Measles Immunity Status of Greek Population after the Outbreak in 2017-2018: Results from a Seroprevalence National Survey

Accurate data on susceptibility rates against measles in the general population of Greece are scarce. Many studies have estimated the vaccination coverage, but none have calculated the nationwide immunity rate, including all age groups, against the measles virus. The purpose of our study was to determine the measles immunity status, especially after the latest outbreak in 2017-2018. In total, 3972 leftover blood samples were obtained during 2020-2021. They were collected from a nationwide laboratory network using a geographically stratified sampling strategy and were tested for the presence of measles-specific IgG antibodies. The overall crude seroprevalence was calculated to be 89.6% and the adjusted was 89.8% (95% CI: 88.8-90.8%). There was no statistically significant difference in seropositivity between sexes (p = 0.783). Higher immunity rates and antibody concentrations were found in older age groups ≥41 years old (94.9%, 95% CI: 93.7-95.9%, and 730.0 mIU/mL) in comparison with younger individuals aged 1-40 years old (83.4%, 95% CI: 81.6-85.7%, and 616.5 mIU/mL). Comparing the seroprevalence among the Nomenclature of Territorial Units for Statistics (NUTS 2), a statistically significant difference was estimated among them (<0.001). The two regions where higher measles incidence was observed during the 2017-2018 outbreak, Eastern Macedonia and Thrace, and Western Greece, were among the four regions with lower seropositivity (84.6%, 95% CI: 79.9-89.4%, and 85.9%, 95% CI: 81.4-90.4%, respectively). Our study showed a measles immunity gap that affects the younger age groups and makes a new measles outbreak likely. The enforcement of vaccination campaigns and addressing vaccine hesitancy could bridge it and achieve the required target of herd immunity.