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Updated: Aug 9, 2026
Merkel Cell Polyomavirus Infection and Detection
Published on: February 7, 2019
Two outbreaks of measles in Germany 2005
A Siedler1, A Tischer, A Mankertz
1Respiratory Diseases and Immunization group, Department for Infectious Disease Epidemiology, Robert Koch-Institut, Berlin, Germany.
Abstract:
Measles re-emerged in some counties in Germany in 2005, despite increasing vaccination coverage rates in children at school entry in recent years, which had led to decreasing incidence (with the lowest incidence ever recorded, 0.2 cases per 100,000 inhabitants in 2004). Regional outbreaks have been detected by the mandatory reporting system in the states of Hesse and Bavaria. Although both outbreaks led to similar incidences in the affected areas (14 and 12 cases respectively per 100,000 inhabitants) they differed in age distribution, transmission patterns and measles virus genotype. In Hesse, 223 cases were submitted, from which 160 belonged to 41 clusters mainly defined by ,000). Results of measles virus diagnosis showed genotype D4 and identical nucleotide sequences for all analysed cases from Hesse. In Bavaria, 279 cases were submitted, most of which had occurred in schools and preschool facilities. Age-specific attack rate was highest in children aged between 5-9 years (129 per 100,000). Laboratory diagnosed viruses were identified as genotype D6 and were identical at the nucleotide level. In both outbreaks the vast majority of cases (95% in Hesse and 98% in Bavaria) were in unvaccinated children, but vaccination coverage differed in the affected areas and was slightly lower in Bavaria than in Hesse. Local accumulation of unvaccinated children and their concentration in schools and kindergarten preceded the outbreak in Bavaria. Despite high average vaccination coverage levels, local variations may lead to regionally limited outbreaks.
Insights
Measles outbreaks occurred in Germany in 2005 despite high vaccination rates. Localized pockets of unvaccinated children, particularly in schools, fueled these regional measles epidemics.
Area of Science:
- Epidemiology
- Virology
- Public Health
Background:
- Measles incidence decreased in Germany due to rising vaccination coverage.
- Despite this, measles re-emerged in 2005, with outbreaks in Hesse and Bavaria.
- These outbreaks highlighted regional variations in disease transmission and virus genotype.
Purpose of the Study:
- To investigate the characteristics of measles outbreaks in Hesse and Bavaria in 2005.
- To compare the age distribution, transmission patterns, and measles virus genotypes between the two outbreaks.
- To understand the role of vaccination coverage and local factors in measles re-emergence.
Main Methods:
- Analysis of mandatory reporting system data for measles cases in Hesse and Bavaria.
- Epidemiological investigation of outbreak clusters, including age distribution and transmission settings.
- Molecular analysis of measles virus samples to determine genotype and nucleotide sequences.
Main Results:
- Hesse outbreak: 223 cases, genotype D4, primarily in unvaccinated children.
- Bavaria outbreak: 279 cases, genotype D6, highest attack rate in 5-9 year olds, concentrated in schools/preschools, predominantly unvaccinated children.
- Both outbreaks showed high proportions of unvaccinated cases (95% Hesse, 98% Bavaria).
Conclusions:
- Localized low vaccination coverage and high concentrations of unvaccinated children in settings like schools can trigger outbreaks.
- Even with high average vaccination rates, regional disparities can lead to significant measles re-emergence.
- Targeted vaccination strategies addressing local coverage gaps are crucial for measles prevention.
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