Bulletin of the World Health Organization

Towards elimination: measles susceptibility in Australia and 17 European countries

Nick Andrews, Annedore Tischer, Annette Siedler, Richard G Pebody, Christopher Barbara, Suzanne Cotter, Arnis Duks, Nina Gacheva, Kriz Bohumir, Kari Johansen, Joel Mossong, Fernando de Ory, Katarina Prosenc, Margareta Sláčiková, Heidi Theeten, Marios Zarvou, Adriana Pistol, Kalman Bartha, Dani Cohen, Jo Backhouse, Algirdas Griskevicius, Anthony Nardone

Objective

To evaluate age-specific measles susceptibility in Australia and 17 European countries.

Methods

As part of the European Sero-Epidemiology Network 2 (ESEN2), 18 countries collected large national serum banks between 1996 and 2004. These banks were tested for measles IgG and the results converted to a common unitage to enable valid intercountry comparisons. Historical vaccination and disease incidence data were also collected. Age-stratified population susceptibility levels were compared to WHO European Region targets for measles elimination of < 15% in those aged 2–4 years, < 10% in 5–9-year-olds and < 5% in older age groups.

Findings

Seven countries (Czech Republic, Hungary, Luxembourg, Spain, Slovakia, Slovenia and Sweden) met or came very close to the elimination targets. Four countries (Australia, Israel, Lithuania and Malta) had susceptibility levels above WHO targets in some older age groups indicating possible gaps in protection. Seven countries (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.

Conclusion

Although all countries now implement a two-dose measles vaccination schedule, if the WHO European Region target of measles elimination by 2010 is to be achieved higher routine coverage as well as vaccination campaigns in some older age cohorts are needed in some countries. Without these improvements, continued measles transmission and outbreaks are expected in Europe.

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