No 12 - 2012

Free MMR vaccination for young adults

As from 1 April 2012, a temporary offer of free vaccination against measles, mumps and rubella (MMR) will come into force. The offer applies to young adults who have not had  measles or previously been vaccinated against measles, EPI-NEWS 9/12.

The offer comprises persons above 18 years of age born in 1974 or later and will stay in force until end of 2012.

Background

MMR vaccination was introduced into the Danish childhood vaccination programme on 1 January 1987, EPI-NEWS 9/86 and 46/86. When the programme was initiated, persons under 13 years of age born in 1974-1986 were offered a single dose of MMR vaccine. The coverage of this catch-up programme was low; for children born in 1976, the coverage was 31%, EPI-NEWS 35/89, while the coverage for children born in 1986 was 84%, EPI-NEWS 6/07.  Practically all persons born before 1974 have had measles and are thus immune.

In the period before 1987, the diseases were very common, e.g. measles epidemics occurred every 2-3 years and Denmark typically saw a total of 20-60,000 annual cases. After the introduction of MMR vaccination, the number of cases rapidly dropped to approx. 500 annual cases. Subsequently, the number of cases decreased even further, and in 1997 a total of 61 cases were recorded. During a 31-month "honeymoon" period from 2002 to 2005, no cases were recorded, after which measles started occurring in Denmark once again.

Concurrently with a decrease in the occurrence, the frequency of measles complications such as bacterial super infections, measles-encephalitis, and deaths also decreased.  

Low vaccination coverage

Measles are one of the most infectious viruses that exist, and therefore a minimum of 95% of the population needs to be immune to avoid persistently circulating virus. This goal has not been met for any birth year since the introduction of the vaccine, EPI-NEWS 21/11, and a considerable number of non-immune young adults have therefore accumulated.

When virus is imported to Denmark, e.g. after travels to an area where the measles virus is in circulation, outbreaks may follow. This was observed in 2002, in 2006 and 2008, and again in 2011, when Denmark experienced its most serious outbreak in the past 17 years, EPI-NEWS 24/11. In this outbreak, which had a total of 84 reported cases, approx. 1/3 were young adults (all but one were unvaccinated), 70% of whom were admitted to hospital. The MMR vaccination is therefore now being offered to all adults born in 1974 or later.

Along with intensified vaccination measures among children, the vaccination offer to young adults may contribute to the elimination of measles in Denmark.

Measles in Europe

Measles are still common in Europe, and the number of recorded cases has quadrupled in 2010-11 compared with 2008-9.
2011 saw a total of 30,567 cases in EU/EFTA countries. More than 90% of the cases occurred in one of the following five countries: France (15,206), Italy (5,181), Rumania (4,015), Spain (1,986) and Germany (1,609). Eight measles-associated deaths were recorded in Europe in 2011.

On 13 March 2012, the ECDC reported more than 5,000 cases in Ukraine in 2012. Ukraine and Poland are to host the European Soccer Championships in June 2012, and the risk of becoming exposed to infection is estimated to be high why all travellers to the Ukraine should have received the measles vaccine, www.europa.ecdc.eu. WHO aims for the elimination of measles and rubella from the European region by 2015 at the latest, EPI-NEWS 17/09.

Vaccination programme

The currently used MMR vaccine (Priorix^®) provides protection against measles in 98% of vacinees. As the individual protection is so high, it is considered sufficient to offer adults a single dose of MMR vaccine in the catch-up programme.

MMR vaccination carries no risk, even though you have had the mumps and/or rubella. If you are already immune to one or both conditions, the circulating antibodies will simply neutralise the corresponding part of the vaccine.

Rubella

Rubella infection is not a serious disease in children, but may have serious sequelae for the foetus if a pregnant woman is infected in her first trimester. Unvaccinated women above 18 years of age may therefore be vaccinated against rubella free of charge with the MMR vaccine. Rubella infection in pregnant women and congenital rubella syndrome have been individually notifiable since 1994; and since then, a total of 19 cases of rubella infection in pregnant women have been recorded (most recently in 2008), while no cases of congenital rubella have been recorded.

Mumps

In the 1994-2011 period, an average of 18 cases of mumps were notified annually. Before the introduction of the MMR vaccine, a total of 200-250 children were admitted to hospital annually with serous meningitis due to mumps. Furthermore, individual cases of mostly one-sided hearing loss and orchitis, in post-puberty males were recorded.

Side effects

Like any other pharmaceutical, the MMR vaccination may cause side effects. The most frequently observed are local reactions at the vaccination site (>10%), fever and/or rash, and symptoms of upper respiratory infection (1-10%). In adult women, incidence rates for arthritis and arthralgia are generally higher than those seen in children (1.2-2%), and the reactions tend to be more marked and of longer duration. For information about non-common and rare side effects and contraindications, please see the Summary of Product Characteristics of the MMR vaccine (Priorix®), which is available at www.ssi.dk.

How to order

As always, MMR vaccines are ordered via the SSI Order Office, and vaccines are supplied in 10-dose packages.

National Health Insurance settlement

When giving an MMR vaccination in connection with consultation for any other reason, code 8620 is used. When giving independently, code 8621 is used.
As there may be a risk of measles in connection with travels abroad, vaccination clinics can vaccinate adults free of charge before travelling. It is a prerequisite for the settlement with the Danish Regions that it is done electronically, and via the systems recommended by the Regions.

(P.H. Andersen, L.K. Knudsen, P. Valentiner-Branth, Department of Infectious Disease Epidemiology)