In Budva, Montenegro’s most popular tourist destination, an outbreak of measles has been reported in the middle of the season.

This news, covered extensively by local and regional media, did not come as a surprise to Milka Joksimović, an epidemiologist at the Institute of Public Health (IIZ) in Montenegro.

She mentioned to Radio Free Europe (RSE) that only 42 percent of preschool children in Budva are vaccinated, which is the lowest percentage in the country. The national average is 59.4 percent.

Since achieving herd immunity requires at least 95 percent of the population to be vaccinated, Joksimović cautions about the potential for the epidemic to spread:

“We have all the conditions for a significant epidemiological outbreak. We are concerned that it could ignite locally, and then at the state level.”

The local health care authority reported the outbreak on August 8. All seven affected individuals were unvaccinated, and four of these cases were epidemiologically linked, meeting the criteria for declaring an epidemic.

Currently, there are 16 patients in Montenegro.

Full vaccination against measles is achieved through two doses of the MMR vaccine—one dose after the first year and another before school entry.

In the Health Center, it is noted that some parents postpone their children’s vaccinations for health reasons, while others openly refuse to immunize them.

“Perhaps this epidemic will motivate some of these parents to have their children vaccinated, as it is the only effective way to prevent the disease,” says RSE director Blažo Radoman.

Mary, a mother of a two-year-old girl, shared her views in the Health Center, believing that the issue surrounding those who have not vaccinated their children is “overblown”:

“It’s everyone’s choice whether to vaccinate or not.”

Ana, whose two-year-old son has not been vaccinated, claims that she needs to first address his acute health issue.

“I’m not particularly aware of the developments regarding this topic; I didn’t even know an epidemic had been reported,” Ana mentions, despite the official announcement being made more than ten days prior.

Conversely, Maja, a mother of a four-year-old, finds the epidemic concerning:

“My son received the MMR vaccine. I was advised not to vaccinate him because some parents were against it. But I didn’t want to take risks with my child’s health.”

In Montenegro, vaccination against measles is mandatory, and if parents refuse, pediatricians are required to report it to health authorities, which can lead to legal action against the parent.

The Health Center has no information regarding such reports. RSE also inquired with a local misdemeanor court but received no response.

Parents who neglect to vaccinate can face fines ranging from 100 to 2,000 euros.

Seasonal Visitors and Environmental Virus

Along with the significant number of unvaccinated children in Budva, another contributing factor to the outbreak is the presence of the virus in surrounding areas, according to IIZ allegations.

“There has been an ongoing epidemic in Serbia and Bosnia and Herzegovina, where the virus carriers may originate. The influx of tourists during the season increases the likelihood of the virus entering the area,” Joksimović explains.

According to the Public Health Institute, this year, in Bosnia and Herzegovina, 7,361 measles cases were reported, resulting in two adolescent fatalities, while in Serbia, there were 255 cases reported by early August, along with 40 in Albania, 21 in Croatia, and 16 in Slovenia.

“This is the first I’ve heard of the epidemic, but I’m not worried because my son is vaccinated,” says Jelena from Kragujevac, who is vacationing in Budva.

The local tourist organization reports that they have received no inquiries from tourists concerning the epidemic.

“We also have no information regarding negative impacts from travel agencies or hotel staff, suggesting that the epidemic has not yet affected this tourist season,” says Ljubica Pribilović from the Budva tourist organization.

IIZ: Do Not Send Unvaccinated Children to Kindergarten

Joksimović believes the epidemic could exacerbate as the school year approaches.

With the school year beginning in a few weeks, she recommends that unvaccinated children refrain from attending kindergartens, play areas, and sports activities while the epidemic persists or until they are vaccinated.

“Unvaccinated children do not belong in collective settings, according to the Institute’s stance,” states Joksimović.

Since mid-August, this recommendation has been included in the certificates issued by the Health Center for enrolling children in kindergartens and schools. However, this recommendation is not legally binding, as the law does not prohibit unvaccinated children from attending educational institutions.

This is also confirmed by the Budva Kindergarten, which has sought clarification and guidance from the Health Center and the Institute of Public Health.

“The law states that our only requirement for enrolling a child is a health certificate confirming the child is healthy enough to attend kindergarten,” says RSE director Žarko Ristić of Kindergarten “Ljubica Jovanović Masha.”

RSE has also contacted the Ministry of Education for information on measures to be taken at the beginning of the school year to prevent the spread of the measles epidemic.

They responded briefly, stating that they would follow the guidelines from the Ministry of Health and the Institute for Public Health, although they did not specify what those guidelines entail.

A few months ago, the Ministry of Health proposed changes to the Law on Infectious Diseases to mandate vaccinations for children attending collective settings, especially preschools.

“We believe that the alarming low vaccination rates cannot be improved without legal amendments and strict enforcement,” emphasizes Joksimović.

RSE inquired with the Ministry of Health regarding potential legal changes to prevent unvaccinated children from enrolling in kindergartens and schools, but no response has been received.