The seroepidemiology of measles in Western Europe.

Abstract

Background The World Health Organization has targeted measles for elimination from Europe in 2007. Whether this can be achieved through routine immunization strategies now in place remains to be seen.Methods As part of the European Seroepidemiology Network, seven Western European countries conducted age‐ and sex‐stratified serological surveys of measles antibody from 1994 to 1998. The countries included the Denmark, Finland, France, Germany, Italy, Netherlands, and the United KingdomResults Overall, susceptibility levels among 2‐ to 4‐year‐olds ranged from 2.9 to 29.8%, in 5‐ to 9‐year‐olds from 2.5 to 25% and 10‐ to 19‐year‐olds from 2.1 to 13.9%. Susceptibility‐profiles were categorized as low, intermediate, and high. A country's susceptibility profile was highly associated with vaccine coverage for the first dose. First‐dose coverage ranged from 91 to 97.5% for four low‐susceptibility countries, 75–85% for two intermediate‐susceptibility countries and 55% for the one high‐susceptibility country. The low‐susceptibility countries had achieved or are very close to measles elimination. In moderate susceptibility countries endemic transmission still exists as does the risk of outbreaks as pools of susceptible individuals accumulate. Only the high‐susceptibility country still reported epidemics of measles regularly occurring in 4‐year cycles.Conclusion For the low‐susceptibility countries, the priority should be to maintain uniformly high MMR vaccine coverage for both vaccine doses. For the moderate‐susceptibility countries catch‐up campaigns may close the gap between the highly vaccinated infants and the older children who missed the new programs of infant vaccination. In the high susceptibility country the priority should be to increase infant vaccine coverage and reduce regional variation in coverage levels. The surveys from these seven Western European countries using comparable designs provides a special opportunity to compare serological impact of measles vaccination with the epidemiology of disease. These data provide an assessment of the progress being made toward measles control in Western Europe as well as an understanding for countries around the world of the sort of coverage we will need to attain.