4% and 1.2% of the total reported cases selleck of measles for the period 2007–2001 and of 5% in 2006, so we do not believe this might have biased our findings. Although the authors are well aware of the recommendation of two doses of measles

vaccination, only data on MCV1 coverage was taken into account due to the vast heterogeneity in data availability for MCV2 doses across EU/EEA MS. Our dataset lacked information for certain countries and certain years on both vaccination coverage (n = 24 data points) and burden (n = 3). We imputed the former using the previous years’ value, and deleted those cases missing the latter from the statistical analysis; it is not known if results would vary given the availability of complete data on these two variables, although this is unlikely. When removing the countries with one or more missing coverage years, the regression coefficient for vaccination coverage was similar (−0.013) to the result we reported (coefficient = −0.025). It was however no longer statistically significant (95%

CI: −0.045 to 0.019), perhaps due to the smaller sample size and the associated reduction in statistical power. selleck kinase inhibitor This study has also some relevant strengths. In order to calculate DALYs attributed to measles, a well-defined and detailed disease progression model (Fig. 1) that comprehensively takes into account the possible consequences of a measles infection was used. To our knowledge no other study to date has tried to assess the impact of national measles vaccination coverage on the burden of measles using DALYs across 29 EU/EEA MS over several years with this level of detail. Also, the statistical approach used allowed unexplained heterogeneity across countries to be taken into account, and so that the non-independence of burden estimates from the same country within the study period was not overlooked. In conclusion, this study shows that the higher the vaccination coverage, the lower the burden of measles, suggesting science that the degree

of success of national measles vaccination programs, when measured by the coverage obtained, is significantly associated with the burden of measles across EU/EEA MS. Attaining a higher measles vaccination coverage would thus result in important benefits in terms of early significant reduction of the overall impact of measles in the population, and would put EU/EEA MS on the right track toward the goal of eventual elimination. All authors contributed extensively to the work presented in this paper. E.C., S.A.M., P.C.S., P.L. and A.C. designed the study. E.C., M.C.B. and P.C.S. collected the data. E.C., M.C.B., S.A.M. performed the data management. E.C. and S.A.M. performed the analysis. E.C., S.A.M., P.L., P.C.S., M.C.B. and A.C. interpreted and discussed the results. E.C. and S.A.M. drafted the manuscript and all other co-authors extensively contributed to its writing and finalization.