No 21 - 2011

MMR vaccination coverage 2010

The coverage was calculated as per 31 December 2010. For some birth cohorts, vaccination was expected not to have been concluded at the calculation date. In the 2009 birth cohort, this was the case for MMR1 and in the 2006 and 1998 cohorts for MMR2 at four and 12 years of age, respectively. As from 1 April 2008, MMR2 vaccination was advanced to the 4-year preventive health care examination, EPI-NEWS 9/08 (pdf). Children who were older than four years by 1 April 2008 should still receive the MMR 2 vaccination at 12 years of age. Until April 2016, MMR2 vaccination will thus be offered to two birth cohorts every year, those aged 4 and 12 years, respectively.

Childhood vaccination database

The National Childhood Vaccination Database consists of person-identifiable data from GPs (General Practitioner’s)' settlements with the National Health Insurance. The reported coverage thus only includes vaccinations performed in Denmark by GPs.

MMR 1

In the 1996-1998 birth cohorts, coverage was 85-88% and in the 1999-2004 cohorts 89%. For the 2005-2007 birth cohorts, coverage was 86-87%, while for the 2008 cohort, it was only 85%; delayed vaccination may have contributed to the lower coverage observed in 2008, Figure 1.

The lowest MMR1 coverage was found in the City of Copenhagen, i.e. in the Municipalities of Frederiksberg and Copenhagen, Table 1.

MMR2 at 12 years

Overall MMR2 coverage remained unchanged with respect to the previous report, EPI-NEWS 10/10. The vaccination coverage in the 1991-1997 birth cohorts was 85-87%. For birth cohort 1998, coverage was only 68% which may be due to delayed vaccination, Figure 1.

MMR2 at 4 years

For those who followed the programme, i.e. the 2004 birth cohort born after 1 April and the entire 2005 cohort, coverage was 69% and 73%, respectively. As for the 2006 cohort, coverage was 59% which may be explained by delayed vaccination.

Vaccination age

As was previously shown for MMR1, EPI-NEWS 10/10, MMR2 at four years is also given with considerable delay with respect to the recommended vaccination age, Figure 2. The figure shows that the delay was shortened with each of the three reported birth cohorts. Some MMR2 vaccinations were given in conjunction with DTaP-IPV revaccination at five years.

Commentary

MMR vaccination coverage generally remains unchanged and low across Denmark, EPI-NEWS 10/10, and it even followed a slightly decreasing trend in the 2005-2008 birth cohorts. With the exception of one birth cohort on the island of Bornholm, coverage was below 90% for MMR1 as well as MMR2 in all Danish birth cohorts. As previously, MMR2 coverage was generally lower than MMR1 coverage. Furthermore, MMR2 given at four years has not yielded the expected coverage.

The inadequate MMR coverage and the delay with respect to the recommended vaccination age have been observed for a number of years accumulating an increasing number of unprotected children and adolescents. In consequence hereof, since January 2011 Denmark has seen the largest measles outbreak in 15 years currently counting more than 71 diagnosed cases. Unless the MMR1 and MMR2 coverage improves markedly, recurring measles outbreaks should be expected and Denmark will be unable to control measles occurrence; a 2015 WHO objective for Europe.

The National Board of Health recommends that physicians pay special attention to ensure that all children attending practice receive vaccination, and that young unvaccinated adults who have not had the measles receive vaccination, EPI-NEWS 36/08 (pdf). Thirty percent of measles patients are currently >18 years.

(P. Valentiner-Branth, S. Glismann, L.K. Knudsen, Department of Epidemiology, J. Simonsen, Department of Epidemiology Research) 

link to Individually notifiable diseases and selected laboratory diagnosed infections (pdf)

25 May 2011