Review of outbreaks and barriers to MMR vaccination coverage among hard to reach populations in European countries

Surveillance and monitoring

In recent years, substantial progress had been made towards eliminating measles, mumps and rubella in Europe. Measles vaccine coverage is on the rise and measles cases decreasing in many countries. However, there have still been several large outbreaks of measles, mumps and rubella reported in European countries. In order to meet the WHO European Region target date for the elimination of endemic measles and rubella by 2015 it will be necessary to achieve and sustain a very high vaccination coverage (=95%), with two doses of measles and at least one dose of rubella vaccine through high-quality, routine immunisation services. A decline in immunisation rates in some countries or regions can be attributed to a rise in scepticism towards vaccination; increasing migration and population 

Executive Summary

There are recognised hard-to-reach population groups within Europe who have a disproportionate risk of measles susceptibility due to under-vaccination with the MMR vaccine. These include migrants and nomadic groups, immigrants, religious groups, anthroposophic groups, complementary medicine users and healthcare workers. Across Europe, the review identifies that national immunisation programmes lack adequate information to monitor vaccination coverage in these hard-to-reach population groups, since few countries collect information on ethnic, religious and migrant status.

When reported in the literature, vaccination coverage was generally low and varied greatly, with a range of 7–46% for religious groups; 0.6–65% for anthroposophic groups and 0–82% for nomadic groups (travellers and Roma). The list of barriers includes discrimination; administrative and financial problems; language or literacy limitations; lack of cultural knowledge; lack of knowledge on health and vaccination; religious reasons; a fatalistic approach to life and a distorted risk perception in relation to vaccines and vaccine-preventable diseases among some individuals and groups.

Addressing MMR under-vaccination is the responsibility of every national authority, and every health professional working in the area of disease prevention and health promotion. MMR vaccination coverage needs to be monitored within each population group at risk of under-vaccination. Improving access to health services is critical in order to ensure that vaccination is available to those who need it.