to cover at least 80% of the 1.2 million teenagers comprising the target group.

Kyrgyzstan

During the current measles outbreak, Kyrgyzstan reported 7477 cases between May 2014 and February 2015. The first case was identified in Bishkek city on 3 May 2014, but the number increased dramatically in 2015. About 50% of those who fell ill were hospitalized and two children aged 1 year died.

The Ministry of Health of Kyrgyzstan plans to launch a nationwide supplementary vaccination campaign with measles–rubella vaccine, starting in March 2015 and targeting over 2 million children, adolescent and young adults.

Russian Federation

The Russian Federation reported 3247 measles cases across 71 federal districts to the WHO Regional Office for Europe in 2014. All age groups were affected, but particularly people aged 20 years and older.

Supplementary immunization activities were launched in Dagestan and the Chechen Republic, targeting adolescents and young adults. These were extended to risk groups and susceptible populations such as migrants and Roma. The regions of West and East Siberia and the Far East organized measles immunization of workers from other parts of the country.