Analysis of 3-dose oral/inactivated poliovirus vaccine (OPV3/IPV3) immunization coverage

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1 A MONTHLY NEWSLETTER OF THE COMMUNICABLE DISEASE UNIT, WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR EUROPE, COPENHAGEN, DENMARK Issue 5, March 2009 Analysis of 3-dose oral/inactivated poliovirus vaccine (OPV3/IPV3) immunization coverage Member States in the WHO European Region use a 3-dose schedule of IPV, OPV or IPV/OPV sequential vaccine. As of 2008, 33 Member States have a 3-dose schedule of IPV countries, while an OPV/IPV sequential schedule is implemented in 6 countries, and 14 countries follow a 3-dose OPV schedule (Figure 1). The percentage of the Region s under 1 population living in countries which follow IPV, OPV/IPV and OPV schedules is 50%, 31% and 19%, respectively. The last case of indigenous wild poliovirus was reported in 1998 in the European Region. The Region was certified as polio-free in The strategy of sustained high coverage (>90%) of 3 doses of OPV, IPV, or OPV/IPV has helped ensure that there is low risk of transmission of wild poliovirus if it was imported into the Region. During , the regional coverage for 3 doses of polio containing vaccine was 95% 96%. In 2007; 47 countries (with 97% of the Region s under 1 population) reported greater than 90% coverage (Figure 2). However, at the sub-national level, pockets exist where coverage is low (Figure 3). It is important that Member States implement effective plans to improve immunization coverage and monitoring of coverage in districts with low coverage. These areas are at risk of importation of wildpolio as wild virus is still circulating in Africa and south east Asia, and further transmission of the virus into the European Region is possible. The WHO Regional Office for Europe also urges Member States to conduct and sustain high quality acute flaccid paralysis (AFP) and environmental surveillance to detect possible wildpolio virus circulation (Table 3). Figure 1. 3 doses IPV/OPV vaccination schedule IPV IPV/OPV Sequential OPV Figure 2. IPV3/OPV3 coverage at national level, 2007 >= 95% 90% % 80% % < 80% No Data Figure 3. IPV3/OPV3 coverage at sub-national level, 2007 >= 95% 90% % 80% % < 80% No Data Data source: WHO UNICEF Joint Reporting Form, 2006 and 2007

2 Regional and country updates Meeting of the WHO Regional Office for Europe Expert Technical Advisory Group of Experts on Immunization (ETAGE), March 2009 The 9th meeting of the European Technical Advisory Group of Experts on Immunization (ETAGE) convened at the WHO Regional Office for Europe, Copenhagen, March Among the objectives set for the meeting, the ETAGE held technical discussions regarding progress towards and rubella elimination, polio eradication, and accelerated disease control updates in the Region including the feasibility and process for establishing a regional goal for hepatitis B control, and issues regarding maintaining adequate human resources for health (immunization programmes) and the European Immunization Week, April A full report of the proceedings, including ETAGE recommendations will be on the Regional Office s immunization website at Upcoming events Netherlands HPV campaign: The Netherlands plans to introduce the HPV vaccine for 12-year-old girls in September 2009, including a catch-up vaccination programme, starting in the first half of 2009, for girls between the ages of 13 and 16. Preparation for the launch of this nationwide vaccination programme to fight cervical cancer includes an award winning series of virtual surgeries presented on Habbo ( an online site targeting teens, where young girls could come and speak to a real nurse about the vaccination program. The challenge was to engage young girls to answer their questions and prepare them for the vaccine procedure. Regional Global Alliance for Vaccines and Immunization (GAVI) workshop: A workshop on improving implementation and reporting of GAVI support programmes in eligible countries for related ministry of health (national immunization programme and health system strengthening) staff from eight Member States in the European Region will be held in Copenhagen, Denmark, April The theme of the workshop will be "improving implementation and reporting of GAVI support programmes". The Regional Certification Committee (RCC) on polio eradication for the WHO Regional Office for Europe will meet on June 2009 to review Member State progress towards maintaining a regional free of polio, including a focus on political commitment, resource allocation and the quality of national polio surveillance systems. European Immunization Week Update on the European Immunization Week (EIW) For the fourth European Immunization Week (EIW), taking place on April 2009, the WHO Regional Office for Europe will concentrate on promoting immunization in general under the motto: back to basics: immunization works. Issues that will be highlighted are: Immunization is safe and effective in preventing severe illness, disability and even death caused by vaccine-preventable infections and diseases (VPDs). Not getting vaccinated is dangerous. Immunization remains important in the Region, as outlined in the 7 key reasons ( and by: The recent increase of outbreaks in Western Europe. The risk of the introduction of diseases or cases (such as the importation of polio cases into the region and exportation cases from the European Region to other regions). Only 1 year to go to 2010 and rubella elimination goals in the European Region. Keeping the Region polio-free (in November 2008 it has been 10 years since the last indigenous case of polio was identified in the European Region, all 53 Member States were certified polio-free in June 2002). Issue 5 March 2009 page 2

