On 19 April, Italy reported a measles epidemic, following a fall-off in vaccinations, as the United States issued a warning to visitors about the outbreak of the potentially fatal disease.

Italy's Ministry of Health stated that there had been almost 1,500 registered cases of measles so far this year, compared with 840 in 2016 and 250 in 2015.

"Italy and Romania have an epidemic at the moment," said Walter Ricciardi, president of the Higher Health Institute.

This is mainly due to the gaps in vaccination coverage against measles, which have led to multiple outbreaks in Europe the past year, with both children and young adults affected, health officials said on 24 April.

Adults are also not vaccinated against measles

During the first two months of 2017, more than 1,500 measles cases were reported from 14 European countries due to "an accumulation of unvaccinated individuals," said officials from the European Centre for Disease Prevention and Control (ECDC).

In 10 countries - Austria, Belgium, Croatia, France, Germany, Italy, Poland, Romania, Spain and Sweden - the number of cases reported in January-February 2017 was more than double that of the first two months of 2016.

"It is unacceptable to hear that children and adults are dying from disease where safe and cost-effective vaccines are available," Vytenis Andriukaitis, the EU's health commissioner, said in response to the ECDC's data.

The Higher Health Institute also said that only about 85% of 2-year-olds were being vaccinated against measles in the country, well below the 95% threshold recommended by the World Health Organisation.

Furthermore, ECDC's report said that what was most concerning was that the recent outbreaks included the older age groups. In 2015 and 2016 around a third of all measles cases in Europe were in adults over 20 years old. Many adults also do not realise they are susceptible to vaccine preventable diseases such as measles.

Public trust in immunisation is a big factor

"Closing immunisation gaps in adolescents and adults who have not received vaccination in the past as well as strengthening routine childhood immunisation programmes will be vital to prevent future outbreaks," it said.

The main problem is the lack of public trust in immunisation as it often leads to people turning down potentially life-saving vaccines. For Italy, the government has accused the anti-establishment Five Star Movement (M5S) of spreading concern among parents by questioning the safety of some vaccines, denouncing huge efforts to make vaccinations mandatory.

"Vaccinations have played a vital role in eradicating terrible illnesses ... but nonetheless, they bring a risk associated with side effects," M5S founder Beppe Grillo wrote in 2015, saying mandatory vaccination represented a gift for multinational pharmaceutical firms.

A leading M5S politician, Andrea Cecconi, also suggested that the recent jump in measles cases might be part of a natural cycle for the illness rather than a preventable epidemic.

Controversies also make public health professionals doubt vaccines

Such negative attitudes have caused hesitancy among some family doctors. It was also reported by public health officials on 20 April that a public health nurse pretended to vaccinate as many as 550 children in the northern Italian city of Treviso.

The nurse has since then been placed under internal investigation after her colleagues reported her for injecting the children, but throwing away full vaccine vials. Suspicions arose when none of the children cried at the shot, which can be painful.

Local health authority director-general, Francesco Benazzi, who reported the nurse to prosecutors suggested that although the nurse refused to explain her actions, her motive may have been "linked to conscientious objection."

The latest data for 2015 showed vaccination coverage for the second dose of measles was below the recommended 95% in 15 out of 23 European Union/European Economic Area countries, the ECDC said. For the first dose, coverage was below 95% in 12 of 27 countries who reported data. MIMS

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