Although there has been a Increased measles cases in Spain34 cases have been passed in 2023 to more than 200 in 2024, our country is still in the situation of measles elimination, which has been maintained since 2016. According to the data of the National Epidemiological Surveillance Network of the National Epidemiology Centersince 2014 there is no continued circulation of the virus.
However, he said in a meeting organized by Science Media CenterNOemí López PereaResearcher at the National Epidemiology Center of the Carlos III Institute of Health, we are sometimes having «imports of the virus from countries where measles continues to circulate. These imported cases can generate outbreaks of different sizes ».
Currently, he said, in Spain we have an outbreak, with 110 confirmed cases, most in the Basque Countrywhere 41 cases are confirmed, some in hospital environments and others in the family. Nationally, 34 cases have been imported and the rest are part of small scattered shoots, with less than 10 cases each. “This is what is expected in a removal situation.”
When the disease affects health environments, diffusion is usually greater. María del Mar Tomás, from the Spanish Society of Infectious Diseases and Clinical MicrobiologyHe stressed the importance of health professionals being aware of the importance of quickly detecting possible cases through molecular biology techniques to avoid the spread of the virus. “Sequencing the variants allows you to know the origin of the virus and anticipate its impact,” he said.
As measles was considered practically eradicatedhe said, many toilets do not have it in mind when making differential diagnoses. Therefore, “it is key to reinforce awareness in pediatricians and all health professionals on the use of rapid diagnostic techniques.”
For the pediatrician Fernando Moragaalthough in Spain the situation is relatively stable, the concern is globally. In 2020, he said, «before the pandemic, he had already alerted the re -emergence of measles. Since 2017, there was a significant increase in cases in the world and WHO acknowledged that the eradication goal for 2020 was not attainable ».
According to Moraga, from the Spanish Association of Vaccinationdespite the fact that during the Covid pandemic, the incidence fell, possibly due to the reduction of social interactions and the use of masks, cases detection of cases was also difficult. However, «since 2022, measles has returned strongly, and in 2023 the WHO reported an increase of 30 times in global cases compared to 2022. In fact, when reviewing the full year, the real figure was an increase in 65 times. This rebound – he said – is directly related to the fall in vaccination coverage».
Thus, Moraga said, with the data of 2023, the average coverage of the first dose is very good, 97.8%, although there are four communities below 95%. The second dose has lower coverage, with 11 communities below 95%.
In addition, he added, there are differences within cities. «A study of vaccination coverage by neighborhoods would reveal that, although a city may have an average of 97%, there may be areas where coverage is only 50%. This generates Bags of susceptible people who can facilitate outbreakslike the one that happened in Granada a few years ago in a neighborhood with low vaccination ».
The Carlos III Health Institute expert recognized that the second dose of the triple viral vaccine, which is administered between 3 and 4 years, has a lower coverage than the first. In 2012, the vaccination calendar was modified, establishing the first dose at 12 months and the second between 3 and 4 years, according to the Autonomous Community. In Spain, “the coverage of the first dose has always been greater than 95%, but the second dose has been slightly below.”
In this regard, he commented that in some specific areas, the vaccination rate of the second dose is less than 95%, allowing the virus to circulate and cause small outbreaks. Although the outbreaks are reduced, when they join generate the feeling that there is a massive increase in cases, he said.
Vaccination reticence
Compared to the countries of our entone, Spain is in a favorable position and has one of the most complete vaccination calendars in Europe. However, Moraga warned that vaccination reluctance is growing, although it is not just about anti -vacacon groups.
Thus, Lopez insisted that nOr we are in an alarming situation, «neither we must worry or alarm the population». Although there are groups of susceptible people, they are not large vulnerable population bags.
And while it is true that between 2010 and 2012 there was a huge peak in Andalusia, we are now in a post-elimination period in Spain.
Since 2014 there is no endemic circulation of the virus, so current cases are imported and generate small outbreaks. “There may be medium outbreaks, such as the one we are seeing in the Basque Country, but this is largely due to transmission in hospital environments, where the dissemination of the virus is amplified,” said López Perea.
