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An Italian study examined whether the decline in MMR vaccination rates and the recent measles epidemic were linked to cuts in the health budget.
Measles is a highly contagious viral disease that causes high fever, sore throat, runny nose and rash. In some cases, there may be serious health complications, such as pneumonia or encephalitis (inflammation of the brain) that can result in permanent disability or death.
The MMR vaccine is very effective in the prevention of measles. According to current public health recommendations, children should receive the first dose of MMR vaccine between 12 and 15 months of age and a second dose between 4 and 6 years of age. A vaccination rate of about 95% of the population provides a "collective immunity". This avoids measles outbreaks in unimmunized vulnerable individuals.
Increase in measles observed in disadvantaged areas of Italy
In recent years, MMR vaccination rates have declined in several countries, resulting in measles outbreaks. Anti-vaccination pressure groups promoting unproven claims that the MMR vaccine is dangerous or linked to autism are often blamed for this decline. However, in Italy, it was noted that while anti-vaccination attitudes are more prevalent in affluent areas, measles progression has been observed in the most disadvantaged areas. Other factors may therefore be involved.
Reducing health budgets that impact prevention programs can be a contributing factor. Researchers at Bocconi University in Milan, Italy, examined whether the decline in MMR vaccination rates and the recent measles outbreak in the country could be linked to cuts in the health budget. They recently published their findings in the European Journal of Public Health.
The researchers examined data from the Italian National Institute of Health on 24-month MMR coverage rates (by examining the first dose of MMR vaccine only) for 19 Italian regions during the period 2000-2014. . They also collected data on annual public health expenditure per capita in these regions for the same period, corrected for inflation.
Each 1% reduction in health expenditures was associated with a 0.5% decrease in RRO coverage
The researchers observed an upward trend in public health spending of about 3.5% per year until 2009. This trend has reversed and decreased by about 2% between 2010 and 2014. There were regional variations, with the largest spending cuts occurring in the more disadvantaged southern regions, with some experiencing reductions of more than 10%.
MMR coverage has gradually increased from about 74% of the population in 2000 to a high of about 90% in 2012. However, MMR coverage levels have subsequently fallen to about 85%. in 2014. Regional variations were observed. In Lazio, public health expenditure decreased by 5%, while coverage by the MMR was reduced by more than 3%. However, in Sardinia, even though it was historically a disadvantaged area, public health expenditure increased slightly and MMR coverage remained stable. Using statistical modeling, the researchers estimated that each 1% reduction in public health spending per capita was associated with a 0.5 percentage point decrease in MMR coverage.
The researchers concluded that a reduction in public health expenditures was linked to the decline in MMR vaccination rates, which had led to the recent measles outbreak. The Italian government is trying to reverse this trend by increasing health budgets and introducing compulsory vaccination for Italian children. These policies can help increase coverage of MMR and improve measles prevention.
Written by Julie McShane, Medical Editor
References:
- Toffolutti V, McKee M., Melegaro A, et al. Austerity, Measles and Compulsory Vaccination: Transregional Immunization Analysis in Italy 2000-14. European Journal of Public Health DOI: 10.1093 / eurpub / cky178.
- EurekAlert. Cuts in health care are "strongly linked" to the resurgence of measles. Sept. 12, 2018. https://www.eurekalert.org/pub_releases/2018-09/bu-hc091218.php
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