3 At the national level, countries will carry out activities to meet their specific national and sub-national challenges regarding immunization and to target vulnerable and hard-to-reach groups in particular, as has been the case in previous years. Coming soon is the release of an innovative social media tool kit to help all participants generate greater visibility for their EIW activities through the use on an innovative online strategy targeting parents and caregivers. The strategy will use the social media, active online communities, social network/media site users as well as online media, including relevant bloggers to spread the overall EIW message and to promote the positive value of immunization in general. Updated media tools and documentation are available to Member States and interested immunization partners on the website More information For more information and guidance regarding the planning for European Immunization Week 2009 please visit our web site and the campaign web site which will be available from 15 April. Our focal points at the Regional Office for European Immunization Week are Dr Jeffrey V. Lazarus and Mr Leo Weakland, who can be reached at EURO Quick Stats Countries with a high incidence rate of in , WHO European Region, January 2007 February France Germany Switzerland United Kingdom Italy Number of cases Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nod Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nod Dec Jan Feb Month and Year The above graph shows a curve for the five countries with the highest incidence in In 2009, France, Germany and Switzerland continue to report high (>10 per million) annual incidence rates. However, the number of cases in the United Kingdom has declined in 2009 (for further details see Table 1). Issue 5 March 2009 page 3

4 Table 1. Classification of suspected and rubella cases, Jan Feb 2009 (data as of 1 April 2009) Country Lab confirmed Epi-Link Clinical 2 Discarded % Complet e- ness Lab confirmed Epi-Link Clinical 1 Discarded % Timeliness % % Complete-Timelinesness Albania % 100% % 100% Andorra % 50% % 50% Armenia % 50% 1 1 (100%) % 50% Austria % 0% % 0% Azerbaijan % 0% % 0% Belarus % 50% % 50% Belgium (100.0) % 50% % 0% Bosnia and Herzegovina % 0% % 0% Bulgaria % 100% % 0% Croatia (100.0) % 100% % 0% Cyprus % 100% % 100% Czech Republic % 100% % 0% Denmark (100.0) % 50% % 0% Estonia % 100% % 100% Finland % 100% % 0% France (100.0) % 0% % 0% Georgia (100.0) % 0% % 0% Germany (100.0) % 100% % 0% Greece % 50% % 0% Hungary % 100% % 0% Iceland % 100% % 0% Ireland (88.0) % 100% (100%) % 100% Israel % 0% % 0% Italy % 0% % 0% Kazakhstan % 100% (100%) % 100% Kyrgyzstan % 0% % 0% Latvia % 50% % 0% Lithuania % 50% % 100% Luxembourg % 0% % 0% Malta % 50% % 0% Monaco % 0% % 0% Montenegro % 50% % 50% Netherlands % 0% % 0% Norway (100.0) % 100% % 0% Poland (68.0) % 0% % 0% Portugal % 0% % 0% Republic of Moldova % 0% % 0% Romania % 0% % 0% Russian Federation (100.0) % 100% % 0% San Marino % 0% % 0% Serbia % 100% % 0% Slovakia % 100% % 50% Slovenia % 50% % 0% Spain (100.0) % 100% % 0% Sweden (100.0) % 50% % 0% Switzerland (91.0) % 0% % 0% Tajikistan % 0% % 0% The former Yugoslav Republic of Macedonia Population 1 Annualized Incidence Rate per 1 million population (100.0) % 50% 1 1 (100%) % 0% Turkey % 0% % 0% Turkmenistan % 50% % 0% Ukraine (100.0) % 100% % 0% United Kingdom (100.0) % 50% % 0% Uzbekistan % 0% % 0% /Averages (91.0) % 48% (100.0) % 16% Data source: Monthly aggregate and case-based data reported by Member States to WHO/Europe and/or EUVAC.NET. 1 Source: "World Population Prospects: The 2006 Revision", New York, United Nations, 2 Cases with missing classification are classified as "Clinical" (% of suspected cases) 3 Imported or import related cases included in total. Measles Classification Importation 3 Monthly Reporting suspected Rubella (%) Rubella Classification Monthly Reporting Issue 52 March 2009 page Page 4 6

