The global plan to eradicate measles by 2010 is unlikely to come about say epidemiology experts because of high rates of infection in some parts of Europe where many children go unvaccinated.

The research was the work of Dr Mark Muscat, of the Department of Epidemiology at Statens Serum Institut in Copenhagen, Denmark, and colleagues, and is published early online on 7 January in The Lancet.

Although measles vaccination has been a routine part of childhood vaccination programmes in Europe for more than 20 years, the disease persists, prompting Muscat and fellow epidemiologists to see if the World Health Organization (WHO) goal of global elimination by 2010 is feasible.

For the study, Muscat and colleagues looked at national surveillance data covering 2006-2007 from 32 European countries that covered age, confirmation of diagnosis, vaccination, hospital treatment, deaths, and whether acute encephalitis (inflammation of the brain) occurred as a complication of the disease. They were also able to get data from 30 of the countries on disease importation.

They then selected only clinical cases that had been confirmed by lab tests, analyzed them by age group and categorized the countries into indigenous incidence bands ranging from zero, low, moderate to high incidence (zero being 0, low being 0.1, moderate being 0.1 to 1.0, and high being over 1.0 cases per 100,000 inhabitants per year).

The results showed that for 2006-2007:

  • There was a total of 12,132 recorded cases of measles in 32 European countries, with 85 per cent of them in just five countries: Romania, Germany, UK, Switzerland, and Italy.
  • Most cases were unvaccinated or incompletely vaccinated children; however, almost 20 per cent of them were aged 20 years or older.
  • Seven measles-related deaths were recorded.
  • It appears than in some European countries the vaccination programme is not working as well as it should.
  • 210 of the total number of cases were recorded as imported, and of these 117 (56 per cent) came from another European country and 43 (20 per cent) came from Asia.

Muscat and colleagues wrote that:

“The suboptimum vaccination coverage raises serious doubts that the goal of elimination by 2010 can be attained. Achievement and maintenance of optimum vaccination coverage and improved surveillance are the cornerstones of the measles elimination plan for Europe.”

These findings suggest that the upsurge of measles in Europe puts the WHO goal under severe threat. Since most of the infected patients were either unvaccinated or incompleted unvaccinated, it would seem that new vaccination policies are needed to target those most susceptible to the disease, both in the general population and in high risk groups, notes an editor in the same issue of the journal.

The situation in Europe affects other parts of the world. For instance in the USA in 2008, according to the US Centers for Disease Control and Prevention (CDC), cases of measles infection were at their highest since 1996, and many of them were either imported from or linked to people who travelled into the US from other countries, particularly from Europe.

The study was funded by the European Commission and the Statens Serum Institut in Denmark.

“Measles in Europe: an epidemiological assessment.”
Mark Muscat, Henrik Bang, Jan Wohlfahrt, Steffen Glismann, Kåre Mølbak, for the EUVAC.NET group.
The Lancet, Early Online Publication, 7 January 2009

Click here for Article (registration required to view full text).

Sources: The Lancet.

Written by: Catharine Paddock, PhD