Low percentages of measles vaccination coverage with two doses of vaccine and low herd immunity levels explain measles incidence and persistence of measles in the European Union in 2017–2018
- 109 Downloads
Several factors may explain why measles persisted in the European Union in 2017–2018. The study assessed mean measles vaccination coverage and anti-measles herd immunity levels in the target measles vaccination population in countries of the European Union during the 2015–2017 period. The study found that the measles vaccination coverage with two doses of vaccine was < 95% in 28 (96.5%) countries, and that the prevalence of individuals with vaccine-induced measles protection in the target vaccination population was lower than the herd immunity threshold of 94.4% in 22 (75.9%) countries during 2015–2017. The study found a significant negative correlation between the incidence of measles in 2017–2018 in different countries of the European Union and measles vaccination coverage with two doses of measles vaccine, prevalence of individuals with vaccine-induced measles protection and herd immunity levels in the target measles vaccination population during 2015–2017. Measles vaccination coverage and herd immunity levels did not improve from 2010–2015 to 2015–2017 in the European Union. Low percentages of measles vaccination coverage with two doses of vaccine and low herd immunity levels could explain measles incidence in countries of the European Union in 2017–2018. New measles prevention strategies should be developed to increase measles vaccination coverage and herd immunity levels in the European Union.
KeywordsIncidence of measles European Union Measles vaccination coverage Herd immunity
The average vaccination coverage for the first, the second, and two doses of measles containing vaccine in countries of the WHO European region and in the 30 countries of the European Union were calculated using the information of the WHO on “Reported estimates of MCV1 coverage”, and “Reported estimates of MCV2 coverage”:
Compliance with ethical standards
Conflict of interest
The author declares that he has no conflict of interest.
The work did not require an ethical approval.
The work did not require an informed consent.
- 1.World Health Organization (WHO) (2012) Global measles and rubella strategic plan: 2012–2020. WHO, Geneva, SwitzerlandGoogle Scholar
- 3.World Health Organization (WHO) (2003) Strategic plan for measles and congenital rubella infection in the WHO European region. WHO Regional Office for Europe, Copenhagen, DenmarkGoogle Scholar
- 4.WHO. (2015–2018) Centralized Information System for Infectious Diseases (CISID). Measles-Number of cases. Available from: http://data.euro.who.int/cisid/Default.aspx?TabID=488389. Accessed 12 Mar 2019
- 5.WHO. Centralized Information System for Infectious Diseases (CISID). Measles-Number of hospitalizations, 2015–2018. Available from: http://data.euro.who.int/cisid/?TabID=488387. Accessed 12 Mar 2019
- 6.WHO. Centralized Information System for Infectious Diseases (CISID). Measles-Number of deaths, 2015–2018. Available from: http://data.euro.who.int/cisid/?TabID=488391. Accessed 12 Mar 2019
- 7.European Centre for Disease Prevention and Control (ECDC) (2018) Monthly measles and rubella monitoring, February 2018. ECDC, Stockholm Available from: https://ecdc.europa.eu/sites/portal/files/documents/Monthly/Measles%20and%20Rubella%20monitoring%20report%20%20February%202018.pdf (Accessed 12 March 2019)Google Scholar
- 8.European Centre for Disease Prevention and Control (ECDC) (2019) Monthly measles and rubella monitoring report, February 2019. ECDC, Stockholm Available from: https://ecdc.europa.eu/sites/portal/files/documents/measles-rubella-monthly-monitoring-report-february-2019.pdf (Accessed 12 March 2019)Google Scholar
- 9.World Health Organization Regional Office for Europe (2014) Eliminating measles and rubella. Framework for the verification process in the WHO European Region. Copenhagen, WHO Regional Office for Europe. Available from: http://www.euro.who.int/__data/assets/pdf_file/0009/247356/Eliminating-measles-and-rubella-Framework-for-the-verification-process-in-the-WHO-European-Region.pdf
- 11.European Centre for Disease Prevention and Control (ECDC) Measles: recommended vaccination. https://vaccine-schedule.ecdc.europa.eu/Scheduler/ByDisease?SelectedDiseaseId=8&SelectedCountryIdByDisease=-1
- 14.Plans P, Torner N, Godoy P, Jané M (2014) Lack of herd immunity against measles in individuals aged <35 years could explain re-emergence of measles in Catalonia (Spain). Int J Infect Dis 18:81–83 Available from: http://download.journals.elsevierhealth.com/pdfs/journals/12019712/PIIS120197121300307X.pdf CrossRefGoogle Scholar
- 16.World Health Organization (1985-2018) WHO-UNICEF estimates of MCV1 coverage [internet]. WHO, Geneva [accessed 29 January 2019]. Available from: http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragemcv1.html
- 17.World Health Organization (1985-2018) WHO-UNICEF estimates of MCV2 coverage [internet]. WHO, Geneva [accessed 29 January 2019] Available from: http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragemcv2.html
- 18.Anderson RM, May RM (1991) Infectious diseases of humans: dynamics and control. Oxford University Press, Oxford, UKGoogle Scholar
- 19.Gay NJ (2003) The theory of measles elimination: implications for the design of elimination strategies. J Infect Dis 189(Suppl 1):S27–S35Google Scholar
- 20.Guerra F, Bolotin S, Lim G, Heffernan J, Deeks SL, Li Y, Crowcroft NS (2017) The basic reproduction number (Ro) of measles: a systematic review. Lancet Infect Dis:e420–e428. https://doi.org/10.1016/S1473-3099(17)30307-9
- 21.Demicheli V, Rivetti A, Debalini MG, Di Pietrantonj C (2012) Vaccines for measles, mumps and rubella in children (review). The Cochrane library issue 2. Accesible from: https://www.princeton.edu/~sswang/demicheli_pietrantonj12_cochrane_report_MMR-risks.pdf
- 22.Marin M, Nguyen HQ, Langidrik JR, Edwards R, Briand K, Papania MJ, Seward JF, LeBaron CW (2006) Measles transmission and vaccine effectiveness during a large outbreak on a densely populated island: implications for vaccination policy. Clin Infect Dis 42:315–319. Available from: https://doi.org/10.1086/498902
- 23.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 8:184–188 Available from: http://www.tandfonline.com/doi/pdf/10.4161/hv.18444 CrossRefGoogle Scholar
- 24.McBrien J, Murphy J, Gill D, Cronin M, O’Donovan C, Cafferkey MT (2000) Measles outbreak in Dublin. Pediatr Infect Dis 22:580–584Google Scholar
- 25.Poland GA, Jacobson RM (2011) The age-old struggle against the antivaccinationists. Ned Engl J Med 364:97–99 Available from: http://www.edwardjennersociety.org/wp-content/uploads/NEJM.pdf CrossRefGoogle Scholar
- 26.Centers for Disease Control (CDC). Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary recommendations of the Advisory Committee on Immunization Practices (ACIP) (2013) MMWR 62(RR04);1–34. Available from: https://www.cdc.gov/mmwr/pdf/rr/rr6204.pdf
- 30.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 11:119–122Google Scholar
- 31.De Quadros CA, Hersh BS, Nogueira AC, Carrasco PA, da Silveira CM (1998) Measles eradication: experience in the Americas. Bull WHO 76(Suppl 2):47–52Google Scholar