5 Table 2. Measles and rubella laboratory test results, Jan Feb 2009 (data as of 1 April 2009) Specimen* (Serum, Oral Fluid, Swab, Urine and other) Reporting Country Tested for Positive for (%) Measles Equivocal Negative for Tested for rubella Positive for rubella (%) % % Rubella Negative Completeness Timeliness Equivocal for rubella Albania 1 0 (0.0) Andorra Armenia 8 0 (0.0) (13.0) Austria (0.0) (5.0) Azerbaijan Belarus 32 0 (0.0) (6.0) Belgium 15 2 (13.0) (33.0) Bosnia and Herzegovina Bulgaria 11 0 (0.0) (0.0) Croatia 1 0 (0.0) Cyprus Czech Republic 8 1 (13.0) (24.0) Denmark Estonia 19 0 (0.0) (0.0) Finland 36 0 (0.0) (0.0) France Georgia Germany (36.0) Greece 18 0 (0.0) (18.0) Hungary 14 1 (7.0) (3.0) Iceland Ireland 33 0 (0.0) (0.0) Israel 17 2 (12.0) (23.0) Italy Kazakhstan 3 0 (0.0) (92.0) Kyrgyzstan 33 0 (0.0) (28.0) Latvia 54 1 (2.0) (2.0) Lithuania Luxembourg 34 0 (0.0) (0.0) Malta Monaco Montenegro Netherlands 41 6 (15.0) (0.0) Norway 11 2 (18.0) (25.0) Poland (60.0) (20.0) Portugal Republic of Moldova 5 0 (0.0) (0.0) Romania 88 2 (2.0) (3.0) Russian Federation (4.0) (5.0) San Marino Serbia Slovakia (100.0) Slovenia 8 0 (0.0) (0.0) Spain 18 1 (6.0) (10.0) Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan 2 0 (0.0) (0.0) Ukraine 78 5 (6.0) (37.0) United Kingdom (23.0) (0.0) Uzbekistan 1 0 (0.0) (0.0) / Average (15%) (8%) *Specimen based data are not population based, and should not be interpreted as indicators for epidemiological surveillance. Laboratories may have received more than 1 clinical sample or may have conducted more than 1 test for a given case reported in Table 1. Data source: Aggregated monthly lab data provided by laboratories of the regional and rubella lab network. Issue 52 March 2009 page Page 5 7

6 Table 3. Classification of AFP cases and key AFP surveillance indicators, Countries doing AFP surveillance in WHO European Region Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Estonia Georgia Germany Greece Hungary Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Malta Montenegro Norway Poland Portugal Republic of Moldova Romania Russian Federation Serbia Slovakia Slovenia Spain Switzerland Tajikistan The former Yugoslav Republic of Macedonia Polio AFP Cases Compatible 2008 (Weeks 1-52) Turkey Turkmenistan Ukraine Uzbekistan Average/ Non polio AFP cases per children under the age of 15 years (annualized for year 2009). 2 Two stool specimens collected at least 24 hrs. apart within 14 days of onset of paralysis and adequately shipped to the laboratory. 3 Surveillance Index = non-polio AFP rate up to 1.0 x (% AFP cases with atleast 1 adequate specimens within 14 days of onset). 4 Hot Cases = AFP case reported with a priority code (e.g. less than three doses of polio vaccine/clinically polio/recent travel to endemic country/high risk group). 5 number of AFP cases pending final classification 90 days after date of onset. Surveillance Rates / Index Pendig % With 2 Classification AFP Rate 1 Index3 Cases Compatible Non-Polio Surveillance AFP Polio Stool Specimens 2 Target 1.00 Targ et 0.8 Target 80.0% 2009 (Weeks 1-13) Pending Classification Surveillance Rates / Index % % Annualized % With 2 Surveillance complete Timeliness Hot 4 Non-Polio Stool Index ness of >90 of weekly Cases Days 5 AFP Rate 1 Specimens 2 Targ et 0.8 weekly reporting Targ et 1.00 Targ et 80.0% reporting Issue 52 March 2009 page Page 6 8

7 EURO Immunization Monitor is published by: World Health Organization Regional Office for Europe Division of Health Programmes Communicable Diseases Unit Scherfigsvej 8, DK 2100 Copenhagen Ø, Denmark Chief editor: Dr David Mercer, Surveillance, Monitoring and Evaluation Editors: Mr Ajay Goel, Surveillance, Monitoring and Evaluation Dr Rebecca Martin, Targeted Diseases and Immunization Strengthening Editorial Team: Dr Niyazi O. Cakmak, Targeted Diseases and Immunization Strengthening Mr Jason Hoggan, Surveillance, Monitoring and Evaluation Dr Jeffrey V. Lazarus, Advocacy and Community Relations Dr. Srdan Matic, Head a.i. of the Communicable Diseases Unit Mr Ole Nørgaard, Advocacy and Community Relations Ms Nathalie Suez-Panama, Advocacy and Community Relations For comments or suggestions please write to EURO Immunization Monitor is available in Russian under the title Европейский вестник иммунизации World Health Organization 2009 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Issue 52 March 2009 page Page 7 9