title: A measles outbreak in Catania, Sicily: the importance of high vaccination coverage and early notification of cases for health and economic reasons.
abstract: Measles is a paediatric exanthematous disease. Even though vaccination has dramatically reduced measles morbidity and mortality, outbreaks still occur due to insufficient vaccination coverage and importation of the virus from endemic regions. Although child vaccination coverage in Italy has been broadened (from 74% in 2000 to 90.1% in 2011), outbreaks are still observed at a regional level. We describe epidemiological and clinical characteristics of cases reported from January 2009 to May 2010 to the Epidemiology Service of the Provincial Health Authority of Catania. We obtained demographic data and vaccination status from the database of the Epidemiology Service and clinical features and laboratory data from medical records. In all, 522 cases were notified: 286 males (54%), median age 12 years (interquartile range (IQR) 4-18); 401 cases (77%) were notified by the hospital, and 121 (23%) by general practitioners. Only one patient had been previously vaccinated. 52 cases were hospitalized, median age 18 years (IQR 17-23). We observed hypertransaminasaemia in 20 patients (38%), thrombocytopenia in 22 patients (42%) and a creatine phosphokinase increase in 16 (30%). Complications (pneumonia, haemorrhagic cystitis, acute hepatitis) occurred in 10 patients (19%), all older than 18. Recent outbreaks show that immunization practices are still insufficient. Most cases were recorded in adolescents and young adults; even if the vaccine has limited virus circulation in childhood, it did not prevent the infection of other age groups. The number of notifications also suggests that the phenomenon is underestimated. In order to monitor the disease we need early notification of cases and increased vaccination coverage.
authors.affiliation: Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania; Epidemiology Service, Provincial Health Authority of Catania; Section of Occupational Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania; Unit of Pediatrics and Pediatric Emergency, University Hospital OVE-Policlinico, Catania, Italy.
authors.forename: Benedetto Maurizio
authors.initials: BM
authors.lastname: Celesia
authors.affiliation: Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania; Epidemiology Service, Provincial Health Authority of Catania; Section of Occupational Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania; Unit of Pediatrics and Pediatric Emergency, University Hospital OVE-Policlinico, Catania, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Fontana
authors.affiliation: Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania; Epidemiology Service, Provincial Health Authority of Catania; Section of Occupational Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania; Unit of Pediatrics and Pediatric Emergency, University Hospital OVE-Policlinico, Catania, Italy.
authors.forename: Marilia Rita
authors.initials: MR
authors.lastname: Pinzone
authors.affiliation: Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania; Epidemiology Service, Provincial Health Authority of Catania; Section of Occupational Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania; Unit of Pediatrics and Pediatric Emergency, University Hospital OVE-Policlinico, Catania, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cuccia
authors.affiliation: Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania; Epidemiology Service, Provincial Health Authority of Catania; Section of Occupational Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania; Unit of Pediatrics and Pediatric Emergency, University Hospital OVE-Policlinico, Catania, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bellissimo
authors.affiliation: Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania; Epidemiology Service, Provincial Health Authority of Catania; Section of Occupational Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania; Unit of Pediatrics and Pediatric Emergency, University Hospital OVE-Policlinico, Catania, Italy.
authors.forename: Liliana
authors.initials: L
authors.lastname: Rapisarda
authors.affiliation: Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania; Epidemiology Service, Provincial Health Authority of Catania; Section of Occupational Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania; Unit of Pediatrics and Pediatric Emergency, University Hospital OVE-Policlinico, Catania, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Rinnone
authors.affiliation: Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania; Epidemiology Service, Provincial Health Authority of Catania; Section of Occupational Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania; Unit of Pediatrics and Pediatric Emergency, University Hospital OVE-Policlinico, Catania, Italy.
authors.forename: Venerando
authors.initials: V
authors.lastname: Rapisarda
authors.affiliation: Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania; Epidemiology Service, Provincial Health Authority of Catania; Section of Occupational Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania; Unit of Pediatrics and Pediatric Emergency, University Hospital OVE-Policlinico, Catania, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Pavone
authors.affiliation: Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania; Epidemiology Service, Provincial Health Authority of Catania; Section of Occupational Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania; Unit of Pediatrics and Pediatric Emergency, University Hospital OVE-Policlinico, Catania, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Cacopardo
authors.affiliation: Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania; Epidemiology Service, Provincial Health Authority of Catania; Section of Occupational Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania; Unit of Pediatrics and Pediatric Emergency, University Hospital OVE-Policlinico, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nunnari
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D018563:Disease Notification; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008457:Measles / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*; D008458:Measles Vaccine; D011634:Public Health; D012802:Sicily / Q000453:epidemiology; D013997:Time Factors; D014611:Vaccination
chemical_list: D008458:Measles Vaccine