Welcome to the new EURO Immunization Monitor

Transcription

1 Welcome to the new EURO Immunization Monitor The Communicable Diseases Unit of the WHO Regional Office for Europe is charged with maintaining the fight against infectious diseases. One of the priority areas is vaccine-preventable diseases, and immunization is one of the primary tools to reduce their transmission. In order to provide timely feedback to and share information with our European Region Member States and partners, we decided to combine the two disease-specific bulletins (the EURO Polio Page and the Measles and Rubella Surveillance Bulletin) with the European Immunization Week Newsletter. Regional news and developments regarding immunization are now available in our new bulletin: the EURO Immunization Monitor. The EURO Immunization Monitor will provide regular information on immunization-related activities occurring in the European Region while continuing to monitor the performance of polio, measles, and rubella surveillance and immunization coverage rates. With the introduction of new vaccines in the Region, we will also monitor the performance of surveillance for such diseases as Hib and rotavirus in future. We seek to provide strategic information in the area of immunization and vaccinepreventable diseases in an integrated manner to strengthen the synergy of activities that are delivered in the Member States. WHO s goals include keeping the Region polio-free and achieving measles and rubella elimination by In general, immunization coverage rates are relatively high in the Region, at over 90%; however, this figure masks pockets of susceptibility at the subnational level. Where there are declining coverage rates, the incidence of vaccine-preventable diseases can increase. his is documented by the measles outbreaks seen in many western European countries in 2007 and 2008 causing illness, and even disability or death, and placing a considerable burden on the health care system. Immunization is a collective responsibility involving governments, legislators, health providers, parents/care-givers, and other stakeholders. European Immunization Week, celebrated annually in April, is one of our initiatives to assist countries to collectively address national immunization challenges. We hope the EURO Immunization Monitor will provide the needed information that will benefit your immunization efforts. As in the past, we look forward to any feedback from you on the bulletin and its contents. The Editorial team Regional Committee: report of progress towards 2010 measles and rubella elimination goals At the Regional Committee for Europe (15-18 September, Tbilisi, Georgia) the progress regarding the implementation of Resolution EUR/RC58/R7 (strengthening of national immunization systems through elimination of measles and rubella and prevention of congenital rubella infection) was reported for the period In conclusion, the elimination goals for 2010 are reachable, if countries ensure that the gains made to date are sustained and not jeopardized by the challenges that are still being faced. Substantial successes have been achieved within the Region regarding the control of measles and rubella. All 53 countries now have a routine 2-dose measles vaccination programme and all but one country has introduced rubella vaccine. Reported measles incidence in the Region in 2007 (6923 cases to date) dropped almost 90% from 2006 levels, and the number of countries reporting measles incidence of <1 per population (elimination target) increased to 29 from 19 in Furthermore, in 2006 and 2007 nationwide supplementary immunization activities were successfully implemented in Armenia, Azerbaijan, Turkmenistan and Uzbekistan, reaching nearly 15 million children, young adults, and women of childbearing age, while strengthening routine immunization programmes and surveillance. However, in the countries with the lowest vaccination coverage, national immunization programmes are challenged by a combination of public and political complacency regarding the value of immunization, and by a disturbing rise in the influence of anti-vaccination groups and their dangerously misleading advocacy campaigns. Nine of the ten countries in the Region with the lowest average measles immunization rates from 2000 through 2007 are in the European Union. 18th Meeting of the Global Advisory Committee on Vaccine Safety, June 2008 The Global Advisory Committee on Vaccine Safety (GACVS), an expert clinical and scientific advisory body, was established by WHO in 1999 to respond promptly, efficiently and with scientific rigour to vaccine safety issues of potential global importance. Issues described by the Committee during its 18th meeting, held 1

