Measles is a highly infectious disease and about 90% of individuals would be infected by the age of 10 in the absence of vaccination [10] and [11]. With the resolution of 16th September 2010, all countries in the European Region of the World Health Organization 17-AAG nmr (WHO),

which includes EU/EEA MS, have renewed their commitment to eliminate measles and rubella by 2015, and have identified essential criteria for elimination of measles and rubella in the WHO European region, including the demonstrated protection of at least 95% of the population against measles and rubella [12], [13] and [14]. Challenges in reaching good vaccination coverage have emerged in several EU/EEA MS leading to progressive accumulation of susceptible individuals, loss of heard immunity and several outbreaks of measles across Europe in recent years [11], [15], [16],

[17], [18] and [19]. These challenges are due, among other reasons, to the reluctance Bioactive Compound Library of specific subgroups of the population to undergo vaccination, and to the difficulty in reaching specific communities [20], [21], [22], [23] and [24]. Previous studies have investigated the relationship between the incidence of measles, or the likelihood of new outbreaks, and the vaccination coverage of a population [25], [26], [27] and [28]; however, no studies to our knowledge have studied the relationship between vaccination coverage across EU/EEA MS and the burden of measles using DALYs. In this study we wanted to investigate the effect of vaccination programs on the burden of measles in Europe. In order to reach this goal we compared measles national vaccination coverage and burden of measles expressed in DALYs across EU/EEA MS and studied their correlation

in the period 2006–2011. We obtained measles incidence and vaccination coverage data TCL for 29 EU/EEA MS, from 1998 through 2011 inclusive. Age-group specific incidence data were available from The European Surveillance System (TESSy), an European database held by ECDC [29]. The incidence data reported to TESSy were corrected for under-estimation by applying a multiplication factor of 2.5 as suggested by Stein et al., under the assumption that EU/EEA MS have good measles control [6]. Vaccination coverage (MCV1; measles containing vaccine, first dose) was obtained from WHO’s Centralized Information System for Infectious Diseases (CISID) [30]. Country names were anonymised before analysis. Because of extensive missing coverage data and the sparse availability of incidence data before 2006, the dataset was reduced by restricting to the period 2006–2011. For 14 countries, vaccination coverage for one or more years in the period 2006–2011 was missing; these missing values were imputed using the previous year’s value (or the value from two or more years previous, if the previous year’s value was also missing); 13.8% (24/174) of vaccination coverage values were consequently imputed.