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Challenges continue for measles elimination effort in Europe
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Despite a reduction in measles in Europe to fewer than 10 cases per one million people, challenges may prevent the European Region of WHO from achieving the goal of measles eradication by 2010.
Measles rates reached an all-time low of 7.8 cases per one million people in 2007. Health officials attribute the reduction to high vaccine coverage and expanded surveillance activities. About 94% of children aged 12 to 23 months in Europe received at least one dose of the measles vaccine between 2005 and 2007. All states in the European Union currently report clinically diagnosed measles cases to WHO.
However, unfounded information about vaccine safety has caused concerns and led to reductions in coverage in many European countries. This, in turn, has contributed to a resurgence of measles in some countries in Western Europe. It has been demonstrated that some Eastern European countries also have susceptible populations.
MMWR. 2009;58(06);142-145.
Measles has been a major killer of children in the world, accounting for about 750,000 deaths annually as recently as 2000. Recognizing the substantial health burden of measles, four of the six WHO regions (the Americas, Europe, Eastern Mediterranean and Western Pacific) have goals to eliminate measles. The two other regions (Africa and Southeast Asia) have goals to reduce measles deaths by 90% or more from 2000 levels.
The strategy calls for high coverage with two doses of measles-containing vaccines. Often, in places with difficulties in routine immunization, the second dose is delivered to all children of the target age group, regardless of prior vaccination status, as part of a second opportunity in mass campaigns. Of the four regions with elimination goals, only the Americas appears to have interrupted transmission. This occurred in 2002 and has been sustained. This report reviews progress in measles elimination in Europe, which has a target date of 2010. Reported measles incidence has declined from 41.4 per million people to 8.8 per million people, indicating marked progress. But substantial transmission continues to occur.
In Western Europe, which accounted for the great majority of cases in 2008, the problem appears to be failure to vaccinate as a result of active opposition to vaccination because of concerns about vaccine safety, which are unwarranted, combined with the misperception that measles is a mild disease. In Eastern Europe, the major problem has been failure to vaccinate, in part due to weaknesses in the delivery system.
Many countries in Eastern Europe have improved coverage and mounted successful second opportunity campaigns, which have contributed to the marked drop in measles in these countries. However, safety scares regarding temporally-related adverse events, which turned out not to be caused by vaccines, have adversely affected some campaigns. This, in turn, has raised concern that a number of susceptibles, who could fuel future outbreaks, exist. Achieving elimination will require high level political commitment, overcoming vaccine hesitancy and assuring that all persons have access to two doses of vaccine.
– Walter Orenstein, MD
Infectious Diseases in Children Editorial Board member