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The elimination of indigenous measles, mumps, and rubella from Finland by a 12-year, two-dose vaccination program.
N Engl J Med. 1994 Nov 24; 331(21):1397-402.NEJM

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.

Authors+Show Affiliations

National Public Health Institute, Helsinki, Finland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

7969278

Citation

Peltola, H, et al. "The Elimination of Indigenous Measles, Mumps, and Rubella From Finland By a 12-year, Two-dose Vaccination Program." The New England Journal of Medicine, vol. 331, no. 21, 1994, pp. 1397-402.
Peltola H, Heinonen OP, Valle M, et al. The elimination of indigenous measles, mumps, and rubella from Finland by a 12-year, two-dose vaccination program. N Engl J Med. 1994;331(21):1397-402.
Peltola, H., Heinonen, O. P., Valle, M., Paunio, M., Virtanen, M., Karanko, V., & Cantell, K. (1994). The elimination of indigenous measles, mumps, and rubella from Finland by a 12-year, two-dose vaccination program. The New England Journal of Medicine, 331(21), 1397-402.
Peltola H, et al. The Elimination of Indigenous Measles, Mumps, and Rubella From Finland By a 12-year, Two-dose Vaccination Program. N Engl J Med. 1994 Nov 24;331(21):1397-402. PubMed PMID: 7969278.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The elimination of indigenous measles, mumps, and rubella from Finland by a 12-year, two-dose vaccination program. AU - Peltola,H, AU - Heinonen,O P, AU - Valle,M, AU - Paunio,M, AU - Virtanen,M, AU - Karanko,V, AU - Cantell,K, PY - 1994/11/24/pubmed PY - 1994/11/24/medline PY - 1994/11/24/entrez SP - 1397 EP - 402 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 331 IS - 21 N2 - 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. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/7969278/The_elimination_of_indigenous_measles_mumps_and_rubella_from_Finland_by_a_12_year_two_dose_vaccination_program_ L2 - http://www.nejm.org/doi/full/10.1056/NEJM199411243312101?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -