Measles cases hit record high in Europe in 2018

Leong, Wei Yee

doi:10.1093/jtm/tay080

Cited by 25 publications

(16 citation statements)

References 4 publications

(4 reference statements)

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“…However, high vaccine coverage rates consistently above 95% have not been achieved in Europe even though MMR is freely available. Despite some intermediate successes, Europe is currently experiencing a major measles resurgence [5,6], further propagated by travel and migration [6,7] with low vaccine coverage rates in certain subpopulations [8]. In 2018, 47 of 53 Member States of the WHO European Region reported over 84,000 confirmed measles cases.…”

Section: Introductionmentioning

confidence: 99%

Resurgence of Measles in Europe: A Systematic Review on Parental Attitudes and Beliefs of Measles Vaccine

Wilder-Smith¹,

Qureshi²

2019

JEGH

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Background and Objectives: Europe has experienced a major resurgence of measles in recent years, despite the availability and free access to a safe, effective, and affordable vaccination measles, mumps and rubella vaccine (MMR). The main driver for this is suboptimal vaccine coverage. Parental attitudes and beliefs toward measles vaccination are of paramount importance in influencing vaccine coverage. The three objectives of this study are to synthesize and critically assess parental attitudes and beliefs toward MMR uptake, to develop strategies and policy recommendations to effectively improve MMR vaccine uptake accordingly, and ultimately to identify areas for further research. Methods: A systematic review was conducted using primary studies from PubMed, Medline, Embase, and Scopus published between 2011 and April 2019. Inclusion criteria comprised primary studies in English conducted in Europe and studying parental attitudes and behavior regarding MMR uptake. Data were extracted using an inductive grounded theory approach. Results: In all, 20 high-quality studies were identified. Vaccine hesitancy or refusal were mainly due to concerns about vaccine safety, effectiveness, perception of measles risk and burden, mistrust in experts, and accessibility. Factors for MMR uptake included a sense of responsibility toward child and community health, peer judgement, trust in experts and vaccine, and measles severity. Anthroposophical and Gypsy, Roma, and Traveler populations presented unique barriers such as accessibility. Conclusion: A multi-interventional, evidence-based approach is vital to improve confidence, competence, and convenience of measles vaccination uptake. Healthcare professionals need an understanding of individual contextual attitudes and barriers to MMR uptake to tailor effective communication. Effective surveillance is needed to identify under-vaccinated populations for vaccination outreach programs to improve accessibility and uptake.

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Section: Introductionmentioning

confidence: 99%

Resurgence of Measles in Europe: A Systematic Review on Parental Attitudes and Beliefs of Measles Vaccine

Wilder-Smith¹,

Qureshi²

2019

JEGH

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“…They might not comprehensively identify and mitigate all the underlying drivers and determinants of IDTE in an increasingly interconnected and interdependent world (Glaesser, Kester, Paulose, Alizadeh, & Valentin, ; Jones et al, ; Morens et al, ; Paules & Fauci, ; Semenza, Lindgren, et al, ; Semenza, Rocklov, Penttinen, & Lindgren, ; Weiss & McMichael, ). For example, measles has recently resurfaced in Europe as a result of global resurgence, increasing mobility and low vaccine uptake, in part related to vaccine hesitancy (Leong, ; Massad, ). In 2017, the chikungunya virus was introduced into France and Italy by viraemic passengers and spread by Aedes albopictus mosquitoes, in part due to favourable climatic conditions (Lillepold, Rocklov, Liu‐Helmersson, Sewe, & Semenza, ; Rezza, ; Rocklöv et al, ; Semenza & Suk, ).…”

