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BMJ. 2008 January 12; 336(7635): 66.
PMCID: PMC2190248

England and Wales are among European countries at highest risk of measles epidemic

Seven European countries, including England and Wales, can expect measles epidemics at some point in the near future, a new report says.

These countries need to strengthen their routine vaccination programmes, target catch-up campaigns at susceptible age groups, such as elderly people, and stress the safety of the measles, mumps, and rubella (MMR) vaccine, say the authors of the report (Bulletin of the World Health Organization doi: 10.2471/BLT.07.041129).

“It is critical that all countries in Europe achieve and maintain very high vaccine coverage if the target of measles elimination by 2010 in the [WHO] European region is to be reached,” write the authors, from the UK’s Health Protection Agency.

“It is of concern that in seven of the 18 countries [looked at in the study], there is high susceptibility in several age groups, including young children. Belgium, Bulgaria, Cyprus, England and Wales, Ireland, Latvia and Romania were deemed to be at risk of epidemics as a result of high susceptibility in children and also, in some cases, adults.”

The researchers analysed the results from measles serological surveillance in 16 European countries and Israel and Australia. They used information on measles IgG antibody titres from large national serum banks, together with data on measles vaccination coverage and disease incidence.

They compared the percentage of seronegative people in each country with the WHO targets of <15% in children aged 2-4 years, <10% in those aged 5-9, and <5% in people aged 10-19, 20-39, or ≥40.

Their results show that three countries (Czech Republic, Luxembourg, and Spain) met the WHO targets in all age groups and that four (Hungary, Slovakia, Slovenia, and Sweden) missed only the target in the 20-39 year old age group.group.

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The report says that these countries have had two-dose measles vaccination programmes since the 1970s and very high reported coverage of the first dose of the vaccine (mostly >95%) for the five years to 2001, when the reported incidence of measles had fallen to very low levels in nearly all the countries. The authors say that in these seven countries the risk of an outbreak of measles is low.

Four countries (Australia, Israel, Lithuania, and Malta) had met the WHO targets for children aged 2-4 years and 5-9 years but not those for older children and adults and thus were classed as having intermediate susceptibility. These countries have had routine two-dose measles programmes since the early 1990s, and the reported coverage of the first dose of the vaccine for 1997 to 2002 was >90%.

The remaining seven countries (Belgium, Bulgaria, Cyprus, England and Wales, Ireland, Latvia, and Romania) had not met the WHO targets in the 2-4 years and 5-9 years age groups—and, apart from Romania, had also not met the targets for some of the older age groups—and thus were classed as having high susceptibility.

The report says that in Belgium, Cyprus, Ireland, and England and Wales coverage of the first dose of the two-dose measles vaccine in the five years up to 2001 was below 90%. “This,” they say, “has led to the proportion of children susceptible to measles exceeding the WHO susceptibility targets.”

The report adds: “This lower coverage has only been a recent phenomenon in England and Wales and to some extent in Ireland—which also has high susceptibility in adults—reflecting the impact of parental concern on the safety of MMR vaccine on uptake.

“To achieve elimination, all these higher susceptibility countries will need to strengthen their routine measles programmes to achieve [coverage of] greater than 95% with both doses and address older susceptible age groups through catch-up campaigns. These activities will need to be supported by information campaigns highlighting the importance and safety of MMR vaccine.”


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