A child has died of measles in Berlin, four months after health officials warned there was an outbreak of the disease in the city.
The 18-month-old boy died in hospital, and it was not clear how he had contracted the disease.
Authorities in Berlin also confirmed that a secondary school had closed on Monday after a measles case was reported there.
The measles outbreak – the worst Berlin has seen in a decade – has restarted the debate on the safety of vaccinations, and whether they should be compulsory.
Health Minister Hermann Gröhe had suggested at the weekend that it may be necessary to introduce a mandatory vaccination program, but said on Monday that the government would first push vaccinations through a concerted plan involving daycare centres, schools and doctors,
The government shied away from introducing mandatory vaccinations but said that all parents enrolling their children in day care centres would receive advice on vaccinations, including information on their safety and side effects. “There are quite a few old wives' tales being told here," said Mr. Gröhe.
"If that doesn’t work," he added, "mandatory vaccination isn't a taboo. But it isn't on the agenda right now."
Almost 600 people have caught measles in Berlin since an outbreak last October.
The outbreaks in Germany are part of a wider global rise in measles and a growing reluctance among many parents to vaccinate their children, in part because they fear a link between the triple vaccine MMR, which vaccinates against measles, mumps and rubella, and autism. The link was first suggested by British doctor Andrew Wakefield but has since been discredited.
In the U.S., the debate over vaccinations has intensified since an outbreak began in Disneyland in California in mid-December. Around 120 people had been at the theme park and have since returned home to places as far flung as Mexico and Canada.
Video: How Measles made a comeback.
Almost 600 people have caught measles in Berlin since an outbreak began last October, but the Robert Koch Institute, a government-backed public health body which has monitored the outbreak of measles since 2005, said it is only one of several outbreaks around the country. Each outbreak affects anything from a few hundred to over a thousand people, most of whom have not been vaccinated against the disease.
Most patients are young children but the Institute notes that since 2006, more adolescents and adults have been affected.
International experts believe that the measles vaccination is safe, and they note that the minimal residual risk from side effects is much smaller than the risks associated with the disease, which can be dramatic and life-threatening.
Official data from the 2012 vaccination program in Germany shows there were almost 11,000 cases of harmful side effects of vaccinations from 2005 to 2009, of 211 million vaccine doses administed.
Data from the World Health Organization shows that the incidences of measles in Europe jumped more than threefold, from 7,892 cases in 2009 to 30,604 in 2010. Last year, the numbers appeared to be falling, with 15,995 cases recorded, almost half the 32,818 cases in 2013 but officials fear the numbers could rise again with the recent spate of outbreaks.
Peter Thelen is a correspondent for Handelsblatt reporting on social security and public policy. To contact the author: [email protected].