Why does measles persist in Europe?

Original Article

Abstract

Several reasons may explain why measles was not eliminated by 2015 and continues to persist in Europe, including low measles vaccination coverage, low anti-measles herd immunity levels, and the mobility of individuals with measles across Europe. The study assessed the mean measles vaccination coverage in the European Union and the WHO European region with one and two doses of measles vaccine from 1980 to 2015, and the prevalence of vaccine-induced protected individuals and anti-measles herd immunity levels in the WHO European region during 2000–2015. The study found that measles vaccination coverage with two doses of vaccine was <90% in the European Union and the WHO European region from 1995 to 2015. In the WHO European region, the two-dose measles vaccination coverage during the 2000–2015 period was <95% in 41 countries (79%), and the prevalence of vaccine-induced protected individuals in the target vaccination population was lower than the herd immunity threshold of 94.4% in 33 countries (63%). The additional vaccination coverage required to establish herd immunity in these countries ranged from 0.2% to 18%. Two of the factors explaining measles persistence in Europe in 2015 were the two-dose measles vaccination coverage <95% and the prevalence of individuals with vaccine-induced protection of <94.4% in most countries of the WHO European region during the 2000–2015 period. Screening and vaccination programs should be developed to detect and immunize susceptible individuals in areas and population groups without anti-measles herd immunity in all European countries.

References

  1. 1.
    World Health Organization (WHO) (2010) Resolution. Renewed commitment to elimination of measles and rubella and prevention of congenital rubella syndrome by 2010 and Sustained support for polio-free status in the WHO European region. WHO Regional Office for Europe, Moscow, Russia. Available from: http://www.euro.who.int/__data/assets/pdf_file/0016/122236/RC60_eRes12.pdf
  2. 2.
    Moss WJ, Strebel P (2011) Biological feasibility of measles eradication. J Infect Dis 204 [Suppl 1]:S47–S53CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    World Health Organization (WHO) Centralized Information System for Infectious Diseases (CISID). European region. Measles—2015 and 2016. http://data.euro.who.int/cisid/?TabID=417891. Accessed 20 April 2017
  4. 4.
    European Centre for Disease Prevention and Control (2016) Measles and rubella monitoring, January 2016 – Disease surveillance data: 1 January 2015–31 December 2015. Stockholm, ECDC. Available from: http://ecdc.europa.eu/en/publications/Publications/2016_issue_1_%20Measles%20rubella%20monitoring_final.pdf
  5. 5.
    European Centre for Disease Prevention and Control (2017) Measles and rubella monitoring, January 2017—Disease surveillance data: 1 January 2016–31 December 2016. Stockholm, ECDC. Available from: http://ecdc.europa.eu/en/publications/Publications/measles%20-rubella-monitoring-170424.pdf
  6. 6.
    World Health Organization (WHO) (2003) Strategic plan for measles and congenital rubella infection in the WHO European Region. Copenhagen, Denmark: WHO Regional Office for Europe. Available from: http://www.euro.who.int/document/e81567.pdf
  7. 7.
    WHO (2017) WHO vaccine-preventable diseases: monitoring system. 2016 global summary. Immunization schedule for measles, Europe. http://apps.who.int/immunization_monitoring/globalsummary/diseases. Accessed 20 April 2017
  8. 8.
    WHO (2016) Measles-containing vaccine. Reported estimates of MCV1 coverage. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tscoveragemcv1.html. Accessed 12 December 2016
  9. 9.
    WHO (2016) Measles-containing vaccine 2nd dose. Reported estimates of MCV2 coverage. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tscoveragemcv2.html. Accessed 12 December 2016
  10. 10.
    Demicheli V, Rivetti A, Debalini MG, Di Pietrantonj C. Vaccines for measles, mumps and rubella in children (review) (2012) The Cochrane Library, Issue 2. Available from: https://www.princeton.edu/~sswang/demicheli_pietrantonj12_cochrane_report_MMR-risks.pdf
  11. 11.
    Anderson RM, May RM (1991) Infectious diseases of humans: dynamics and control. Oxford University Press, OxfordGoogle Scholar
  12. 12.
    Gay NJ (2004) The theory of measles elimination: implications for the design of elimination strategies. J Infect Dis 189 [Suppl 1]:S27−S35CrossRefPubMedGoogle Scholar
  13. 13.
    Plans-Rubió P (2012) Evaluation of the establishment of herd immunity in the population by means of serological surveys and vaccination coverage. Hum Vaccin Immunother 8:184–188CrossRefPubMedGoogle Scholar
  14. 14.
    Plans-Rubió P (2010) Prevalence of antibodies associated with herd immunity: a new indicator to evaluate the establishment of herd immunity and to decide immunisation strategies. Med Decis Making 30:438–443CrossRefGoogle Scholar
  15. 15.
    Hinman AR, Urquhart GA, Strikas RA (2007) Immunization information systems. National Vaccine Advisory Committee progress report, 2007. J Public Health Manag Pract 13:553–558CrossRefPubMedGoogle Scholar
  16. 16.
    Muller CP, Kremer JR, Best JM, Dourado I, Triki H, Reef S, WHO Steering Committee for Measles and Rubella (2007) Reducing global disease burden of measles and rubella: report of the WHO Steering Committee on research related to measles and rubella vaccines and vaccination, 2005. Vaccine 25:1–9CrossRefPubMedGoogle Scholar
  17. 17.
    Plans P (2013) New preventive strategy to eliminate measles, mumps and rubella from Europe based on the serological assessment of herd immunity levels in the population. Eur J Clin Microbiol Infect Dis 32:961–996CrossRefPubMedGoogle Scholar
  18. 18.
    Rota PA, Brown K, Mankertz A, Santibanez S, Shulga S, Muller CP et al (2011) Global distribution of measles genotypes and measles molecular epidemiology. J Infect Dis 204 [Suppl 1]:S514–S523CrossRefPubMedGoogle Scholar
  19. 19.
    Pannuti CS, Morello RJ, De Moraes JC, Curti SP, Afonso AMS, Camargo MCC, De Souza VAUF (2004) Identification of primary and secondary measles vaccine failures by measurement of immunoglobulin G avidity in measles cases during the 1997 São Paulo epidemic. Clin Diagn Lab Immunol 11:119–122PubMedPubMedCentralGoogle Scholar
  20. 20.
    Davidkin I, Jokinen S, Broman M, Leinikki P, Peltola H (2008) Persistence of measles, mumps, and rubella antibodies in an MMR-vaccinated cohort: a 20-year follow-up. J Infect Dis 197:950–956CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Public Health Agency of CataloniaDepartment of Health of CataloniaBarcelonaSpain
  2. 2.CIBER of Epidemiology and Public Health (CIBERESP)Instituto de Salud Carlos IIIMadridSpain

Personalised recommendations