Three key messages on vaccine-preventable diseases

Spotlight Immunisation

ECDCEuropean Centre for Disease Prevention and ControlStockholm, 24 April 2010

Message 1Vaccines are powerful tools for protecting our health

Vaccines are powerful tools for protecting our healthImmunisations have lead to the control and elimination of diseases in Europe that in the past caused death and disability for millions of people:• Prime examples for this are the global eradication of smallpox and the

elimination of poliomyelitis from most regions of the world.

• Diphtheria and tetanus are now under control in Europe and Haemophilus influenzae type b (Hib) infections in young children have been dramatically reduced.

• The number of new hepatitis B infections has fallen significantly in Europe following the introduction of universal vaccination of children against the hepatitis B virus.

• Pneumococcal conjugate vaccine (PCV), which is given to young infants, also indirectly protects unimmunised elderly people from pneumococcal pneumonia by reducing the risk of getting exposed to an infected child.

• New vaccines licensed for use in the European Union include vaccines against human papilloma virus (HPV), herpes zoster virus, and rotavirus. A new 4-valent meningococcal vaccine improves protection against bacterial meningitis.

• A new nasal preparation of a trivalent attenuated live influenza vaccine will soon simplify vaccination logistics, and an intradermal inactivated trivalent influenza vaccine could reduce vaccination costs.

Message 2Achieving and maintaining high vaccination coverage in Europe: the challenge remains

Vaccination: Challenges for public health

A majority of Europeans appreciate the benefits of vaccines and trust the information and recommendations from immunisation programmes. A challenge for national programmes is to maintain and strengthen this trust in an environment where the risks and consequences of not being immunised are shifting out of focus. Public health strategies need to:

• tackle "routine immunisation fatigue": some vaccine-preventable diseases have become so rare that parents, and sometimes even health professionals, fail to realise the benefits of immunisation;

• develop and implement clear procedures for vaccine safety monitoring;

• increase collaboration between national immunisation programmes and harmonise surveillance and reporting systems; and

• strengthen surveillance for vaccine-preventable diseases.

Vaccination: Challenges for public health

Causes of measles outbreaks include:

• Pockets of unimmunised children among disadvantaged groups and vaccine sceptics are often the starting point for larger measles outbreaks.

• Most measles outbreaks in Europe are imported from another European country.

• Low overall vaccine coverage sustains outbreaks.

Measles incidence rates

Figure 1a: Reported incidence of indigenous measles per 100 000 population, by EU/EEA country, 2001

< 0.1

0

0.1 – 1.0

> 1

Not included or not reporting

Source: ECDC

2001

Measles incidence rates

Figure 1b: Reported incidence of indigenous measles per 100 000 population, by EU/EEA country, 2002

< 0.1

0

0.1 – 1.0

> 1

Not included or not reporting

Source: ECDC

2002

Measles incidence rates

Figure 1c: Reported incidence of indigenous measles per 100 000 population, by EU/EEA country, 2003

< 0.1

0

0.1 – 1.0

> 1

Not included or not reporting

Source: ECDC

2003

Measles incidence rates

Figure 1d: Reported incidence of indigenous measles per 100 000 population, by EU/EEA country, 2004

< 0.1

0

0.1 – 1.0

> 1

Not included or not reporting

Source: ECDC

2004

Measles incidence rates

Figure 1e: Reported incidence of indigenous measles per 100 000 population, by EU/EEA country, 2005

< 0.1

0

0.1 – 1.0

> 1

Not included or not reporting

Source: ECDC

2005

Measles incidence rates

Figure 1f: Reported incidence of indigenous measles per 100 000 population, by EU/EEA country, 2006

< 0.1

0

0.1 – 1.0

> 1

Not included or not reporting

Source: ECDC

2006

Measles incidence rates

Figure 1g: Reported incidence of indigenous measles per 100 000 population, by EU/EEA country, 2007

< 0.1

0

0.1 – 1.0

> 1

Not included or not reporting

Source: ECDC

2007

Measles incidence rates

Figure 1h: Reported incidence of indigenous measles per 100 000 population, by EU/EEA country, 2008

< 0.1

0

0.1 – 1.0

> 1

Not included or not reporting

Source: ECDC

2008

Measles incidence rates

Figure 1i: Reported incidence of indigenous measles per 100 000 population, by EU/EEA country, 2009

< 0.1

0

0.1 – 1.0

> 1

Not included or not reporting

Source: ECDC

2009

Message 3Measles elimination is within reach but needs more effort

Measles elimination

• Because of ongoing measles outbreaks in Europe, the 2010 regional target1 will only be met by some countries, but the work towards measles elimination continues.

• In 2008, more than 8 500 measles cases were reported in the EU/EEA countries, with more than 90% of the infected people lacking immunisation.

• Recent measles outbreaks in Europe often began with an index case imported from another European country. In order to interrupt this transmission pattern, Europe needs a very high vaccination coverage, yet in some west European countries measles immunisation coverage has fallen below the 95% mark recommended by WHO.

• Vaccination programmes against measles and rubella in Europe require political commitment and societal support. This includes special efforts to ensure easy access to vaccines, particularly for groups that already have difficulties accessing mainstream healthcare services.

1 World Health Organization (WHO) describes its target for measles elimination in Europe as an ‘interruption of indigenous measles transmission by 2010’. The definition of ‘interrupted transmission’ states that any imported outbreak will cease spontaneously and that the incidence of measles stays below 1 per 100 000 population.