Vaccine 27 (2009) 3927–3934 Contents lists available at ScienceDirect Vaccine journal homepage: www.elsevier.com/locate/vaccine Review Measles risk groups in Spain: Implications for the European measles-elimination target Isabel Pe ˜ na-Rey a,c,* , Victoria Martínez de Aragón a,c , Mar Mosquera b,c , Fernando de Ory b,c , Juan Emilio Echevarría b,c , Measles Elimination Plan Working Group in Spain 1 a National Centre for Epidemiology, Carlos III Institute of Health, Av Monforte de Lemos, 5, 28029 Madrid, Spain b National Microbiology Center, Carlos III Institute of Health, Madrid, Spain c Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain article info Article history: Received 5 December 2008 Received in revised form 31 March 2009 Accepted 3 April 2009 Available online 3 May 2009 Keywords: Measles Risk groups Spain abstract The European Region has set itself the goal of eliminating measles by 2010. Incidence has increased in recent years. This study sought to investigate outbreaks in Spain in the period 2005–2007, in order to identify measles-vulnerable groups and compare Spain to other European countries which have also had measles outbreaks. The pattern observed for Spain proved different to that of other European countries, i.e., whereas young adults and infants aged under 15 months were affected in Spain, children aged under 9 years comprised the predominant group in other European countries. Measles cases in Spain reflect low coverage when vaccination began, a pattern that could be repeated in neighbouring countries. Vaccination efforts should thus be targeted at vulnerable groups, namely: young adults; health professionals; travelling communities; and adopted infants and foreigners from countries with important pockets of susceptibles. © 2009 Elsevier Ltd. All rights reserved. Contents 1. Introduction ........................................................................................................................................ 3927 2. Materials and methods ............................................................................................................................ 3928 3. Results .............................................................................................................................................. 3928 4. Discussion .......................................................................................................................................... 3930 Acknowledgements ................................................................................................................................ 3932 Appendix A. Measles Elimination Plan Working Group in Spain .............................................................................. 3932 References ......................................................................................................................................... 3933 1. Introduction In 1998, as one of its “Health for All in the 21st century” (HEALTH21) targets, the World Health Organization (WHO) envis- aged the elimination of measles in the European Region by 2007 [1], and urged Member States to set up national indigenous measles- * Corresponding author at: National Epidemiology Centre, Carlos III Institute of Health, Av Monforte de Lemos, 5, 28029 Madrid, Spain. Tel.: +34 918222636; fax: +34 913877815. E-mail address: sabela@isciii.es (I. Pe ˜ na-Rey). 1 See Appendix A. elimination plans [2]. In 2004, after reviewing the situation, the WHO Regional Office for Europe deferred the elimination deadline to 2010 [3]. Strategies for attaining the goal of eliminating endemic circula- tion of measles in the WHO European Region are based on: attaining and maintaining high vaccination coverages (≥95% with 2 doses of measles vaccine); and strengthening surveillance systems by rigor- ous epidemiological and laboratory investigation of all suspected cases, characterization of circulating virus and dissemination of information to health professionals and the public alike [3]. In 1998, the European Parliament adopted a European Com- mission proposal to set up a Surveillance Community Network for Vaccine-preventable Infectious Diseases (EUVAC.NET) [4]. To 0264-410X/$ – see front matter © 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.vaccine.2009.04.024