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Volume 331:1397-1402 November 24, 1994 Number 21 Next

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ABSTRACT

Background In the 1970s measles, mumps, and rubella were rampant in Finland, and rates of immunization were inadequate. In 1982 a comprehensive national vaccination program began in which two doses of a combined live-virus vaccine were used.

Methods Public health nurses at 1036 child health centers administered the vaccine to children at 14 to 18 months of age and again at 6 years, and also to selected groups of older children and young adults. Vaccination was voluntary and free of charge. In follow-up studies, we focused on rates of vaccination, reasons for noncompliance, adverse reactions, immunogenicity, persistence of antibody, and incidence of the three diseases. Since 1987, paired serum samples have been collected from all patients with suspected cases of measles, mumps, or rubella.

Results Over a period of 12 years, 1.5 million of the 5 million people in Finland were vaccinated. Coverage now exceeds 95 percent. The vaccine was efficient and safe, even in those with a history of severe allergy. No deaths or persistent sequelae were attributable to vaccination. The most frequent complication requiring hospitalization was acute thrombocytopenic purpura, which occurred at a rate of 3.3 per 100,000 vaccinated persons. The 99 percent decrease in the incidence of the three diseases was accompanied by an increasing rate of false positive clinical diagnoses. In 655 vaccinated patients with clinically diagnosed disease, serologic studies confirmed the presence of measles in only 0.8 percent, mumps in 2.0 percent, and rubella in 1.2 percent. The few localized outbreaks were confined to patients in the partially vaccinated age groups. There are now fewer than 30 sporadic cases of each of the three diseases per year, and those are probably imported.

Conclusions Over a 12-year period, an immunization program using two doses of combined live-virus vaccine has eliminated indigenous measles, mumps, and rubella from Finland. Serologic studies show that most reported sporadic cases are now due to other causes, but a continued high rate of vaccination coverage is essential to prevent outbreaks resulting from exposure to imported disease.

Source Information

From the National Public Health Institute (H.P., O.P.H., M.Valle, M.P., M.Virtanen, V.K., K.C.); the Division of Infectious Diseases, Children's Hospital, University of Helsinki (H.P., M.Virtanen, V.K.); and the Department of Public Health, University of Helsinki (O.P.H., M.P.) -- all in Helsinki, Finland.

Address reprint requests to Dr. Peltola at Children's Hospital, University of Helsinki, 11 Stenback St., FIN-00290 Helsinki, Finland.

Full Text of this Article

Related Letters:

The Measles–Mumps–Rubella Vaccination Program in Finland
Redd S. C., Wharton M., Hadler S. C., Orenstein W. A., Lerman S. J., Peltola H., Heinonen O. P.
Extract | Full Text  
N Engl J Med 1995; 332:1102-1103, Apr 20, 1995. Correspondence

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