Measles Among the Foreign-Born Population Residing in Spain, 2014-2022: Missed Opportunities for Vaccination

Abstract

Background/objectives: Spain has been in a measles elimination phase since 2014. No evidence exists about the distribution of measles cases among the population born outside Spain. The aim of this study was thus to describe the epidemiological situation of measles, stratified by place of birth, during the post-elimination period in Spain. Methods: This is a retrospective study of confirmed measles cases reported to RENAVE between 2014 and 2022. A descriptive analysis of case characteristics (sex, age group, vaccination status, imported case) was performed, was well as an analysis of temporal trends and geographic distribution in measles incidence rate (IR; cases/million inhabitants). All analyses were stratified by place of origin (Spain born vs. born outside Spain). We then performed a sensitivity analysis of those born outside Spain, with the representation of Kaplan-Meier curves taking into account the year of arrival in the country until the onset of measles. Results: Between 2014 and 2022, 951 measles cases were reported in Spain (overall IR: 2.3). Among these, 18.6% (177 cases, IR: 3.0) were born outside Spain. The IRs show differences (p < 0.001) in terms of distribution by age group and origin. By age group, children under 5 years had the highest IR, but adults aged 30 years and older reported the highest proportion of cases. The incidence rate ratio (IRR) was 5-fold higher among foreign-born children under 5 years than among native-born children. The measles time trend shows the highest peak in 2019 for foreign-born and native-born (IR: 8.6 and 5.4, respectively), consistent with the European-wide scenario, while only one case of measles was reported in 2022. Geographical variability in incidence rates by region was observed: Catalonia and the Valencian Community accumulated the highest proportion of cases throughout the study period. Among those born outside Spain, the median time from arrival to onset of rash was 6 years. Conclusions: The incidence of measles is 40% higher in Spain's foreign-born population than in its native-born population. Taking into account the increasing migrant population in Spain, we consider that public health efforts need to be directed towards susceptible groups of people. In this context of advanced elimination, specific interventions for identifying and attending the most vulnerable populations should be designed and implemented.