The following information has been published by the superintendent of Public Health


1st August 2018

Dear Doctor

During this year, five (5) imported cases of measles have reported to the Infectious Disease Prevention and Control Unit. Furthermore, one of these cases resulted in autochthonous (local) transmission in a contact, after relatively minor exposure without personal protective equipment.
These imported cases follow the marked increases in measles transmission across Europe.
According to the European Centre for Disease Prevention and Control, outbreaks of measles are ongoing in the Czech Republic, Croatia, France, Greece, Italy, Romania, Slovakia and the United Kingdom. To date, 31 deaths have also been reported across the region in 2018.
These outbreaks are the direct result of falling vaccination levels in these countries.
Despite measles and rubella elimination being sustained, Malta is facing the serious risk of importation through travellers, international students and workers. This could result in the possibility of further spread in the local community within non-immune adults and children.
To stop measles transmission and protect those most vulnerable to severe complications and death, especially infants, at least 95% of the population needs to be vaccinated with two doses of measles-containing vaccine. Currently, children are given the MMR vaccine at 13 months year old, followed by a second dose at 3- 4 years of age in accordance with the local immunisation schedule.
The vaccine is highly immunogenic. Individuals who have received two doses of measles vaccine (or confirmed to have measles infection in the past) are considered immune to measles. For those with incomplete vaccination or an unknown vaccination history, two doses are required to achieve immunity.

What can you do?
1. As a health care provider, it is vital to ensure that you have taken two doses of the measles vaccine in the past. If this is not the case, or if you are unsure, take two doses of measles (or MMR) vaccine as soon as possible. The vaccine is extremely safe, with minimal side effects, even if you had taken the vaccine in the past.
2. Until you have confirmed that you have taken two doses of measles vaccine, wear appropriate PPE if you are attending to a suspected case. This includes wearing an FFP (N-95) mask as soon as you suspect that the patient could be a case of measles; if you do not have an FFP mask, a normal surgical mask will still provide a reasonable level of protection
3. Keep patients with fever and an erythematous rash as separate as possible from other patients in your clinic.
4. If you feel that you need to refer the patient to a clinic or hospital, it is essential that you alert the institution’s infection control nurse before sending the patient, in order to arrange for immediate isolation and avoid contact with other patients in the facility.
5. Since cases are now so rare in Malta, update yourself on the various ways in which measles can present and the type of haematogenous rash found in this infection.
6. Encourage your patients get fully vaccinated against measles, especially in the case of parents with young children. Address any misconceptions they may have about the safety of the vaccine; this ECDC webpage will be useful in this respect:
Measles is highly infectious, even with relatively minimal contact. Infected persons are contagious to others from four days before the onset of the rash through to four days after.

Besides measles vaccination, please advise your patients to take the following measures to
prevent measles:
• Maintain good personal and environmental hygiene;
• Maintain good indoor ventilation;
• Keep hands clean and wash hands properly;
• Wash hands when they are contaminated by respiratory secretions, such as after sneezing;
• Cover the nose and mouth while sneezing or coughing and dispose of nasal and mouth discharge properly;
• Clean used toys and furniture properly; and
• Children with measles should be kept out of school/ nursery till four days from the appearance of rash to prevent spread of the infection to non-immune persons in school. Adults with measles should be isolated and stay indoors for the same period.
Measles is a statutory notifiable disease in Malta. Suspected or confirmed measles cases should be immediately notified to the Infectious Disease Prevention and Control Unit on 23266109/122/119 or 79004731, in realtime, while you are seeing the patient, in this way, we can guide you further and trigger an immediate public health response.
Measles outbreaks continue to occur in many EU/EEA countries, and there is a risk of spread and sustained transmission in areas with susceptible populations. A concerted effort it required by all sectors.

Thank you for your support in prevention and control of communicable diseases.

Yours truly,
Dr Charmaine Gauci MD, MSc, PhD, FRSPH, FFPH
Director General/Superintendent of Public Health