The Measels-Mumps-Rubella Vaccination from a health political and economical point of view.

INTRODUCTION: Measels, Mumps and Rubella (MMR) are highly contagious infectious diseases which may lead to severe complications. These diseases are vaccine-preventable. The present Health Technology Assessment report (report on technological consequences, HTA report) was commissioned by the German Institute of Medical Documentation and Information (DIMDI) and addresses various aspects of the MMR vaccination, the key question being how the MMR immunisation coverage rate can be increased in Germany.

OBJECTIVES: The objectives of this report were to describe the benefits of the MMR vaccination for Germany and to analyse how the desired MMR immunisation coverage of >95% can be achieved.

METHODS: A systematic literature search was performed in 29 literature data bases. Particularly for epidemiological data and information on vaccination programs, this systematic search was supplemented by an extensive hand search, written and oral enquiries, as well as interviews with experts. A total of 200 texts were used to prepare this report.

RESULTS: At 92.5% (as of 2004) based on the whole of Germany, the current immunisation coverage for measles in children is above the weighted EC-15-average of 90.67%. Statements can only be made regarding the probability of illness for measles, as no data is available for mumps and rubella. With 2.8 infections (per 100,000 residents) in 2006, Germany has not achieved the WHO target. Of cases submitted to the laboratory, only 32% were validated by diagnostic laboratory findings and 45% confirmed clinical-epidemiologically. There are only few economic analyses of vaccination programs in Germany. In international publications, mainly measels are validated economically. An analysis of the cost of measles for Germany shows potential cost savings. Unfortunately, no complete economic evaluation (cost-effectiveness, cost-benefit, or cost-utility analyses) for MMR vaccination has been performed for Germany. Analyses conducted in the US and a model calculation for a hypothetical Western-European country show a considerable cost saving potential for society in general as well as for the health care system. INTERVENTIONS TO INCREASE THE IMMUNISATION RATE WERE CATEGORIZED IN THREE MAIN GROUPS ACCORDING TO THEIR GOALS: interventions increasing the demand for vaccinations, those improving access to vaccination services and those aiming at the providers (e.g. physicians) of vaccinations.

DISCUSSION: Various studies concluded that reminders to clients, provided in written, electronic or oral form, are a highly recommendable intervention. Provider based interventions were also strongly advised. DESPITE EFFORTS MADE DURING THE PAST YEARS TO ACHIEVE HERD IMMUNITY IN GERMANY, SOME DEFICITS REMAIN: i. e. there are still ample regional differences between and within German federal states.

CONCLUSIONS: In the authors' opinion, a key point in increasing immunisation coverage is the development of a binding vaccination program for Germany with regionally differentiated immunisation targets. During the development of such a program, special emphasis should be placed on determining responsibilities of the federal government, the Laender and health insurance funds (e. g. in the case of a measles outbreak).