Headlines - Updates to the management strategy in the event of a major measles outbreak in France

On April 23, 2018, the High Council for Public Health (HCSP) issued an opinion regarding the vaccination strategy (1) in the event of a measles epidemic. The objectives of this strategy are: a) to improve vaccination coverage among the population targeted by vaccination recommendations, b) to limit the spread of the outbreak, c) to protect individuals at risk of severe measles.a) Improving vaccination coverage aims to achieve a 95% coverage rate without waiting for the impact of the recently implemented vaccination mandate AND by catching up on vaccinations among people born since 1980, particularly in communities.b) Limiting the spread of the outbreak around cases requires identifying the vaccination status of susceptible individuals, including those who have not been in contact with a case if it occurs in a community setting. Post-exposure vaccination should be administered within 72 hours of exposure and remains recommended even if this timeframe has passed. In the event of clustered cases, given the short timeframe and the high positive predictive value of the clinical diagnosis of measles, this measure may be implemented without waiting for confirmation of the index case’s diagnosis. Post-exposure vaccination is indicated for infants aged 6 to 11 months, to individuals who have received two doses but received one before the age of 1, to infants 12 months and older who have received only one dose, to individuals born after 1980 who have not received two doses, and to individuals born before 1980 with no known history of measles and who are unvaccinated, especially if they were born in the 1970s) Protection of individuals at risk of severe measles (infants under 1 year of age, pregnant women, and immunocompromised individuals). Their protection relies on vaccination of those around them (family members, early childhood care staff, and hospital staff), post-exposure vaccination within 72 hours for infants aged 6 to 11 months, prophylaxis with polyvalent immunoglobulins within 6 days of exposure for infants aged 6 to 11 months (if the 72-hour window has passed), and for individuals who cannot be vaccinated (under 6 months of age, pregnant women, immunocompromised individuals).In healthcare settings, the patient’s pathway must be traced, and standard hygiene measures and additional “airborne” precautions must be implemented. The HCSP recommends defining two epidemic levels, adapting the strategy for monitoring measles cases during an epidemic (individuals at risk of severe measles, outbreaks in communities at risk of severe forms), and biologically confirming cases during an epidemic with established priorities.