Measles surveillance activities in the Metropolitan Area of Milan during 2017-2018.


Measles surveillance
Measles laboratory confirmed cases
Measles epidemiological investigations
Indicators to monitor quality of Measles laboratory surveillance



In Italy, the transmission of measles is still endemic and between January 2017 and December 2018 7,919 cases were reported to the National Surveillance System. Aim of this study is to report the results of the measles surveillance activities in the Metropolitan City of Milan from March 2017 to December 2018, and to evaluate the surveillance performance WHO indicators.


The Local Health Units (LHUs) carried out case investigations and collected specimens to send to the EpiSoMI Lab (Subnational Reference Laboratory, SRL) of the University of Milan for cases/outbreaks confirmation and genotyping performed according to the WHO Guidelines.


Overall, 610 suspected measles cases were reported by the surveillance system of the Metropolitan City of Milan. A total of 439 cases were laboratory-confirmed by molecular and/or serological assays. Two hundred and thirty-six cases were notified as sporadic and 203 as related to 94 outbreaks. The most confirmed cases was aged 15–39 years, almost all not vaccinated. Overall, 282 cases were genotype D8 and 118 genotype B3.

The evaluation of a set of indicators to monitor the quality of surveillance activities demonstrated  the proficiency of the EpiSoMI Lab.


A well done investigation of cases and outbreaks by the surveillance local system, in a timely manner, in order notify and investigate suspected cases and to laboratory confirm or discard cases is fundamental to reduce morbidity, to prevent further virus transmission and to achieve measles elimination.


European Centre for Disease Prevention and Control. Risk of measles transmission in the EU/EEA, 21 March 2018. Stockholm, ECDC. Available at: (Accessed on 16 January 2019).

World Health Organization. Global Measles and Rubella Strategic Plan: 2012–2020. 2012. Available at: (Accessed on 10 January 2019).

European Centre for Disease Prevention and Control (2018) Monthly measles and rubella monitoring report, July 2018. Stockholm: ECDC; Available at: (Accessed on 17 January 2019).

World Health Organization Regional Office for Europe (2014) European Vaccine Action Plan 2015-2020. Copenhagen: WHO. Available at: (Accessed on 16 January 2019).

World Health Organization. Regional Office for Europe Eliminating measles and rubella. Framework for the verification process in the WHO European Region. 2014. Available at: (Accessed on 24 January 2019).

Sniadack DH, Crowcroft NS, Durrheim DN, Rota PA. Roadmap to elimination standard measles and rubella surveillance. Wkly Epidemiol Rec. 2017;92(9-10):97-105.

Magurano F, Baggieri M, Mazzilli F, Bucci P, Marchi A, Nicoletti L; MoRoNet Group. Measles in Italy: Viral strains and crossing borders. Int J Infect Dis. 2018; pii: S1201-9712(18)34583-1. doi: 10.1016/j.ijid.2018.11.005.

Morbillo & Rosolia News, January 2019. Available at: (Accessed on 16 March 2019).

Amendola A, Bianchi S, Frati ER, Ciceri G, Faccini M, Senatore S, Colzani D, Lamberti A, Baggieri M, Cereda D, Gramegna M, Nicoletti L, Magurano F, Tanzi E. Ongoing large measles outbreak with nosocomial transmission in Milan, northern Italy, March-August 2017. Euro Surveill. 2017;22(33). pii: 30596. doi: 10.2807/1560-7917.ES.2017.22.33.30596.

Porretta A, Quattrone F, Aquino F, Pieve G, Bruni B, Gemignani G, Vatteroni ML, Pistello M, Privitera GP and Lopalco PL. A nosocomial measles outbreak in Italy, February-April 2017. Euro Surveill. 2017;22(33). pii: 30597. doi: 10.2807/1560-7917.ES.2017.22.33.30597.

