Amid a rise in measles cases across the WHO European Region in the past year, and to prevent a large-scale outbreak in Serbia, a catch-up measles, mumps, and rubella (MMR) vaccination campaign this year reached almost half of the missed-dose children in 12 selected municipalities in the country. The campaign to identify and vaccinate susceptible children was funded by the European Union (EU) and conducted by the Serbian Ministry of Health in collaboration with WHO Serbia.
Targeting areas with the greatest need
Serbia’s national coverage with the first dose of measles vaccine was 81% in 2022. However, WHO recommends at least 95% coverage to prevent outbreaks of this potentially serious disease. To reach children vulnerable to measles and other diseases, a data-driven approach identified districts in the country with the lowest vaccination rates, and the national immunization information system pinpointed municipalities for targeted action. In the previous round, catch-up vaccination was offered in 10 municipalities. One of these municipalities, with the lowest immunization coverage, was also among the 12 targeted in the second round.
For the second round, health workers in the 12 primary health-care centres examined hard-copy vaccination records to identify unvaccinated and undervaccinated children born between 2015 and 2021 for targeted catch-up vaccination outreach activities.
From personal invitation letters to home visits: a comprehensive approach
In accordance with action plans developed for each municipality, district immunization coordinators and paediatricians carried out promotional activities at municipal level. Outreach included sending invitation letters to parents of unvaccinated or undervaccinated children. Nurses further reached out directly, informing parents about available catch-up vaccinations for their children.
Additionally, in some municipalities, the home care service actively participated in the invitation process by visiting the homes of children whose parents had not responded to the vaccination invitation.
At the same time, district immunization coordinators and paediatricians conducted promotional activities at local level, leveraging the engagement of local media and setting up educational sessions for parents through lectures and workshops, and distributing printed informational material. Awareness-raising messages were also disseminated on health-care facility websites and social media channels, emphasizing the importance of catching up on missed vaccinations.
Building trust and developing skills for effective engagement with parents
“Almost half of the targeted unvaccinated and undervaccinated children in these vulnerable areas received a dose of the MMR vaccine. This success underscores the importance of collaboration to reach communities where they are, ensuring that every child has access to life-saving vaccinations,” said Dr Verica Jovanović, Director of the Institute of Public Health of Serbia.
Health workers are a trusted source of information about vaccines. Strengthening the capacities of health workers to address parents’ questions about vaccines and the diseases they prevent has been an integral aspect of this collaboration. Over 230 health-care professionals completed specialized training programmes developed by WHO and the Institute of Public Health, enhancing their abilities to engage with parents and respond to vaccination-related concerns.
These concerted and proactive efforts are particularly important in light of the recent sharp increase in measles cases across the European Region. Catch-up immunization activities are vital to reach those most vulnerable before the virus does. Serbia reported 52 measles cases in 2023, primarily in the first half of the year.
Partnering with the EU for equitable access to vaccines
The outreach campaign was part of an EU-funded project aimed at strengthening health systems’ resilience and immunization services in the western Balkans. The project is being implemented in Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia and Kosovo.*
*All references to Kosovo should be understood to be in the context of the United Nations Security Council resolution 1244 (1999).