furter efforts needed to achieve measles elimination in Germany: results of an outbreak investigation

Abstract

Objective To determine morbidity and costs related to a large measles outbreak in Germany and to identify ways to improve the country's national measles elimination strategy. Methods We investigated a large outbreak of measles in the federal state of North Rhine-Westphalia (NRW) that occurred in 2006 after 2 years of low measles incidence (< 1 case per 100 000). WHO's clinical case definition was used, and surveillance data from 2006 and 2001 were compared. All cases notified in Duisburg, the most severely affected city, were contacted and interviewed or sent a questionnaire. Health-care provider costs were calculated using information on complications, hospitalization and physician consultations. Findings In NRW, 1749 cases were notified over a 48-week period. Compared with 2001, the distribution of cases shifted to older age groups (especially the 10-14 year group). Most cases (n = 614) occurred in Duisburg. Of these, 81% were interviewed; 15% were hospitalized and two died. Of the 464 for whom information was available, 80% were reported as unvaccinated. Common reasons for non-vaccination were parents either forgetting (36%) or rejecting (28%) vaccination. The average cost per measles case was estimated at €373. Conclusion An accumulation of non-immune individuals led to this outbreak. The shift in age distribution has implications for the effectiveness of measles control and the elimination strategy in place. Immediate nationwide school-based catch-up vaccination campaigns targeting older age groups are needed to close critical immunity gaps. Otherwise, the elimination of measles in Germany and thus in Europe by 2010 will not be feasible.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español.

Heterogeneity in vaccination coverage explains the size and occurrence of measles epidemics in German surveillance data

“…Since most measles cases were unvaccinated or incompletely vaccinated, the differences in incidence are likely to be due to differences in the success of national vaccination programmes [1,2]. For instance, there have been several outbreaks in some of the 16 federal states of Germany in recent years [3][4][5][6]. Detailed investigations of selected outbreaks showed that most cases occurred in unvaccinated individuals [4].…”

The effects of weather conditions on measles incidence in Guangzhou, Southern China

“…The similar situations that a shift in age distribution of measles cases toward older age groups were found even in some developed countries where measles has been controlled. 22,23 Nowadays people aged >14 y are not involved in the EPI program in China and few would like to receive the MV vaccination for measles prevention. Teenagers and young adults usually have low sero-positive prevalence, and have more social contacts than younger children, which results in the higher risk of measles.…”

Hot Spot: Epidemiologie der Masern und Röteln in Deutschland und Europa

“…Insgesamt versterben in Industrieländern etwa 1-3/1000 Fälle an den Masern [7,8,9,10]. Das Risiko schwerwiegender Komplikationen ist bei Kindern unter 5 Jahren und Erwachsenen über 20 Jahren am höchsten [7,11,12,13]. Daten zu Komplikationen durch eine Maserninfektion während der Schwangerschaft liegen für Deutschland nicht vor.…”

“…Ferner fanden im Jahr 2012 Ausbrüche in UK, Spanien und Schweden statt [33]. [11,36]. Die Ausbrü-che waren regional und zeitlich begrenzt und traten in Bevölkerungsgruppen auf, die eine ungenügende Immunität gegen die Masern aufwiesen.…”