{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T13:35:35Z","timestamp":1759412135643},"reference-count":22,"publisher":"European Centre for Disease Control and Prevention (ECDC)","issue":"28","license":[{"start":{"date-parts":[[2018,7,12]],"date-time":"2018-07-12T00:00:00Z","timestamp":1531353600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,7,12]]},"abstract":"<jats:p>We report three simultaneous measles outbreaks with 112 confirmed cases in three Health Regions of Portugal, from February to April 2018. The mean age of cases was 30 years, 79% worked in a healthcare setting and 87% were vaccinated. Genotype B3 was identified in 84 cases from the three outbreaks. Primary cases in each outbreak were imported. Several cases presented with modified measles, highlighting the importance of rethinking the measles case definition for vaccinated cases.<\/jats:p>","DOI":"10.2807\/1560-7917.es.2018.23.28.1800328","type":"journal-article","created":{"date-parts":[[2018,7,12]],"date-time":"2018-07-12T15:55:19Z","timestamp":1531410919000},"update-policy":"http:\/\/dx.doi.org\/10.2807\/1560-7917.es.crp2020","source":"Crossref","is-referenced-by-count":10,"title":["Challenging measles case definition: three measles outbreaks in three Health Regions of Portugal, February to April 2018"],"prefix":"10.2807","volume":"23","author":[{"given":"Gon\u00e7alo Figueiredo","family":"Augusto","sequence":"first","affiliation":[{"name":"Directorate-General of Health, Lisbon, Portugal"}]},{"given":"Diogo","family":"Cruz","sequence":"additional","affiliation":[{"name":"Directorate-General of Health, Lisbon, Portugal"}]},{"given":"Andreia","family":"Silva","sequence":"additional","affiliation":[{"name":"Directorate-General of Health, Lisbon, Portugal"}]},{"given":"Nat\u00e1lia","family":"Pereira","sequence":"additional","affiliation":[{"name":"Directorate-General of Health, Lisbon, Portugal"}]},{"given":"B\u00e1rbara","family":"Aguiar","sequence":"additional","affiliation":[{"name":"Directorate-General of Health, Lisbon, Portugal"}]},{"given":"Ana","family":"Le\u00e7a","sequence":"additional","affiliation":[{"name":"Directorate-General of Health, Lisbon, Portugal"}]},{"given":"Elisabete","family":"Serrada","sequence":"additional","affiliation":[{"name":"Directorate-General of Health, Lisbon, Portugal"}]},{"given":"Paula","family":"Valente","sequence":"additional","affiliation":[{"name":"Directorate-General of Health, Lisbon, Portugal"}]},{"given":"Teresa","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Directorate-General of Health, Lisbon, Portugal"}]},{"given":"Fernando","family":"Guerra","sequence":"additional","affiliation":[{"name":"Directorate-General of Health, Lisbon, Portugal"}]},{"given":"Paula","family":"Palminha","sequence":"additional","affiliation":[{"name":"National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal"}]},{"given":"Elsa","family":"Vinagre","sequence":"additional","affiliation":[{"name":"National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal"}]},{"given":"S\u00edlvia","family":"Lopo","sequence":"additional","affiliation":[{"name":"National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal"}]},{"given":"Rita","family":"Cordeiro","sequence":"additional","affiliation":[{"name":"National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal"}]},{"given":"Emma","family":"S\u00e1ez-L\u00f3pez","sequence":"additional","affiliation":[{"name":"European Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden"},{"name":"National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal"}]},{"given":"Maria","family":"Neto","sequence":"additional","affiliation":[{"name":"North Region Health Administration (SNS), Porto, Portugal"}]},{"given":"Paulo Jorge","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Directorate-General of Health, Lisbon, Portugal"}]},{"given":"Gra\u00e7a","family":"Freitas","sequence":"additional","affiliation":[{"name":"Directorate-General of Health, Lisbon, Portugal"}]}],"member":"7995","reference":[{"key":"r1","unstructured":"European Commission. Commission Implementing Decision of 8 August 2012 amending Decision 2002\/253\/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119\/98\/EC of the European Parliament and of the Council. Luxembourg: Publications Office of the European Union. L262 Sep 27, 2012. Available from: http:\/\/eur-lex.europa.eu\/legal-content\/EN\/TXT\/?uri=OJ%3AL%3A2012%3A262%3ATOC"},{"key":"r2"},{"key":"r3"},{"key":"r4","unstructured":"National Institute of Health Dr Ricardo Jorge (INSA). Inqu\u00e9rito Serol\u00f3gico Nacional 2015-16 [National Serological Survey 2015-16]. Lisbon: INSA; 2017. Available from: http:\/\/repositorio.insa.pt\/handle\/10400.18\/5401"},{"key":"r5","unstructured":"French Public Health Agency. Rougeole: Bulletin \u00e9pid\u00e9miologique Semaine 19, 16\/05\/2018 [Measles: Epidemiological Bulletin Week 19, 16\/05\/2018]. Paris: Public Health Agency; 2018. [French]: available from: http:\/\/invs.santepubliquefrance.fr\/content\/download\/146828\/534556\/version\/18\/file\/Bulletin_rougeole_S19.pdf"},{"key":"r6"},{"issue":"20","key":"r7","doi-asserted-by":"crossref","first-page":"18","DOI":"10.2807\/1560-7917.ES.2018.23.20.18-00224","article-title":"Measles outbreak in a tertiary level hospital, Porto, Portugal, 2018: challenges in the post-elimination era.","volume":"23","author":"S\u00e1 Machado","year":"2018","journal-title":"Euro Surveill"},{"key":"r8","unstructured":"Directorate-General of Health (DGS). Sarampo \u2013 Procedimentos em unidades de sa\u00fade \u2013 Programa Nacional Elimina\u00e7\u00e3o Sarampo [Measles \u2013 Procedures in Healthcare Units \u2013 National Measles elimination Programme. Informations to Schools]. Lisbon: DGS; March 2018. Normative Document No. 004\/2017 updated on 16 March 2018. [Portuguese]. 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