2 on June in Geneva, Switzerland, included the safety of yellow fever vaccine, mitochondrial diseases and vaccination, and thiomersal. Safety of yellow fever vaccine The Committee was updated on evidence regarding the safety of 17D yellow fever vaccines. It focused primarily on four fatal cases and one non-fatal case of vaccine-associated viscerotropic disease (YEL-AVD) occurring among individuals vaccinated in the Ica Region of Peru following a yellow fever vaccination campaign conducted in September-October 2007 after a major earthquake. All five cases received vaccine from the same lot. The incidence of YEL-AVD (estimated as 11.7/ vaccinated based on the number of people receiving the vaccine lot or 7.9/ based on all those vaccinated in the Ica Region) was noted to be more than 20 times higher than the risk previously associated with 17D vaccines in general. Following review of the data collected during the investigation, the Committee concluded that the cause of the cluster of cases was not clear. One of the cases presented a known risk factor; a second case presented a potential risk factor. Tests showed that the lot administered met all quality specifications and the yellow fever virus isolated from three confirmed cases was consistent with the vaccine virus and did not appear to have mutated. Approximately doses of the vaccine lot common to the YEL-AVD cases was confirmed to have been used elsewhere in Latin America without additional cases of YEL-AVD. The GACVS reiterated the need to obtain better estimates of rates of serious adverse events and to be better able to predict which individuals are at risk for such events. Members indicated support for the initiatives of WHO and other global partners in these areas. Mitochondrial diseases and vaccination The GACVS reviewed the limited data on mitochondrial disorders and vaccination available from the United Kingdom of Great Britain and Northern Ireland and the United States. The Committee concluded that there is no convincing evidence to support an association between vaccination and deterioration of mitochondrial diseases (inherited disorders of energy metabolism that tend to affect tissues with high energy requirements such as the brain, heart and liver). The topic will be reviewed further if new findings become available. GACVS supports continued vaccination of children with mitochondrial diseases with the same vaccines as are given to healthy children. Thiomersal The Committee reviewed a recently-published pharmacokinetic study of mercury in premature and low-birth-weight infants who received a birth dose of hepatitis B vaccine containing thiomersal, and the results of a study conducted in Italy that examined neuropsychological performance 10 years after immunization in infancy with thiomersal-containing vaccines. On the basis of the presented data, GACVS remains of the view that there is no evidence to support a change in WHO s recommendations for thiomersal-containing vaccines and the vaccination of low-birth-weight infants where indicated. Other topics discussed during the meeting were: diphtheriatetanus-pertussis (DTP) vaccine and asthma; non-specific effects of DTP vaccine on child mortality; and inadvertent administration of rubella vaccine to women shortly before or during pregnancy. The report of the meeting was published in the WHO Weekly Epidemiological Record on 8 August and has been posted on the GACVS web site at COUNTRY UPDATES Georgia In its efforts to reach the regional goal of measles elimination in the European region by 2010, Georgia will conduct supplementary immunization activities starting 20 October A nation-wide measles and rubella mass immunization campaign will target approximately 1.1 million people aged 6-27 years throughout the country will be implemented until 2 November In Georgia experienced its largest measles outbreak since 1973, with more than 85% of all measles cases detected among persons born after The outbreak likely resulted from failure to vaccinate, rather than vaccine failure. Routine immunization coverage in Georgia is still below the 95% target for both MMR1 and MMR2. To achieve the regional measles and rubella elimination goals, high population immunity must be rapidly attained among susceptible birth cohorts that are sustaining measles and rubella transmission. RECENTLY PUBLISHED Jagessar N, Lazarus JV, Laurent E, Matic S Emiroglu N. Immunization: mind the gap [Editorial]. Vaccine. 13 August This editorial in Vaccine, submitted by the WHO Regional Office for Europe, advocates for immunization, and elaborating on its successes and the importance of keeping it high on the public health agenda. Lazarus JV, Häggblom A, Kirkegaard L, Lundgren JD, Matic S. The elusive search for an HIV vaccine-and what to do meanwhile [Editorial]. Vaccine Sep 22. 2

