In Germany there are significant gaps in measles vaccination which lead to repeated outbreaks of the disease. Vaccinations do more than just protect the recipient against infection. They also protect people who cannot be vaccinated, for example infants or people with certain chronic illnesses. However, many adults do not know that they are not completely vaccinated against measles. In order to close this information and vaccination gap, wirksam regieren compared various possible ways to provide patients with information. Brief, direct, target-group-specific information in the form of a letter from the health insurance company proved to be the most effective way to get the information across. It led to 2.5 times as many vaccinations being carried out.
Measles is a highly contagious, serious disease
Measles is not a harmless childhood illness. It is a highly contagious viral disease which can have serious and potentially fatal consequences. When it occurs in adults, it frequently takes a more serious course and leads to lung, middle ear and brain inflammation. The only effective protection against measles is vaccination[i]. If a sufficiently large proportion of the population is vaccinated, infants and people with weak immune systems who cannot themselves be vaccinated can also be protected against infection. This is called herd immunity.
The measles vaccination is so effective that it is possible to eradicate the disease. The Federal Government therefore adopted the National Action Plan for the Elimination of Measles and Rubella in Germany 2015-2020. This recommends, among other things, targeted information about the vaccination for adults born after 1970 who show a significant vaccination gap.
Many adults do not know that they are not completely vaccinated against measles
Surveys by the Federal Centre for Health Education (BZgA) indicate that the immunity gap among adults born after 1970 is due largely to a lack of knowledge about measles and the measles vaccination. One in five of them wrongly believe that measles is not a particularly serious illness; three-quarters are not aware of the vaccination recommendations for adults.
On behalf of the Federal Ministry of Health, wirksam regieren therefore conducted two studies on the effectiveness of information about the measles vaccination for adults. In two randomised, controlled studies involving over 100,000 insured persons and more than 3000 GP practices, various information letters were sent by the health insurance providers to their customers and various ways of providing information to patients were tried out in GP practices. In all cases, the facts about the measles vaccination were written in a clear and comprehensive way.
In 2010 the Robert Koch Institute changed the measles recommendations for adults. People born after 1970 should have received two vaccinations against measles.
Short information letters led to 2.5 times the number of vaccinations
Direct information in the form of a letter from the health insurance company proved to be the most effective way to get the information across. In the three months after sending the letter, 8 out of 1,000 patients who had received the letter saw a doctor to get vaccinated, compared with 3 out of every 1,000 patients who had not received a letter. This corresponds to a 2.5-fold increase.
This result shows that provided information needs to be short and easy to understand. In addition, the information letter explicitly needs to address target groups, especially young adults and the necessity for measles vaccinations in this group. To date, vaccination information typically addresses all age groups. This poses the risk that young adults falsely consider the information irrelevant to them because measles is believed to be a children’s disease. The results of this study were part of the rationale of a new law for measles prevention.
[i] Robert Koch Institute. Epidemiological Bulletin (2015). 23 November 2015 No. 47/48.
Techniker Krankenkasse health insurance provider
Allgemeine Ortskrankenkasse health insurance providers
Robert Koch Institute
Federal Centre for Health Education (BZgA)
on behalf of the Federal Ministry of Health (BMG)