Britain blamed over measles delay

Hopes of banishing measles from Europe by 2010 may have been dashed by poor vaccination rates in a handful of countries including Britain, researchers claim.

A new study has documented more than 12,000 cases of European measles in the two years spanning 2006 and 2007.

All but 15 per cent occurred in just five countries - the UK, Germany, Switzerland, Italy and Romania - and most were infections of unvaccinated or partially vaccinated children.

In Britain, a slump in vaccine take-up has been blamed on unfounded fears about the possible side effects of the triple measles, mumps and rubella (MMR) jab.

With measles infection rates rising, this has led in turn to concerns about the possibility of an epidemic which could affect up to 100,000 young people in England alone.

In August last year the Department of Health launched a campaign to improve MMR take-up rates in England and made available extra supplies of the vaccine.

The new research reported in an early online edition of The Lancet medical journal takes a long hard look at the World Health Organisation's stated goal of eliminating measles from Europe by 2010.

It concludes that if the situation does not change, achieving this target will not be possible.

"The sub-optimum vaccination coverage raises serious doubts that the goal elimination by 2010 can be attained," the authors wrote.

Dr Mark Muscat, from the Statens Serum Institute in Copenhagen, Denmark, and colleagues analysed measles data from 32 European countries.

They found that in 2006 and 2007, a total of 12,132 cases of measles were recorded with 85 per cent occurring in just five countries including the UK.

Although the vast majority involved children, almost a fifth of cases were adults aged 20 or over.

WHO experts believe a two-dose minimum vaccination coverage level of 95 per cent is necessary to eradicate measles in Europe.

However, vaccination rates significantly below this level have existed in countries with high measles incidence for many years, the researchers said.

In the UK, fewer than 90 per cent of two-year-old children were vaccinated between 1999 and 2006, and between 2002 and 2005 the rate plunged to below 85 per cent.

For the same age group in Germany, vaccination coverage for children born between 1996 and 2003 was consistently around 70 per cent. In Italy fewer than 85 per cent of two-year-olds were vaccinated against measles in 2001 to 2003, rising to below 90 per cent in 2004 to 2006.

Switzerland reported a vaccination coverage of just 82 per cent between 1991 and the start of this decade.

Nine countries, Bulgaria, Croatia, Cyprus, Finland, Hungary, Iceland, Portugal, Slovakia and Slovenia, reported no indigenous measles cases over the two studied years. These were also countries with consistently high vaccination rates, the researchers reported.

For instance, in Finland, vaccination coverage was above 95 per cent from 1995 to 2003.

A now discredited 1998 study linking the MMR jab and autism had a direct impact on vaccination rates in the UK.

The findings from Dr Andrew Wakefield at the Royal Free Hospital in London attracted much publicity and sparked a major scare. Between 1997 and 1998 and 2003 and 2004 the proportion of children vaccinated with the MMR jab dropped from 91 per cent to 80 per cent. In some parts of London, only 60 per cent of children were immunised.

The first measles death in the UK for 15 years was reported in 2006. Seven deaths occurred throughout the whole of Europe in 2006 and 2007, according to the new findings.

A "catch-up" campaign in London in 2004 and 2005 gave all primary school children not vaccinated with two doses of the jab a chance to be properly immunised.

Last year the Department of Health launched a similar campaign covering the whole of England. Primary care trusts were asked to offer the jab to all children up to the age of 18 who were not already fully protected.

The authors of the Lancet paper wrote: "Despite an overall reduction in measles cases in 2007 compared with 2006, the continued emergence of outbreaks and persistently high incidence in some European countries have indicated sub-optimum vaccination coverage, which will threaten the success of the measles elimination plan for the region by 2010.

"Since imported cases are a potential source of outbreaks, countries should be aware of possible transmission within Europe and from other continents to ensure that appropriate control measures are implemented in a timely manner.

"For achievement of the measles elimination goal, awareness of the disease and commitment by decision makers and public health authorities in all European countries are essential to strengthen vaccination programmes."

A spokesman for the Health Protection Agency said: "Public confidence in MMR now remains high with at least eight out of 10 children receiving one dose of MMR by their second birthday, and around nine out of 10 by their fifth birthday.

"Recent months have seen improvements in vaccination coverage for children up to five years of age, probably linked to local efforts to increase MMR uptake in all unvaccinated children following the widely reported increase in measles cases across England and Wales during 2008."

A Department of Health spokesman said: "Since we announced the MMR catch-up programme in August, we have provided extra resources to PCTs, we have sourced additional supplies of vaccine, and we have made available software to help GPs identify children who have not received MMR.

"We also called a meeting of PCT immunisation co-ordinators to emphasise the importance of reducing measles cases through improving vaccination uptake."