Underserved Populations in Europe at Risk of Low MMR- Vaccine Uptake: A Systematic Review

Objective: Measles outbreaks continue to occur in Europe, predominately in ethnic minorities, religious communities and immigrant populations. However, the Strategic Advisory Group of Experts of the WHO has identified knowledge gaps in populations that still need to be targeted in the elimination of measles. Therefore the aim of this systematic review is the identification of underserved populations at risk of low Mumps-Measles-Rubella (MMR) vaccine uptake.

Methods: We performed a systematic review in line with the PRISMA guidelines searching for studies identifying a low MMR-vaccine uptake or low Measles, Mumps or Rubella immunity in a European population. The search was conducted in three electronic databases: Pubmed, Embase and Web of Science.

Results: We included 33 articles out of 610. Four main underserved populations with low MMR vaccine uptake were identified: children of large families, individuals with lower income or high degree of deprivation, immigrants, and asylum seekers. Less prominent risk groups were based on education, area of residence or being part of a minority. Homeless children and children with chronic conditions also showed a lower MMR vaccine uptake.

Conclusion: Knowledge of the key risk groups of low MMR vaccine uptake in Europe this systematic review identified will not only aid further research on the barriers they experience but also the implementation of policies in order to achieve a 95% MMR-vaccine coverage demanded by the WHO.