Vaccine and syringe - file picImage copyright Getty Images
Image caption Parents look set to be punished if they fail to get their children immunised

Parents in Germany who fail to seek medical advice on vaccinating their children could face fines of up to €2,500 (£2,175; $2,800).

Health Minister Hermann Gröhe said it was necessary to tighten the law because of a measles epidemic.

A mother of three died of measles in the city of Essen this week.

The government wants kindergartens to report any parents who cannot prove they have had a medical consultation.

However, Germany is not yet making it an offence to refuse vaccinations – unlike Italy.

Speaking to the popular daily Bild, Mr Gröhe said: “Continuing deaths from measles cannot leave anyone indifferent.”

Under the plan, the children of parents who fail to seek vaccination advice could be expelled from their daycare centre. The law is expected to be adopted next month.

The upper house of the German parliament, the Bundesrat, said forcing kindergartens to report some parents to the health authorities might breach data protection laws.

Italy health campaign

Italy has recorded nearly three times more measles cases so far this year than for all of 2016.

Last week the Italian government ruled that parents must vaccinate their children against 12 common illnesses before enrolling them at state-run schools. The list includes measles, polio, whooping cough and hepatitis B.

Measles outbreak across Europe

WHO information on measles

By mid-April this year Germany had 410 measles cases, compared with 325 for the whole of 2016, the Robert Koch Institute reported.

The institute said that besides children, all adults born since 1970 should get immunised against measles, if they had not had the measles jab or had had it only once.

Last week a German court ruled that a father could insist on having his child vaccinated, over the objections of the mother. The case concerned a separated couple, and the child was living with the mother.

Italian officials have attacked what they call “anti-scientific” theories which have led to vaccination rates falling well below levels deemed safe to prevent outbreaks.

Those theories include a long discredited link between autism and the MMR (measles, mumps and rubella) vaccine.

Image copyright Science Photo Library
Image caption Infant with measles rash: The infection sometimes causes serious complications

Vaccination – the picture across Europe

A 2010 survey of vaccinations EU-wide and in Iceland and Norway found much variation in policy. The Venice project survey reported that 15 countries had no mandatory vaccinations, and the rest had at least one mandatory vaccination.

The level of compliance was high, including in countries where vaccinations were recommended, not mandatory.

The report concluded that “the label ‘mandatory’ is not the only driver behind achieving a high vaccination coverage, and many other factors can play a role, such as the use of combined vaccines, prices for the recipient, kind of offer, information and promotional campaigns”.

The World Health Organization (WHO) says that since the introduction of two doses of anti-measles vaccine across Europe the number of cases has dropped sharply. The total in 2016 – about 5,000 – was the lowest ever recorded.

But 14 European countries are described as “endemic” for measles, and most cases this year were reported in seven of them: France, Germany, Italy, Poland, Romania, Switzerland and Ukraine. The largest outbreaks are in Italy and Romania, the WHO says.

The second measles jab needs to be administered to at least 95% of the population, the WHO says – a level not reached in the endemic countries.

Children should be screened for their measles vaccination history when they start school, and those lacking evidence of receipt of two doses should be vaccinated, the WHO says.