Children who miss immunisation: implications for eliminating measles

The United Kingdom aims to eliminate indigenous measles by the year 2000. National coverage of measles, mumps, and rubella immunisation is currently 92%, and protective efficacy of measles vaccine is around 90-95%.1 2 Even with high immunisation coverage, however, primary vaccine failure will continue to sustain measles transmission in the community.2 Thus a two dose measles immunisation schedule has been used for several years in the United States and is now proposed for the United Kingdom.3 Most (97%) children who fail to respond to a single dose will produce antibody after reimmunisation.4 The most cost effective option is probably to give a second dose at the same time as the existing preschool booster of diphtheria-tetanus and polio. For this strategy to be successful it is important to know what proportion of children who miss out on measles, mumps, and rubella immunisation are likely to attend for a preschool booster, and how many will miss out on both. I examined data on children in South Glamorgan to answer these questions