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Small decline in MMR vaccinations could have a serious effect

A 5% drop in measles, mumps and rubella vaccinations caused a threefold increase in annual measles cases, a new study found.

A SMALL DECLINE in vaccine use could have a serious impact on public health and the economy as concerns rise about outbreaks of preventable diseases in the US and Europe, researchers have found.

The study found that just a 5% reduction in take-up of the measles, mumps and rubella (MMR) vaccine among children in the US would result in a three-fold increase in annual measles cases, and could cost the public sector $2.1 million (around €1,795,000).

“Routine childhood vaccination is declining in some regions of the United States due to vaccine hesitancy, which risks the resurgence of many infectious diseases with public health and economic consequences,” the authors wrote in the journal Jama Pediatrics.

The study set out to find the number of measles cases in US children. From there, it set out to find the associated economic costs with regards to different levels of reluctance to use vaccines.

Publicly available data from the US Centers for Disease Control and Prevention were used to examine country-level MMR vaccination coverage in children between the ages of two and 11.

The researchers examined the number of times measles cases came into the US, and the infectiousness of the disease. They then calculated the number of cases that would be expected if MMR vaccination coverage was to decline.

The researchers repeated this process thousands of times, changing the variables and scenarios each time for each state. The model was checked for accuracy using data on measles cases from England and Wales.


The results found that 93% of children aged two to 11 in the US had received MMR vaccinations. Non-medical exemptions made up 2% of that age bracket.

With the current level of vaccination coverage in the US, the researchers estimated that 48 annual measles cases occurred during the study period.

“We found that a 5% decline in MMR vaccine coverage in US children would result in a three-fold increase in national measles cases in this age group, for a total of 150 cases and an additional €2.1 million in economic costs to the public sector,” the authors concluded.

They found that, with declining vaccine coverage, the size of outbreaks increased.

There are ongoing policy debates on the state and national level, including legislation around non-medical (personal-belief) exemptions for childhood vaccination.

Personal-belief controversy 

At the moment, 18 out of 50 states allow for non-medical personal belief exemptions to childhood vaccinations. In addition, all but two states offer non-medical exemption on religious or philosophical grounds.

Given the trends in declining vaccine coverage, the researchers predict that preventing non-medical personal belief exemptions would “substantially reduce” the risk of measles in the US.

They found that, with declining vaccine coverage, the size of outbreaks increased.

The researchers warned that results may be an underestimate, stressing that they did not take into account costs of illness, parental time off work, hospitalisation, or other societal aspects.

The study’s conclusion was supported by a recent study that examined the association between vaccine coverage and measles outbreaks in Denver, Colorado, and found that a reduction in non-medical exemptions through stricter policy would reduce measles cases and economic consequences.

The researchers said:

These findings should play a key role in any policies adapted by state or national governments that relate to childhood vaccinations.

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