Measles in Europe: an epidemiological assessment.
BACKGROUND
Measles persists in Europe despite the incorporation of the measles vaccine into routine childhood vaccination programmes more than 20 years ago. Our aim was therefore to review the epidemiology of measles in relation to the goal of elimination by 2010.


METHODS
National surveillance institutions from 32 European countries submitted data for 2006-07. Data for age-group, diagnosis confirmation, vaccination, hospital treatment, the presence of acute encephalitis as a complication of disease, and death were obtained. 30 countries also supplied data about importation of disease. Clinical, laboratory-confirmed, and epidemiologically linked cases that met the requirements for national surveillance were analysed. Cases were separated by age: younger than 1 year, 1-4 years, 5-9 years, 10-14 years, 15-19 years, and older than 20 years. Countries with indigenous measles incidence per 100 000 inhabitants per year of 0, less than 0.1, 0.1-1, and more than 1 were grouped into categories of zero, low, moderate, and high incidence, respectively.


RESULTS
For the 2 years of the study, 12 132 cases of measles were recorded with most cases (n=10 329; 85%) from five countries: Romania, Germany, UK, Switzerland, and Italy. Most cases were unvaccinated or incompletely vaccinated children; however, almost a fifth were aged 20 years or older. For the same 2 years, seven measles-related deaths were recorded. High measles incidence in some European countries revealed suboptimum vaccination coverage. Of the 210 cases that were reported as being imported, 117 (56%) came from another country within Europe and 43 (20%) from Asia.


CONCLUSIONS
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.
Muscat
Mark
M
EUVAC.NET hub, Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark.
Bang
Henrik
H
Wohlfahrt
Jan
J
Glismann
Steffen
S
Mølbak
Kåre
K
D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control; D005060:Europe / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage*; D011159:Population Surveillance / Q000379:methods*; D011634:Public Health / Q000706:statistics & numerical data* / Q000639:trends; D013997:Time Factors; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
D008458:Measles Vaccine