In this regard, Tomás clarified that although the increase in cases is also due to the Improve molecular techniques. Now we detect many more cases. It is not an uncontrolled increase, but an improvement in detection.
It is a controlled disease as long as high vaccination coverage is maintained
In addition, he indicated, in a world context with a booming Anti -Vacunas movement, especially in the United States and Europe, “it is important to be aware of the risks. For example, in 2023, Romania registered 80% of measles cases in Europe.
However, he wanted to leave a clear message: measles is not eradicated, but it is not a health crisis either. «It is a controlled disease as long as high vaccination coverage is maintained. Vaccinated people can become infected, but the affectation is usually mild. The important thing is to continue fulfilling the vaccination calendar ».
Moraga indicated another important point, as is the possibility of seeing More cases in children under 12 meses. «These children are children of vaccinated mothers, and the passive immunity they receive through the placenta is less durable than in children of mothers who passed the disease naturally. This could explain some cases in infants of 9 or 10 months, ”he explained.
Advance the 2nd dose
Therefore, although it does not consider that the first dose of the vaccine must be advanced, which is currently administered at 12 months, it is urgent 2 years. “This would facilitate access to the vaccine, since children have much more contact with the pediatrician in their first two years of life.”
However, López indicated that the modifications of the vaccination calendar must be maintained within the appropriate frames. «Modifying the vaccination calendar requires consensus within the Interterritorial Health Councilwith the participation of all communities and experts, in addition to a Intense and exhaustive debate»He said.
In fact, he added that the common calendar of the Interterritorial Council of the National Health System specifies that it is a common calendar, but not necessarily unique. In Spain there are currently different immunization calendars, although the differences are minimal. For example, Catalonia has an additional vaccine, while other communities do not manage it. As for the ages of administration, there may be small variations, but the calendar of the Interterritorial Council remains one of the best in Europe. «It is a common calendar, but the autonomous communities, due to their competency transfersthey can make some adjustments in the strategy, although not in all cases or in all doses ».
As for protection in adults, those born in 1971 and later were considered the most susceptible. However, there are cohorts traditionally considered more susceptible because they were born before the introduction of the vaccine in 1981, when the incidence of measles was already descent. These people were not exposed to the virus naturally or received the vaccine.
Nevertheless Measles of measles in correctly vaccinated people are rare. It is considered correctly vaccinated to a person who has received the first dose from 12 months and the second dose with a minimum interval of one month, with well -preserved vaccines. Seroconversion with the first dose is 95%, and with the second it reaches 99.5%. Although it is possible that there are cases of modified measles in vaccinated people, it is rare.
In Spain, cases often affect adults. It is not frequent that there are infections in young children, as in other countries with lower vaccination coverage. But in some sporadic cases, properly vaccinated people can also be infected, especially in hospital environments, where the exhibition is greater. Fortunately, when this occurs, it is usually modified measles, a slightest version of the disease with less infection capacity.
Regarding reticence to vaccination in Spain, experts agree that fortunately it is not a generalized problem like in other countries, where there are strong anti -vacussion movements. There are isolated cases of people who reject vaccination, but not with the intensity observed in northern Europe or in certain groups in France and Eastern Europe, they said.
Vaccination coverage
Moraga calls him vaccination reluctance. «The situation of measles in Spain is not alarm, but alert. In 2023 there were 237 cases and in 2024 we had 217. This indicates something, ”he warned.
Tomás stressed that it is necessary to identify susceptible people and offer them vaccination. In Spain, vaccination coverage are very high in the population born here, but it is important to ensure access to vaccination in more vulnerable populations. From a microbiological point of view, “I would recommend a rapid laboratory diagnosis in the face of any suspicion, as well as the genomic characterization of cases to avoid the dissemination of the virus and contain possible outbreaks.”
Finally, López Perea stressed the importance of not stigmatizing people, but identifying susceptible populations to intervene properly. “The work must focus on identifying these groups and offering vaccination, without pointing out anyone as responsible for the spread of infection.”
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