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Editorial
Is the current prevention strategy based on vaccination coverage and epidemiological surveillance sufficient to achieve measles and rubella elimination in Europe? Expert Rev. Anti Infect. Ther. 12(7), 723–726 (2014)
Pedro Plans-Rubio Public Health Agency of Catalonia, Department of Health of Catalonia, Roc Boronat, 81-95, 08005 Barcelona, Spain and CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain Tel.: +34 935 513 682
[email protected]
Elimination of measles and rubella in Europe is a feasible objective, but it requires achieving a maintaining a high prevalence of protected individuals in order to prevent cases and outbreaks from imported cases. The epidemiology of measles and rubella in Europe in the period 2003–2013 suggests that we are far away from the elimination target for measles, while the situation is better for rubella. In this situation, a new preventive strategy based on serological surveillance systems should be developed in Europe in order to identify and immunise individuals in population groups without sufficient herd immunity against measles and rubella.
In 2010, the European region of the WHO renewed their commitment to the elimination of measles and rubella and the prevention of congenital rubella by the year 2015 [1,2]. Since 1985, great efforts have been made in Europe to eliminate measles and rubella, but cases and outbreaks of measles and rubella are still occurring [3]. The annual number of measles cases reported in Europe during the 2003–2013 period was >25,000 almost all years; and the number of confirmed cases of measles was >7000 since 2006 [4]. In 2013, 18,043 confirmed cases of measles were reported in Europe through the WHO Centralized Information System for Infectious Diseases (CISID) [4]. The annual number of rubella cases reported during the 2003–2013 period was 1 per million inhabitants [3]. The ESEN project found low immunity levels to measles in many European countries in 2001–2003 [10], and a seroepidemiological study carried out in Spain in 2003 in a representative sample of the population aged >5 years showed that herd immunity against measles was established only in individuals aged >35 years [5,6]. By contrast, the incidence and seroprevalence of rubella during the period 2003–2013 are better than that for measles, suggesting that Europe is closer to the elimination objective for rubella than for measles. During the 2003–2013 period, the number of rubella cases was >6000 only in 2012 due to a large outbreak of 20,772 cases in Poland, but rubella cases were reduced to 778 in 2013 [3]. Results obtained in the serological survey carried out in Spain in 2003 showed that herd immunity against rubella was established in all age groups [5], and the ESEN project found a prevalence of susceptible children >10% only in four countries [11]. In this situation, a new preventive strategy based on serological surveillance should be developed in Europe in order to achieve and maintain measles and rubella elimination. Serological surveillance is an important tool for the evaluation of vaccination programs as it monitors immunity in the population and provides information to identify control measures [5,8].
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WHO. Resolution. Renewed commitment to elimination of measles and rubella and prevention of congenital rubella syndrome by 2010 and Sustained support for polio-free status in the WHO European Region. Moscow, Russia, WHO Regional Office for Europe;2010. Available from: www.euro.who.int/__data/assets/pdf_file/ 0016/122236/RC60_eRes12.pdf
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WHO. Strategic plan for measles and congenital rubella infection in the WHO European Region. Copenhagen, Denmark, WHO Regional Office for Europe; 2003. Available from: www.euro.who.int/ document/e81567.pdf ECDC. Surveillance report: measles and rubella monitoring, october 2013. Available from: www.ecdc.europa.eu/en/publications/ Publications/measles-rubella-monitoringFebruary-2012.pdf WHO. Centralized Information System for Infectious Diseases (CISID). Measles-Number of cases, 2006-2013.
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Serological surveillance data, on the other hand, avoid the limitations of passive disease reporting systems. In this new preventive strategy, serological surveillance should be used to identify population groups without sufficient herd immunity against measles and rubella, recommending complementary vaccinations in individuals from these population groups [5]. Three different complementary vaccination strategies could be developed to immunize individuals from population groups without sufficient herd immunity against measles and rubella [5]: vaccination of all individuals from these groups, regardless of their vaccination and disease status (catch-up strategy); vaccination of susceptible individuals from these groups identified by means of a prevaccination screening (catch-up of susceptibles strategy); and vaccination of individuals who have no documentation of completed vaccination, unless they have laboratory evidence of immunity or medical documentation of measles. The ‘catchup strategy’ could be recommended in countries with low percentages of MMR vaccination coverage during childhood or low vaccination effectiveness, and the ‘catch-up of susceptibles strategy’ in countries with high percentages of vaccination coverage. Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.
Available from: http://data.euro.who.int/ cisid
References
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Editorial
Plans P. New preventive strategy to eliminate measles, mumps and rubella from Europe based on the serological assessment of herd immunity levels in the population. Eur J Clin Microbiol Infect Dis 2013.32: 961-6. Available from: http://link.springer. com/article/10.1007%2Fs10096-013-1836-6 Plans P, Torner N, Godoy P, Jane´ M. Lack of herd immunity against measles in individuals aged
