Abstract
ObjectiveWe aimed to quantify progress towards measles elimination in Germany from 2007 to 2011 and to estimate any potential underreporting over this period.MethodsWe determined the annual incidence of notified cases of measles – for each year – in northern, western, eastern and southern Germany and across the whole country. We then used measles-related health insurance claims to estimate the corresponding incidence.FindingsIn each year between 2007 and 2011, there were 6.9–19.6 (mean: 10.8) notified cases of measles per million population. Incidence decreased with age and showed geographical variation, with highest mean incidence – 20.3 cases per million – in southern Germany. Over the study period, incidence decreased by 10% (incidence rate ratio, IRR: 0.90; 95% confidence interval, CI: 0.85–0.95) per year in western Germany but increased by 77% (IRR: 1.77; 95% CI: 1.62–1.93) per year in eastern Germany. Although the estimated incidence of measles based on insurance claims showed similar trends, these estimates were 2.0- to 4.8-fold higher than the incidence of notified cases. Comparisons between the data sets indicated that the underreporting increased with age and was generally less in years when measles incidence was high than in low-incidence years.ConclusionGermany is still far from achieving measles elimination. There is substantial regional variation in measles epidemiology and, therefore, a need for region-specific interventions. Our analysis indicates underreporting in the routine surveillance system between 2007 and 2011, especially among adults.
Highlights
Measles is a viral disease that can lead to severe complications such as encephalitis, pneumonia and death.[1]
Within the Associations of Statutory Health Insurance Physicians (ASHIP) data set, a measles case was defined as a person who had been diagnosed by a physician with a measles-related code from the tenth revision of the International Classification of Diseases and Related Health Problems, 10th Revision (ICD10) – i.e. B05.0, B05.1, B05.2, B05.3, B05.4, B05.8 or B05.9, indicating cases of measles with encephalitis, meningitis, pneumonia, otitis media, intestinal complications, other complications or no complications, respectively
For Germany as a whole, our estimate of the mean annual incidence – based on ASHIP data – was more than threefold higher than the annual incidence of notified measles cases: 27.5 versus 9.1 cases per million population
Summary
Measles is a viral disease that can lead to severe complications such as encephalitis, pneumonia and death.[1] All of the countries within the World Health Organization (WHO) European Region have committed to the elimination of measles by 2015. WHO defines successful elimination of measles as “the absence of endemic measles ... An incidence of less than one measles case per million population has been suggested as a useful indicator of the progress made towards the disease’s elimination.[2] In the years 2012 and 2013, only about a third of the countries in the WHO European Region recorded incidence below this threshold.[2,3] In early 2014, the WHO Strategic Advisory Group of Experts concluded that measles elimination will not be achieved in the WHO European Region by 2015.4
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