3 UPCOMING EVENTS 5-8 November 2008, Lisbon, Portugal: EUPHA annual conference 2008 At the 2008 conference of the European Public Health Association the WHO Regional Office will have session on communicable diseases on Thursday 6 November, including presentations on European Immunization Week, tuberculosis, pandemic preparedness and HIV/Aids November 2008, Berlin, Germany: ESCAIDE The 2008 European Scientific Conference on Applied Infectious Disease Epidemiology will have several sessions addressing vaccine preventable diseases (including measles and rubella elimination) as well as reaching hard-to-reach groups November 2008, Ankara, Turkey: Meeting on New Vaccines Introduction within the Context of Immunization Systems Strengthening The WHO Regional Office for Europe, in collaboration with the International Children s Centre in Ankara, will organize a meeting on policies and strategies for introducing new and underutilized vaccines within the context of immunization systems strengthening. Specific emphasis will be placed on Heamophilus influenza type b (Hib), rotavirus and pneumococcal vaccines. There will also be a session on measles and rubella elimination activities. EUROPEAN IMMUNIZATION WEEK The invitations to all Member States to participate in European Immunization Week 2009 have been sent out and we hope again that many countries will join our efforts to boost immunization programmes across the Region next year. For all participants who would like to join there are guidelines for national planning available on our web site ( where more information and updates about the initiative are presented as well. Evaluation of EIW 2008 As the evaluation report of European Immunization Week 2008 is being finalized we are happy to give a preview of some numbers that have been reported and that indicate the diversity and success of this year s event! Hundred thousands of information materials, posters and flyers were developed and distributed to inform people about the importance of immunization. In addition, the public could search information about immunization through new web sites that were launched, and some countries even opened special immunization hotlines, answering over phone calls. At schools in the Region special lessons were given about immunization. Furthermore, over trainings were organized for health professionals and other groups, including teachers and parents and people of vulnerable groups. Door-to-door distribution of information about immunization reached over half a million people. Other outreach activities resulted in over updated immunization cards, and during the week almost 2 million supplementary vaccinations were administered. All countries that participated were positive about the success of the event, believing that it would have an increasing effect on vaccination uptake in future, and most of them indicated they would like to participate in the initiative again. 3

4 Figure 1. EIW in the European Region The map indicates which countries have participated in European Immunization Week The designations employed and the presentation of this material 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. European Immunization Week in short WHY: While major progress has been made in the fight against vaccine-preventable diseases, gaps in vaccination uptake rates show that immunization strengthening remains vital. Annually an estimated infants in the Region miss their routine vaccination, and children still die from diseases that could have been prevented with vaccines. Some of those not immunized belong to hard-to-reach groups that lack information about the importance and availability of vaccination. Others are not immunized as a result of growing anti-vaccination sentiment and skepticism. European Immunization Week provides the momentum to counter these challenges. WHAT: European Immunization Week assists member states of the WHO European Region to fulfill their obligations of universal immunization. The main purpose is to increase the number of people in the European Region that are immunized against vaccine-preventable diseases. HOW: During the event, participating countries engage in a range of advocacy and targeted communication activities to promote the core message that the immunization of every child is vital to prevent disease and protect life. A special focus is placed on targeting vulnerable and hard-to-reach groups. WHO: The annual initiative is led and coordinated by the WHO Regional Office for Europe and implemented by member states, addressing their own specific immunization issues. Partner organizations contribute to action at both regional and national level. 4

