The Elimination of Indigenous Measles, Mumps, and Rubella from Finland by a 12-Year, Two-Dose Vaccination Program

Peltola, Heikki; Heinonen, Olli P.; Valle, M; Paunio, Mikko; Virtanen, Martti; Karanko, Viena; Cantell, Kari

doi:10.1056/nejm199411243312101

Cited by 274 publications

(130 citation statements)

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“…Both Finland and The Netherlands have had high vaccine coverage for over 10 years, with an interruption of epidemic measles, so virtually no immunity in the younger age groups is naturally acquired and all is vaccine derived. Finland has moved from the control to the elimination phase with no serologically confirmed measles cases identified since 1996 [13,14]. In The Netherlands the annual number of notified measles cases has decreased from 472 (3n1\100 000) to 57 (0n37\100 000) over the period 1992-6 [15].…”

Section: Discussionmentioning

confidence: 99%

The seroepidemiology of measles in Western Europe

Melker

Pebody²,

Edmunds³

et al. 2001

Epidemiol. Infect.

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SUMMARYThe European Regional Office of WHO has targeted measles for elimination from the region in 2007. Large national, age and sex stratified serological surveys of measles antibody were conducted in seven Western European countries from 1994-8 as part of the European Seroepidemiology Network. Three patterns were observed in the country-specific measles seroprofiles, ranging from (very) low susceptibility (four countries) to high susceptibility (one country). Susceptibility levels amongst 2-4-year-olds ranged from 2n9 to 29n8 %, in 5-9-yearolds from 2n5 to 25 % and 10-19-year-olds from 2n1 % to 13n9 %. A country's susceptibility profile was highly associated with vaccine coverage for the first dose. First dose coverage ranged from 91 to 97n5 % for low susceptibility countries, 75 to 85 % for intermediate susceptibility countries and 55 % for the high susceptibility country. Only the high susceptibility country still reports epidemic measles. In low susceptibility countries, which have achieved or are very close to measles elimination, the priority will be to maintain high MMR vaccine coverage in all geopolitical units for both vaccine doses. In moderate susceptibility countries

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Section: Discussionmentioning

confidence: 99%

The seroepidemiology of measles in Western Europe

Melker

Pebody²,

Edmunds³

et al. 2001

Epidemiol. Infect.

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“…Many high and middle income countries have achieved this goal; the USA was apparently free of any indigenous transmission of measles in November 1993 [2], and measles incidence is at an alltime low in the Caribbean and Central America, and in several European countries [3]. However, in many low income countries of sub-Saharan Africa, where measles case fatality ratios are highest, the reported incidence of measles is as high or higher than it was in 1990 (World Health Organization, unpublished data).…”

Section: Introductionmentioning

confidence: 99%

Priorities in global measles control: report of an outbreak in N'Djamena, Chad

Ndikuyeze¹,

Cook

Cutts

et al. 1995

Epidemiol. Infect.

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SUMMARYIn N'Djamena, capital of Chad, measles vaccination coverage of 12-23-monthold children fell from 61 % in 1990 to 15% in 1993. A community survey of measles after an outbreak in 1993 showed that among children < 5 years of age, the mean monthly attack rate was 37 per 1000 (95 % CI, 32-43) and the mean case fatality rate was 74%. Measles incidence was highest (77/1000/month) in children aged 9-11 months and fell among children > 3 years of age. Incidence rates were high (56/1000/month) among 6-8-month-old children, but only 3 deaths occurred in this age group. Measles vaccine efficacy, estimated by comparing attack rates in unvaccinated and vaccinated children, was 71 % (95 % CI, 59-80 %

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“…Vaccination has been accepted well, with coverage stabilized at ϳ95%. 16,17 As with all childhood immunizations in Finland, the MMR vaccine is administered on a voluntary basis and free of charge by public health nurses in the ϳ1000 child health centers of the country. …”

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confidence: 99%

Day-to-Day Reactogenicity and the Healthy Vaccinee Effect of Measles-Mumps-Rubella Vaccination

et al. 2000

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ABSTRACT.Objective. Revaccination policies adopted in many countries to control measles have raised various safety issues including those concerning the second vaccine dose. We performed a prospective, double-blind, crossover trial among twins receiving a measles-mumpsrubella (MMR) vaccine.Study Design. The study comprised 1162 monozygous and heterozygous twins, each of whom randomly received placebo and then vaccine, or vice versa, 3 weeks apart, at 14 to 83 months of age. Most of the oldest children had previously been vaccinated against measles, and one half of the remainder of children had had the disease. Symptoms and signs were recorded daily on structured forms. Statistical methods included a complex analysis of the vaccine attributability of the symptoms and conditional logistic regression.Results. Vaccination-attributable events occurred in 6% overall. At 14 to 18 months of age, reactions developed between days 6 and 14, peaking at day 10. The clearest vaccine-attributable effect was fever exceeding 101.3°F (38.5°C; odds ratio: 3.28; 95% confidence interval: 2.23-4.82; P < .001), but the same trend was found for rash, arthralgia, conjunctivitis, staying in bed, drowsiness, and irritability. At 6 years of age, systemic reactions occurred 5 to 15 times less frequently, only arthralgia being associated with vaccination. Zygocity, gender, history of allergy, or infections did not modify reactions. Instead, respiratory symptoms developed within days postinjection to a level of 15% to 20% without subsequent decline and with no difference between vaccinees and placebo recipients.Conclusion. Vaccination was avoided during infections, but many small children became mildly ill within a week or so with no relation to vaccination (the healthy vaccinee effect). MMR vaccine was virtually nonreactogenic when given at 6 years of age. Pediatrics 2000;106(5). URL: http://www.pediatrics.org/cgi/content/full/106/5/ e62; vaccine, measles, mumps, rubella, reactogenicity, adverse events, zygocity, healthy vaccinee effect.ABBREVIATIONS. MMR, measles-mumps-rubella; OR, odds ratio; VA, vaccine attributability.T he measles components 1-3 used in various measles-mumps-rubella (MMR) vaccines 4,5 have been associated with various short-term and long-term adverse events. This is also true to a lesser extent for the rubella antigen, 6,7 whereas the mumps component (particularly the Jeryl Lynn strain) is deemed virtually harmless. 8 Controlled studies on vaccine reactogenicity are rare, 9 and uncontrolled studies 10 -12 exaggerate findings because of a temporal rather than a causal association with vaccination. Very little is known about factors modifying adverse reactions. 13 We performed a randomized, double-blind, placebo-controlled, and crossover vaccination trial in twins using the MMR vaccine in widest use internationally; the early results were published shortly after the trial. 14 Here we report a thorough analysis of the day-to-day symptoms and signs in 2 age groups with or without previous measles vaccination, and we examine ...

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The Elimination of Indigenous Measles, Mumps, and Rubella from Finland by a 12-Year, Two-Dose Vaccination Program

Cited by 274 publications

References 36 publications

The seroepidemiology of measles in Western Europe

The seroepidemiology of measles in Western Europe

Priorities in global measles control: report of an outbreak in N'Djamena, Chad

Day-to-Day Reactogenicity and the Healthy Vaccinee Effect of Measles-Mumps-Rubella Vaccination

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