http://www.reutershealth.com/archive/2002/04/09/eline/links/20020409elin033.html

Measles outbreak in Germany; docs may be at fault

By Ned Stafford

FRANKFURT, Apr 09 (Reuters Health) - Doctors opposed to vaccinating children against measles might be at least partly responsible for a measles epidemic in southern Germany, according to a regional division of AOK, one of Germany's largest public health insurance groups.

The measles outbreak has struck the district of Coburg in the German state of Bavaria. The district has a population of less than 100,000, but more than 1,000 people, mostly children, have contracted measles since November.

Markus Braun, a spokesman for AOK Bavaria, told Reuters Health Tuesday that AOK believes there is a link between the measles epidemic and opposition from "a few doctors" in the area to the combined measles, mumps and rubella (MMR) vaccine.

A number of people with measles have been admitted to hospitals for care, which is much more costly than MMR vaccines, which for the two-shot program in Germany cost around 100 euros, he said.

Braun declined to say how many doctors in the Coburg area were thought to be opponents of giving children the MMR vaccine, saying only that it was "less than five."

He held out the possibility that AOK would seek monetary damages from doctors opposed to the MMR vaccine.

"That is not ruled out, but at the moment it is not under discussion," he said.

AOK has made its concerns known to the KBV, the Bavarian organization that represents physicians accredited with the public health insurance system.

Martin Eulitz, spokesman for the KBV, told Reuters Health that leadership of the KBV was strongly in favor of the MMR vaccines, and encouraged all members to give the vaccines.

However, he said that German law does not require doctors to give the vaccines.

Referring to the doctors opposed to the vaccine, he said, "We can talk to them and try to convince them the vaccine is necessary. But there is nothing else we can do. We can only kick them out (of the KBV) if they do not follow the rules."

Eulitz also declined to say how many doctors in the Coburg area are opposed to the MMR vaccine. But he said that none of doctors opposed have spoken out publicly against the MMR vaccine. They have spoken only "behind closed doors" to the parents of patients.

"The only people who speak out publicly against the vaccine are the parents," he said.

Eulitz said that since November 1, some 1,140 cases of measles have been reported in the Coburg area. Some 90% of those cases have been children 14 and younger. Children with measles have been admitted to the hospital, but he did not know how many.

In the Coburg district, 76% of children have been vaccinated, which compares with a rate of 88% in the whole state of Bavaria, he said.

Asked whether the lower vaccination rate might have been a trigger for the measles epidemic, Eulitz said, "That might be one of the reasons."

Dr. Waltraud Knipping, head of the Bavarian branch of Germany's Professional Association of Pediatricians, told Reuters Health in late February that as the number of opponents to MMR vaccination has risen, the readiness of parents in Bavaria to have their children vaccinated has declined.

She said at least 90% of all children need to be immunized to effectively combat measles epidemics.

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