Section: Introductionmentioning

confidence: 99%

Systemic resilience to cross‐border infectious disease threat events in Europe

Semenza

Sewe

Lindgren

et al. 2019

Transbound Emerg Dis

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Recurrent health emergencies threaten global health security. International Health Regulations (IHR) aim to prevent, detect and respond to such threats, through increase in national public health core capacities, but whether IHR core capacity implementation is necessary and sufficient has been contested. With a longitudinal study we relate changes in national IHR core capacities to changes in cross‐border infectious disease threat events (IDTE) between 2010 and 2016, collected through epidemic intelligence at the European Centre for Disease Prevention and Control (ECDC). By combining all IHR core capacities into one composite measure we found that a 10% increase in the mean of this composite IHR core capacity to be associated with a 19% decrease (p = 0.017) in the incidence of cross‐border IDTE in the EU. With respect to specific IHR core capacities, an individual increase in national legislation, policy & financing; coordination and communication with relevant sectors; surveillance; response; preparedness; risk communication; human resource capacity; or laboratory capacity was associated with a significant decrease in cross‐border IDTE incidence. In contrast, our analysis showed that IHR core capacities relating to point‐of‐entry, zoonotic events or food safety were not associated with IDTE in the EU. Due to high internal correlations between core capacities, we conducted a principal component analysis which confirmed a 20% decrease in risk of IDTE for every 10% increase in the core capacity score (95% CI: 0.73, 0.88). Globally (EU excluded), a 10% increase in the mean of all IHR core capacities combined was associated with a 14% decrease (p = 0.077) in cross‐border IDTE incidence. We provide quantitative evidence that improvements in IHR core capacities at country‐level are associated with fewer cross‐border IDTE in the EU, which may also hold true for other parts of the world.

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“…In 1998, the WHO European Region set a target to eliminate measles by 2010 [8], which was not achieved. In 2018, Europe saw a major resurgence of measles; the total number of measles cases in 2018 was the highest in this decade, reaching three times the total cases in 2017 [9]. In 2018, Europe reported more than 21,000 cases of measles, including 35 deaths [10].…”

Section: Introductionmentioning

confidence: 99%

Measles Resurgence in Europe: Migrants and Travellers are not the Main Drivers

Leong¹,

Wilder-Smith²

2019

JEGH

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Measles is a highly transmissible viral infection that may lead to serious illness, lifelong complications, and death. As there is no animal reservoir for measles, measles resurgence is due to human movement of viremic persons. Therefore, some have blamed the enormous migration into Europe in the past 5 years for the measles resurgence in this region. We set out to determine the main driver for measles resurgence in Europe by assessing vaccine coverage rates and economic status in European countries, number of migrants, and travel volumes. Data on measles vaccine coverage rates with two vaccine doses of measles, mumps and rubella (MMR) [Measles Containing Vaccine (MCV)2] and total number of measles cases in 2017 for Europe, including Eastern European countries, were obtained, in addition to Gross Domestic Product (GDP), and number of migrants and tourist arrivals. The outcome measured, incidence of measles per 100,000, was log transformed and subsequently analyzed using multiple linear regression, along with predictor variables: number of international migrants, GDP per capita, tourist arrivals, and vaccine coverage. The final model was interpreted by exponentiating the regression coefficients. Incidence of measles was highest in Romania (46.1/100,000), followed by Ukraine (10.8/100,000) and Greece (8.7/100,000). MCV2 coverage in these countries is less than 84%, with lowest coverage rate (75%) reported in Romania. Only vaccine coverage appears to be the significant predictor in the model (p < 0.001) for incidence of measles even after adjusting for international migrants, international tourist arrivals, and GDP per capita. With one unit increase in vaccination coverage, the incidence of measles decreased by 18% [95% confidence interval (CI): 10-25]. Our results showed that number of migrants and international tourist arrivals into any of the European countries were not the drivers for increased measles cases. Countries with high vaccine coverage rates regardless of economic status did not experience a resurgence of measles, even if the number of migrants or incoming travellers was high. The statistically significant sole driver was vaccine coverage rates. These analyses reemphasize the importance of strategies to improve national measles vaccination to achieve coverage greater than 95%.

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Measles cases hit record high in Europe in 2018

Cited by 25 publications

References 4 publications

Resurgence of Measles in Europe: A Systematic Review on Parental Attitudes and Beliefs of Measles Vaccine

Resurgence of Measles in Europe: A Systematic Review on Parental Attitudes and Beliefs of Measles Vaccine

Systemic resilience to cross‐border infectious disease threat events in Europe

Measles Resurgence in Europe: Migrants and Travellers are not the Main Drivers

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