Adamo G, Sturabotti G, Baccolini V, de Soccio P, Prencipe GP, Bella A, Magurano F, Iannazzo S, Villari P, Marzuillo C. Regional reports for the subnational monitoring of measles elimination in Italy and the identification of local barriers to the attainment of the elimination goal. PLoS One. 2018;13(10):e0205147. doi: 10.1371/journal.pone.0205147.

Mo.Ro.Net–liberi dal morbillo e dalla rosolia [Mo.Ro.Net.–free from measles and rubella]. Italian. Available from: (Accessed on 16 April 2019).

World Health Organization. Manual for the Laboratory-based Surveillance of Measles, Rubella, and Congenital Rubella Syndrome. Third edition, June 2018. Available at: (Accessed on 16 January 2019).

World Health Organization. Manual for the laboratory diagnosis of measles and rubella virus infection - Second edition. WHO/IVB/07.01. 2007. Available at (Accessed on 16 January 2019).

WHO Vaccine-Preventable Diseases Surveillance Standards: Measles. Available at: (Accessed on 16 February 2019).

WHO. Surveillance Guidelines for Measles, Rubella and Congenital Rubella Syndrome in the WHO European Region Update December 2012. Available from: data/assets/pdf file/0018/79020/e93035-2013%20pdf?ua=1(Accessed on 6 February 2019).

Hübschen JM, Kremer JR, De Landtsheer S, Muller CP. A multiplex TaqMan PCR assay for the detection of measles and rubella virus. J Virol Methods. 2008;149:246-50. doi:10.1016/j.jviromet.2008.01.032.

Bianchi S, Frati ER, Lai A, Colzani D, Ciceri G, Baggieri M, Lamberti A, Senatore S, Faccini M, Mazzilli F, Gramegna M, Zehender G, Magurano F, Tanzi E, Amendola A. Genetic characterization of Measles virus variants identified during a large epidemic in Milan, Italy, March–December 2017. Epid Infec. 2019;1–5.

Rota PA, Brown K, Mankertz A, Santibanez S, Shulga S, Muller CP, Hübschen JM, Siqueira M, Beirnes J, Ahmed H, Triki H, Al-Busaidy S, Dosseh A, Byabamazima C, Smit S, Akoua-Koffi C, Bwogi J, Bukenya H, Wairagkar N, Ramamurty N, Incomserb P, Pattamadilok S, Jee Y, Lim W, Xu W, Komase K, Takeda M, Tran T, Castillo-Solorzano C, Chenoweth P, Brown D, Mulders MN, Bellini WJ, Featherstone D. Global distribution of measles genotypes and measles molecular epidemiology. J Infect Dis.2011;204, S514–S23. doi: 10.1093/infdis/jir118.

Santibanez S, Hübschen JM, Ben Mamou MC, Muscat M, Brown KE, Myers R, Donoso Mantke O, Zeichhardt H, Brockmann D, Shulga SV, Muller CP, O'Connor PM, Mulders MN, Mankertz A. Molecular surveillance of measles and rubella in the WHO European Region: new challenges in the elimination phase. Clin Microbiol Infect. 2017;23(8):516-523. doi: 10.1016/j.cmi.2017.06.030. (Accessed on 21 March 2019).

Magurano F, Baggieri M, Filia A, Del Manso M, Lazzarotto T, Amendola A, D'Agaro P, Chironna M, Ansaldi F, Iannazzo S, Bucci P, Marchi A, Nicoletti L; Measles Surveillance Group. Towards measles elimination in Italy: Virological surveillance and genotypes trend (2013-2015). Virus Res. 2017;236:24-29. doi: 10.1016/j.virusres.2017.05.009.

Dabbagh A, Patel MK, Dumolard L, Gacic-Dobo M, Mulders MN, Okwo-Beleet JM, et al. Progress toward regional measles elimination—worldwide, 2000–2016. MMWR Morb Mortal Wkly Rep 2017;66:1148–53. pmid:29073125.