Inevitably, an outbreak of a vaccine-preventable disease in the UK triggers calls for compulsory vaccination. As of April 17, 2013,-808 cases of measles have been reported in the Swansea area, about 10% of which have led to hospital admission. One young adult who died is known to have had measles at the time, but it has not yet been confirmed if he died because of measles. Large outbreaks of measles have also occurred in northern England, with 865 confirmed cases in northwest England. Measles has a case fatality rate of between 1 per 1000 and 1 per 3000 reported measles cases, and unless the outbreaks are broughtto a halt, more deaths will result. The lack of compulsory childhood vaccination in the UK has been called into question: commentators look to the USA where there is an element of compulsion and ask why the UK does not go down that route. Although arguments for compulsory vaccination are superficially compelling, further examination suggests it is not so straightforward. In the USA, stronger enforcement of immunisation laws in a state before entry to public school are associated with higher vaccine coverage and lower incidence of some vaccine-preventable infections in those states. However, these comparisons fall down when comparisons are made between countries. In 2011, the uptake of the first dose of measles, mumps, and rubella (MMR) vaccine among 2 year olds in the UK was similar to that in the USA (89-1% vs 897%). The Nordic countries successfully eliminated all three diseases without compulsory vaccination, while high vaccine uptake is achieved in other parts of Europe without compulsion.
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