Examining vaccination coverage in Germany: spatiotemporal clustering of MMR coverage, 2008–14

Vaccine hesitancy is an increasing global health threat but much of the recent research has centred on the USA. European countries provide an interesting context due to increases in vaccine-preventable disease outbreaks as well as variability in vaccination laws. We investigated the spatiotemporal clustering of Measles, Mumps, and Rubella vaccination coverage in Germany, a country with a historic absence of compulsory vaccination laws. We also examined measles incidence in the context of the spatiotemporal clustering results. While we did not identify strong spatial patterns of geographic clustering in Germany, our results suggest a potential relationship between measles incidence and vaccination coverage cluster status.