title: Impact of measles national vaccination coverage on burden of measles across 29 Member States of the European Union and European Economic Area, 2006-2011.
abstract: BACKGROUND
  Challenges in reaching good vaccination coverage against measles emerged in several European Union/European Economic Area Member States (EU/EEA MS) leading to progressive accumulation of susceptible individuals and outbreaks. The Burden of Communicable Diseases in Europe (BCoDE) project developed a methodology for measuring the burden of communicable diseases expressed in Disability-Adjusted Life Years (DALYs) in the EU/EEA MS. The aim of this study was to compare national vaccination coverage and burden of measles across EU/EEA MS.
  
  
  METHODS
  Country-specific data on measles national vaccination coverage 2006-2011 from 29 EU/EEA MS (MCV1) were retrieved from Centralized Information System for Infectious Diseases (CISID). DALYs were calculated for each country separately using a disease progression model with a single input parameter (annual measles incidence, adjusted for under-estimation). A software application was used to compute estimated DALYs according to country-specific and year-specific population age-distributions (data retrieved from Eurostat). Log-linear mixed-effect regression modeling approach was used to investigate a linear relation between natural logarithm-transformed DALYs and coverage.
  
  
  RESULTS
  The reported annual vaccination coverage ranged from 72.6% to 100%. The estimated national annual burden ranged from 0 to 30.6 DALYs/100,000. Adjusting for year, there was a significant negative relationship between coverage and burden. For a given country there was a decrease in log-transformed DALYs/100,000 of 0.025 (95% confidence interval: -0.047 to -0.003) for every percentage increase in vaccination coverage. The largest effect of calendar time on estimated burden of measles was observed for the year 2011, the smallest was for the year 2007.
  
  
  CONCLUSIONS
  This study shows that the degree of success of national measles vaccination programs, when measured by the coverage obtained, is significantly associated with overall impact of measles across EU/EEA MS. In EU/EEA MS each percentage point increase in national vaccination coverage seems to lead to early significant reduction of overall burden of measles.
authors: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Electronic address: edoardo.colzani@ecdc.europa.eu.
authors: E
authors: E
authors: Colzani
authors: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors: S A
authors: SA
authors: McDonald
authors: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors: P
authors: P
authors: Carrillo-Santisteve
authors: London School of Hygiene and Preventive Medicine, London, United Kingdom.
authors: M C
authors: MC
authors: Busana
authors: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors: P
authors: P
authors: Lopalco
authors: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors: A
authors: A
authors: Cassini
mesh_terms: D017281:Cost of Illness; D005060:Europe / Q000453:epidemiology; D005062:European Union; D006801:Humans; D017589:Immunization Programs; D016014:Linear Models; D008457:Measles / Q000453:epidemiology*; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000706:statistics & numerical data*
keywords: Burden of disease; Europe; Measles; Vaccination coverage