Page last updated at 05:15 GMT, Wednesday, 7 January 2009
Doubts raised over measles target
The UK has been named as one of the worst countries in Europe for measles, with case levels dashing global hopes of eradicating the disease by 2010.
The Lancet study says that in 2006-7 most of the 12,000 cases in Europe were found in the UK and four other nations.
In a Lancet comment article, experts said the UK was only recovering slowly from the unsubstantiated scare that the MMR vaccine was linked to autism.
Vaccination levels remain at around 85% of British children, well below target.
That means there are "serious doubts" whether a World Health Organisation target to eradicate measles by 2010 will be reached, the researchers said.
The suboptimum vaccination coverage raises serious doubts that the goal of elimination by 2010 can be attained
Measles remains a major killer in some parts of the world, but the arrival of effective vaccines had raised hopes that it could be virtually eliminated.
However, to do this, the WHO recommends that at least 95% of all young children are properly vaccinated, and several European countries are falling short of this.
The UK coverage fell below 85% between 2002 and 2005, in the wake of safety fears over the MMR vaccine, and has hovered at about that mark since.
Nearly all of the 12,132 recorded cases covered by the study happened in the UK, Romania, Italy, Switzerland and Germany, most of whom have been dogged by poor vaccine uptake.
In total, there were seven deaths as a result of the disease, one of them in the UK.
The study authors, led by Dr Mark Muscat from the Statens Serum Institut in Copenhagen, said: "The suboptimum vaccination coverage raises serious doubts that the goal of elimination by 2010 can be attained.
"Achievement and maintenance of optimum vaccination coverage, and improved surveillance, are the cornerstones of the measles elimination plan for Europe."
The large numbers of cases in Europe has also led to an "embarrassing" problem, said two WHO scientists writing for the journal.
Although there are still instances in which the virus is being "imported" from areas where it is rife, in recent years, substantial outbreaks in otherwise measles-free South America have been traced back to Europe.
Very serious infection which can lead to pneumonia and encephalitis
Highly infectious and can bepassed on without direct contact before the rash appears
Children require two doses of the MMR vaccine by their fifth birthday for optimum protection
Dr Jacques Kremer and Dr Claude Muller, from the Luxembourg-based WHO Regional Reference Laboratory for Measles and Rubella, said: "Rich countries need to be responsible for avoiding cases by implementation of high vaccine coverage, to make it the privilege of resource-poor countries not to worry about reintroductions from Europe."
In much of the UK, even though the original research which cast doubt on the safety of MMR has been discredited, vaccination rates have not risen back to previous levels.
A spokesman for the Department of Health said that it was currently working hard to boost MMR uptake.
He said: "Since we announced the MMR Catch-Up programme in August, we have provided extra resources, we have sourced additional supplies of vaccine, and we have made available software to help GPs identify children who have not received MMR.
"Measles can be serious but it is preventable, and delivery of this important programme is essential."
A spokesman for the Health Protection Agency added: "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.
"Although we are encouraged by these results, we are still seeing continued outbreaks of measles."
The Lancet, Early Online Publication, 7 January 2009
doi:10.1016/S0140-6736(08)61849-8Cite or Link Using DOI
Editors' note: In 2008, the number of measles cases in the USA was the highest since 1996, according to a report by the US Centers for Disease Control and Prevention. Many of the reported cases were imported from or associated with importations from elsewhere, particularly countries in Europe, where several outbreaks are persisting. The upsurge of measles in Europe reported in this paper is putting the WHO goal of measles elimination in Europe by 2010 under severe threat. The majority of patients with measles were unvaccinated or incompletely vaccinated. To achieve the goal of elimination, policies are needed that aim to target susceptible individuals with measles vaccination programmes in both the general population and in particular risk groups.
Measles in Europe: an epidemiological assessment
Dr Mark Muscat MD a Corresponding AuthorEmail Address, Henrik Bang MSc a, Jan Wohlfahrt DMSc b, Steffen Glismann MD a, Ka*re M?lbak DMSc a, for the EUVAC.NET group‡
Measles persists in Europe despite the incorporation of the measles vaccine into routine childhood vaccination programmes more than 20 years ago. Our aim was therefore to review the epidemiology of measles in relation to the goal of elimination by 2010.
National surveillance institutions from 32 European countries submitted data for 2006―07. Data for age-group, diagnosis confirmation, vaccination, hospital treatment, the presence of acute encephalitis as a complication of disease, and death were obtained. 30 countries also supplied data about importation of disease. Clinical, laboratory-confirmed, and epidemiologically linked cases that met the requirements for national surveillance were analysed. Cases were separated by age: younger than 1 year, 1―4 years, 5―9 years, 10―14 years, 15―19 years, and older than 20 years. Countries with indigenous measles incidence per 100 000 inhabitants per year of 0, less than 0?1, 0?1―1, and more than 1 were grouped into categories of zero, low, moderate, and high incidence, respectively.
For the 2 years of the study, 12 132 cases of measles were recorded with most cases (n=10 329; 85%) from five countries: Romania, Germany, UK, Switzerland, and Italy. Most cases were unvaccinated or incompletely vaccinated children; however, almost a fifth were aged 20 years or older. For the same 2 years, seven measles-related deaths were recorded. High measles incidence in some European countries revealed suboptimum vaccination coverage. Of the 210 cases that were reported as being imported, 117 (56%) came from another country within Europe and 43 (20%) from Asia.
The suboptimum vaccination coverage raises serious doubts that the goal of elimination by 2010 can be attained. Achievement and maintenance of optimum vaccination coverage and improved surveillance are the cornerstones of the measles elimination plan for Europe.
European Commission and the Statens Serum Institut, Denmark.
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