What We Do
Measles is a highly contagious disease that can lead to serious complications. It remains one of the world’s major infectious diseases. In France, a resurgence of cases was observed in recent years, particularly in 2018 and 2019. Although the measles virus circulated at low levels throughout the country in 2020–2021, the emergence of outbreaks remains possible, especially in areas with lower vaccination coverage.
Epidemiological Surveillance of Measles
Santé publique France has established a measles surveillance program based on mandatory reporting and a network of partners.
As the disease has become rarer, incidence estimates from the Sentinelles network of physicians have become less accurate, and this surveillance method no longer guaranteed the detection of clusters of cases; this is why measles was re-listed in 2005 on the list of notifiable diseases (ND).
Mandatory reporting
Mandatory reporting involves collecting as comprehensive information as possible regarding all cases of certain diseases known as “reportable diseases” from laboratory technicians and physicians.
For clinicians, any case clinically suggestive of measles (clinical or confirmed) must be reported immediately to the Regional Health Agency (ARS) under whose jurisdiction they fall. The report can be submitted by any means (phone, email, etc.) or using the mandatory reporting form (this form is then sent to the ARS) even if not all fields are filled out. The person in charge of health surveillance will then contact the reporter to complete the form, particularly regarding laboratory tests.
Reporting is crucial to enable the ARS to implement appropriate preventive measures and quickly detect clusters of cases or identify a chain of transmission. The report must be systematically followed by the submission of a mandatory reporting form—if this was not sent to the ARS at the time of the initial report—on which the reporting physician will have completed the case description.
For laboratory professionals, all laboratory-confirmed measles cases must be reported to the ARS, just as clinicians are required to do. This dual reporting system helps align reports and notifications and allows for follow-up with clinicians who may not have reported biologically confirmed cases, ensuring the most comprehensive data possible.
From the reporting stage onward, preventive measures must be taken in addition to isolating the case: active contact tracing, with particular focus on identifying individuals at risk of severe measles in the immediate circle (infants under one year of age, pregnant women, immunocompromised individuals), and vaccination of susceptible individuals in the immediate circle. Whether the case is clinical or confirmed, these measures must be applied to close contacts (family members, children and adults in the same class at daycare or nursery school, children and adults exposed at the home where the case is being cared for by a childminder). They will be extended to contacts who have shared the same premises in group settings (elementary school, middle school, high school, workplace, etc.) if the case is confirmed.
It is therefore recommended that clinicians implement preventive measures within the family circle and that public health surveillance staff at the Regional Health Agency (ARS), in collaboration with physicians from the relevant departments, identify non-family contacts and ensure that the necessary vaccinations have been offered, as well as a recommendation for immunoglobulins for at-risk contacts.
Definition of measles cases to be reported and notified
| Reporting criteria: | Following the report and the information gathered during notification, the selected cases are classified as: |
|---|---|
|
Clinical criteria Biological criteria |
Clinical case: a case meeting the clinical criteria for which no laboratory testing has been performed and which is not epidemiologically linked to another confirmed measles case, or for which laboratory results do not allow the diagnosis to be ruled out (e.g., a negative sample collected outside the recommended time frame). Biologically confirmed case: a patient who presented with clinical signs suggestive of measles and for whom one or more criteria for biological confirmation are present. Epidemiologically confirmed case: a case that meets the definition of a clinical case¹ and that had contact within 7 to 18 days before the onset of the rash with a confirmed measles case². |
Syndromic surveillance
Clinical suspicions of measles are also tracked as part of the SurSaUD® syndromic surveillance system (health surveillance of emergencies and deaths), established in 2004. It relies on several networks of professionals and includes four sources of information:
data from hospital emergency departments participating in the OSCOUR® network (Organization for Coordinated Emergency Surveillance);
data from SOS Médecins associations that are members of the SOS Médecins France Federation;
mortality data from municipal civil registry offices transmitted electronically to INSEE;
data from electronic death certificates.
Emergency room visits, hospitalizations following such visits, and consultations provided by SOS Médecins associations are analyzed on a weekly basis and published on the Agency’s website.
Virological surveillance
Virological surveillance and genetic typing of the measles virus help identify the circulating genotype, particularly in clusters of cases or for imported cases or those linked to an importation. This is carried out by the National Reference Center for Measles, Mumps, and Rubella (Virology Laboratory at the Caen University Hospital).
1In cases of clusters, the diagnosis can be established epidemiologically before all clinical signs are present.
2This case may be a biologically confirmed case or an epidemiologically confirmed case (a situation corresponding to a chain of transmission).
Notification Form
Informing the public about the reporting of notifiable diseases
A network of partners
This surveillance program relies on several partners:
Regional Health Agencies
Overview and contact information for the ARS: http://www.ars.sante.fr/Coordonnees-des-ARS.93676.0.html
The National Reference Center (CNR) for Measles, Rubella, and Mumps Viruses
Overview and contact information: https://www.chu-caen.fr/centres/virus-rougeole-rubeole-oreillons/
The Directorate General for Health (Ministry of Health): https://solidarites-sante.gouv.fr/
Measures to prevent measles
Santé publique France helps promote vaccination through various tools (website, promotional campaigns, brochures, etc.). The information website “Vaccination infoservice.fr” provides reliable, scientifically validated answers to questions that the public and healthcare professionals may have about the various vaccinations available in France.
A section dedicated to measles vaccination is available in two sections—one for the general public and the other for healthcare professionals—to better support them in their practice.
Santé publique France produces informational tools and documents for healthcare professionals and the general public to answer questions about vaccination. These documents are available under the TOOLS tab.
In relation to
Rubella
thematic dossier
Rubella is a viral infection that is usually mild but can, during pregnancy, lead to fetal death or congenital rubella syndrome. A vaccine is available to prevent infection.
Vaccination
thematic dossier
Contagious diseases most often affect children at a very young age. Because children are particularly vulnerable, they are a priority target for vaccination programs.
