Measles alarm in Liguria, where 5 cases have been detected in the last week, all unvaccinated, aged between 25 and 50. «You need to be extremely careful», explains Matteo Bassetti, head of infectious diseases at the San Martino Polyclinic of Genoa. «The cases of 2024, first in the province of Rieti (22 cases) and now in Genoa (6 cases in a week), are all indicators and signs of the fact that sooner or later, in some way, the problem will become evident again» states the doctor, who underlines several times that the only way to fight this infection, which is more serious than what is commonly believed (especially in adults), is vaccination. Professor Bassetti clearly illustrated what the situation is in Italy, when real epidemics could arise and how to recognize measles, remembering that there are no cures.
Doctor Bassetti, is there really a risk of a measles epidemic in Italy?
First of all it is necessary to take a step back and explain what happened in 2023. Europe was hit by a wave of measles cases that had not been seen for many years, 30 thousand cases between Western Europe and Eastern Europe with over 20 thousand of these who required hospitalization. The vast majority of cases involved unvaccinated subjects. We know that there is a gradient from west to east, in the sense that the further east you go the less vaccination coverage for measles is. We arrive at some countries such as Bulgaria, Romania, Albania with truly laughable vaccination coverage percentages (we don’t reach 50%). It is clear that this wave would have arrived in Italy sooner or later and if we look at the data from the Istituto Superiore di Sanità for the first two months of the year they already tell us that we have had more cases than we had in the entire previous year. So there is evidently a major backfire of measles. The cases of 2024, first in the province of Rieti (22 cases) and now in Genoa (6 cases in a week), are all indicators and signs of the fact that sooner or later, in some way, the problem will become evident again.
So in Italy should we worry?
We have truly lost many points of vaccination coverage. Looking at the latest ECDC data we are below 90%. It must be considered that every percentage point of vaccination coverage that is lost against measles leaves room for this extremely contagious virus, which if it finds on its way a population of unvaccinated people (or protected because they have already had the disease) very quickly disseminate. We have an important group between the ages of 15 and 50 of people who have never had the infection and have never been vaccinated: therefore if an outbreak were to start it would find a highly susceptible population of subjects on its way. The measles virus is one of the most contagious: just think that it has R0 between 16 and 18 (that of Covid was between 3 and 5). This means that each person who has measles can infect up to 16-18 people. In a society like ours, which today is far from the minimum objective of vaccination coverage (95%), one can imagine what the speed of propagation could be. Therefore, not only do we have many children who are discovered by vaccination, despite it being compulsory, because their parents decide not to vaccinate them, but then we have a whole group of people between 15 and 50 (when they were children vaccination was not compulsory) who are highly susceptible. In Italy we have communities of Romanian, Albanian and Bulgarian citizens in which vaccination coverage tends strongly towards zero. We all hope to be able to contain an outbreak like the one in Rieti or Genoa, but it’s like putting a match in a dry forest: the fire can spread very quickly. This is not about being alarmist, but just about being realistic.
Should we expect a spike in cases in Italy?
Yes, it is possible, even more so in the coming months, when perhaps there will be a greater exchange of young people who go on holidays to countries abroad, linguistic-cultural exchange programmes, those who return to their country: it is possible that this summer there are epidemics and outbreaks of measles. I think it’s almost inevitable.
Is there a difference between the disease contracted by children or adults?
The most serious thing is that the majority of people consider measles a calm disease, because we perhaps remember when we had measles as children, but as adults the issue is very different. Measles can cause serious complications, of the rest of the 30 thousand cases in 2023, 20 thousand were hospitalized, so it’s not so calm. Every time a person with measles ends up in hospital, in a healthcare system like ours which is already in serious difficulty at hospital level, it takes away the place of another person who needs it. This is why the vaccine is not an individual problem, but a problem of public health and the protection of our healthcare system. In adults the form is more aggressive, the rash can be very serious and there can be a strong involvement of the lungs much more frequently than in children. For adults it is a much more serious disease.
Should those who are vaccinated worry?
The fundamental distinction to be made is between vaccinated and non-vaccinated. Those who are vaccinated or those who have had measles are protected for life and can sleep peacefully, except in cases where they are heavily immunosuppressed following certain therapies, but that is a separate topic. Measles vaccination and natural measles disease provide lifelong immunity. The message to be conveyed is simply: “If you are not vaccinated, get vaccinated.” I never would have thought that in 2024, in a country like ours, we could reach the risk of having epidemic outbreaks of measles, a disease that we had managed, not to defeat, but to significantly reduce. In Liguria, in 2022-2023 we didn’t have a single case of measles, this year we already have 6. We need to send a message to the regions and health companies to implement vaccination recall and awareness campaigns.
Besides vaccination, is there anything else that can be done to prevent infection?
There is nothing else. Many say that when they were children they were taken to “measles parties”, which caused a lot of damage because it is true that out of 100 children it is probable that 95 will not have any kind of consequence, but the other 5 can get pneumonia or encephalitis. I will only provide some numbers regarding the percentage of complications: encephalitis affects 1 case in 1000 in children and potentially 1 case in 200 in adults; Pneumonia in adults affects 1 in 4, a very challenging condition that can even lead to death.
What are the symptoms of measles?
First of all, certainly the maculopapular rash, red dots that appear on the body. A doctor, when he sees one in life, can no longer make mistakes. Then there is the fever and also the enanthema, plaques in the mouth also known as Köplich, white plaques appear on the gums and palate. In short, they are unmistakable symptoms: as a doctor, once you see one, you can no longer be wrong. The diagnosis is clinical, then confirmation can be obtained from laboratory tests through urinalysis. A good doctor who has seen some cases of measles in life cannot be wrong or in any case must know how to direct them to clinical tests which will then provide confirmation. It can also occur without fever, there are forms called “whips”, hybrid and spurious, but in most cases there is a fever. What is important to recognize is the skin rash, unmistakable to a doctor.
How is measles treated?
This is really important to underline: if there is a vaccine for measles that covers 100% of the disease, there is no type of drug to treat it. We don’t have an antiviral that is anti-measles, so it has no cure. In the majority of cases it is the immune system that manages to limit it, but if this is not the case there are no drugs capable of doing so. One more reason to get vaccinated. The only thing to do is check your vaccination card, ask your parents if you have had measles and go and get vaccinated to be safe for life. In case of doubt? A serological test can be done to evaluate the presence of antibodies, there are no excuses.
© ALL RIGHTS RESERVED