The Department of Health and Consumer Affairs of the Andalusian Government has published the new Measles Surveillance and Alert Protocol that has been in development for over three months. Among other updates, this protocol establishes that health centers will assess the susceptibility to measles of their professionals, even in the absence of suspected cases, and will update their vaccination schedules.
The purpose of this measure is to prevent contagion among professionals who may come into contact with a suspected case that arrives at the consultation or hospital emergency room, as has happened precisely this week, when a new outbreak was declared at La Axarquía Hospital in Málaga, in Vélez-Málaga, consisting of one confirmed case imported from Morocco and two probable cases, pending confirmation, who are the healthcare professionals who attended to the infected person in the hospital’s emergency room.
The protocol, which has already been communicated to all public and private healthcare centers in the autonomous community, also includes the search and location of contacts in healthcare centers and the involvement of private centers in the same; it defines the procedures to improve coordination and the adoption of measures in cases of outbreaks; as well as the advancement of the second vaccine dose in children between 12 months and 3 years if they have been in contact with a measles case.
The Directorate General of Public Health and Pharmacy has also updated the section on the use of polyclonal immunoglobulin for contacts and, for outbreak control, it plans to advance the second dose from 15 months of age in all children aged 15 months or older who are pending completion of the triple viral vaccine schedule in the affected area, carry out active screening of susceptible population, or other control measures, depending on the magnitude and risk of outbreak spread.
Finally, two new annexes have been included, one on general information and vaccination recommendations with the triple viral vaccine and another on decision algorithm for post-exposure prophylaxis to measles.
Current Incidence
Since the beginning of the year, 67 confirmed cases of measles have been reported in Andalusia, which represents nine more than last week, four of which are from a family outbreak in Málaga, pending confirmation, all in adults; three imported cases from Morocco (one in Almería and two in Málaga), also in adults; the case of a 45-year-old woman from Málaga, from an unknown source, and one case in Seville in a 13-month-old child with a history of vaccination two weeks before the onset of symptoms. This case is pending genotype confirmation to determine if it is a post-vaccination measles.
Therefore, in 2025, eleven outbreaks have been declared so far, six of which are still active and five have already been closed. Thus, Málaga has a family outbreak with three confirmed cases, of unknown origin declared on March 18; a more recent one, declared on April 14 with four confirmed cases this week in the same family; in addition to the outbreak declared in the healthcare sector, specifically at La Axarquía Hospital in Málaga, declared on April 29.
In the province of Huelva, there are currently active a family outbreak in Moguer, with two confirmed cases of two Moroccan worker siblings, declared on March 29, and the imported family outbreak from Morocco in Lucena del Puerto, with four cases in total in a Moroccan-origin family. Finally, in El Ejido (Almería), a family outbreak was also declared on April 10 with two confirmed cases of two Moroccan worker roommates.
So far, 28% of the cases have been imported cases, these imported cases come from Morocco (17), Belgium (1), and Denmark (1). Of the non-imported cases, 14 cases are isolated cases with an unknown source of infection (seven cases in Málaga capital, two in Marbella, one in Álora, one in Calañas, one in Huelva, one in Palos de la Frontera, and one in Seville).
In addition, eight cases are under 1 year old, from an inactive outbreak in a nursery in Fuengirola (Málaga). 36% have been under 15 years old and 64% adults (ranging from 18 to 70 years). Only two cases (3%) had a documented vaccination history of one dose, the rest of the cases were either not vaccinated or their vaccination status could not be determined (including minors from Morocco and Russia). 36% of cases have required hospitalization.
By provinces, in Almería, seven cases have been recorded (one in Adra, three in El Ejido, one in Níjar, one in Roquetas de Mar, and one in Vera); in the capital of Granada, three; in Huelva, 16 cases (one in Calañas, two in Gibraleón, one in Huelva capital, four in Lucena del Puerto, two in Moguer, three in Palos de la Frontera, one in San Bartolomé de la Torre, and two in San Juan del Puerto); in Málaga, 39 cases (one in Álora, one in Casabermeja, nine in Fuengirola, 16 in Málaga capital, two in Marbella, seven in Mijas, one in Ojén, one in Rincón de la Victoria, and one in Torrox); and in Seville, two cases have been registered in the capital. In Málaga, the majority of cases are concentrated mainly in the Costa del Sol Health District (19 cases) and the Málaga District (17 cases).
Decrease in Incidence and Increase in Imported Cases
In recent weeks, the incidence of confirmed cases has been showing a downward trend. Also, for the past eight weeks, cases have been reported in adults only, mainly between 26 and 47 years, except for the case of the 13-month-old child in Seville, suspected to be post-vaccination. Most of these cases are imported from Morocco, related to imported cases, or associated with outbreaks, significantly reducing cases with unknown sources (two cases in the last six weeks). The active outbreaks at this time are family outbreaks in adults with a small number of cases and generally with two generations of cases.
Health and Consumer Affairs reminds, as confirmed by the data, that measles is an infection that is easily transmitted, can be severe, and can affect both unvaccinated children and adults. For this reason, it recommends vaccination of children according to established schedules and of adults who are not aware of their vaccination status to protect those who cannot be vaccinated (children under 12 months, who represent 14% of cases reported in Andalusia).
The epidemiological situation in the surrounding area of Andalusia, especially Morocco, which has been experiencing a significant measles outbreak since October 2023 and has spread throughout the country with over 40,000 reported cases, including 150 deaths; 3,012 cases in 15 countries of the European Union as of April 15 (Romania leads with 5,104, followed by the Netherlands with 251 and France with 180. Spain had 179); 712 confirmed cases in the United States, with two deaths, as of April 10 or 731 in Canada as of April 11; as well as the presence of susceptible populations that may be significant in some districts and the seasonality of measles (spring), forecasts new outbreaks in the coming weeks and months. The Department of Health and Consumer Affairs will provide a weekly report on Tuesdays with updated data.
The link to the new protocol on the Department of Health and Consumer Affairs website is: