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Outbreak of measles in France shows no signs of abating

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d3161 (Published 20 May 2011) Cite this as: BMJ 2011;342:d3161
  1. Paul Benkimoun
  1. 1Paris

Since 2008 France has been affected by an outbreak of measles that is spreading outside its borders and whose toll is increasing at an impressive speed. The United Kingdom’s Health Protection Agency has consequently urged parents to protect their children against measles by ensuring that they have been vaccinated with two doses of measles, mumps, and rubella (MMR) vaccine before they travel abroad.

In 2006 and 2007 about 40 cases a year were reported to the French surveillance agency, the Institut de Veille Sanitaire. This figure rose to 600 in 2008, 1500 in 2009, and more than 5000 in 2010. The trend shows no signs of slowing, as more than 6400 cases have been notified in the first three months of 2011.

On 19 April the institute said that more than 14 500 cases had been notified in France since 1 January 2008. In 2010 the number of cases in children aged under 12 months was triple that in 2008, while the number of cases in young adults saw a fivefold rise. The most affected regions are Midi-Pyrénées in the south and Rhône-Alpes and Franche-Comté in the east, with the first of these seeing a peak of 27 cases per 100 000 population.

The national incidence has risen from 0.9 cases per 100 000 in 2008 to 8 per 100 000 in 2010. Together with Bulgaria, France is the country with the highest incidence of measles in the European region of the World Health Organization. It is also the European country with the highest rate of exported cases, particularly to the United States, where measles was on its way to being eliminated.

Last March the French health ministry said that the outbreak was due to inadequate and disparate levels of immunisation around the country. It affected “pockets” of individuals who were receptive to the virus, especially people born since 1980. From 2005 to 2010 the ministry had been trying to implement a plan to eliminate measles and congenital rubella, and it has been trying to improve the uptake of the MMR vaccine.

The percentage uptake of the first vaccination injection for children under 24 months, given as part of the MMR vaccination, reached 90% in 2007 (up from 87.5% in 2004) but remains under the 95% that the World Health Organization says is needed to eliminate measles. During the 1980s vaccination coverage rose steadily, from 26% (of 6 year olds) in 1985 to 59% (of 6 year olds) in 1989 and to 71% (of 2 year olds) in 1990.

The publication in the Lancet in 1998 of the research article by Andrew Wakefield purporting to show a link between the MMR vaccine and autism had no significant effect on uptake of the MMR vaccine in France. The main vaccine controversy in France has centred on that against hepatitis B, and this has taken its toll on immunisation campaigns as a whole.

The unfolding of the measles outbreak in the first four months of this year included 13 cases of serious neurological complications and two deaths from pneumonia, which may act as an incentive for MMR vaccination. After consulting the country’s High Council on Public Health, the health ministry recently recommended that doctors narrow the time gap between the first and the second dose of the MMR vaccine so that children get both their injections before the age of 14 months.

Notes

Cite this as: BMJ 2011;342:d3161