5 Table 1: Classification of suspected measles and rubella cases, Jan-Sep, 2008 Measles Rubella Classification Monthly Reporting Classification Monthly Reporting Country suspected measles (%) Lab confirmed Epi-Link Clinical 1 Discarded % Completeness % Timeliness suspected Rubella (%) Lab confirmed Epi-Link Clinical 1 Discarded % % Completeness Timeliness Albania % 100% % 77% Andorra % 88% % 88% Armenia % 55% 3 3 (100%) % 55% Austria (100.0) % 22% % 0% Azerbaijan 1 1 (100.0) % 66% % 44% Belarus % 77% 1 1 (100%) % 88% Belgium (98.0) % 33% % 0% Bosnia and Herzegovina % 0% % 0% Bulgaria 1 1 (100.0) % 44% % 0% Croatia (72.0) % 66% % 0% Cyprus % 88% % 100% Czech Republic (100.0) % 88% % 0% Denmark (71.0) % 55% 9 9 (100%) % 0% Estonia % 55% % 22% Finland (100.0) % 88% % 0% France (94.0) % 44% % 0% Georgia (100.0) % 77% (100%) % 66% Germany (98.0) % 66% % 0% Greece 1 1 (100.0) % 33% % 0% Hungary % 66% % 0% Iceland % 55% % 0% Ireland (84.0) % 66% (100%) % 100% Israel (100.0) % 0% % 0% Italy (100.0) % 11% % 0% Kazakhstan (100.0) % 33% (100%) % 22% Kyrgyzstan 6 1 (17.0) % 88% % 0% Latvia 6 6 (100.0) % 66% 5 5 (100%) % 44% Lithuania 1 1 (100.0) % 55% % 66% Luxembourg % 11% % 0% Malta 1 1 (100.0) % 77% % 0% Moldova % 55% % 0% Monaco % 0% % 0% Montenegro % 44% % 44% Netherlands (100.0) % 0% % 0% Norway (100.0) % 88% % 0% Poland (33.0) % 22% % 0% Portugal % 22% % 0% Romania (9.0) % 22% % 0% Russian Federation (100.0) % 100% % 0% San Marino % 0% % 0% Serbia % 55% % 0% Slovakia % 88% 1 0 (0%) % 44% Slovenia % 88% % 0% Spain (95.0) % 44% % 0% Sweden (96.0) % 66% % 0% Switzerland (84.0) % 11% % 0% Tajikistan % 11% (100%) % 11% The former Yugoslav Republic of Macedonia 5 5 (100.0) % 88% 1 1 (100%) % 22% Turkey 3 3 (100.0) % 0% % 0% Turkmenistan % 55% % 0% Ukraine (100.0) % 66% % 11% United Kingdom (86.0) % 33% % 0% Uzbekistan 2 2 (100.0) % 77% (100%) % 66% /Averages (88.0) % 50% (100.0) % 19% Data source: Monthly aggregate and case-based data reported by Member States to WHO/Europe and/or EUVAC.NET. 1 Cases with missing classification are classified as "Clinical" 2 Importation of measles cases (included in total measles cases): Austria=14; Belgium=2;Bulgaria=1; Czech Republic=1; Denmark=4; Finland=4; France=9;Germany =72; Ireland=3; Latvia=1; Netherlands=4; Norway=2; Poland =3; Romania = 8(including 4 import related cases) ; Spain=5; Sweden=11; Switzerland=10, UK=13. 5

6 Table 2: Measles and rubella laboratory test results, Jan-Sep, 2008 Specimen* (Serum, Oral Fluid, Swab, Urine and other) Reporting Country Collected Tested for measles Positive for measles (%) Measles Equivocal Negative for measles Tested for rubella Positive for rubella (%) Rubella Equivocal Negative for rubella % Completeness % Timeliness Albania (0.0) Andorra Armenia (3.0) (0.0) Austria (9.0) (0.0) Azerbaijan (17.0) (0.0) Belarus (0.0) (1.0) Belgium (35.0) (14.0) Bosnia and Herzegovina Bulgaria (4.0) (2.0) Croatia (34.0) (0.0) Cyprus Czech Republic (17.0) (5.0) Denmark Estonia (1.0) (1.0) Finland (10.0) (0.0) France Georgia (0.0) (15.0) Germany (45.0) (30.0) Greece Hungary (0.0) (0.0) Iceland Ireland (5.0) (0.0) Israel (37.0) (23.0) Italy Kazakhstan (14.0) (60.0) Kyrgyzstan (6.0) (4.0) Latvia (2.0) (0.0) Lithuania (11.0) (0.0) Luxembourg (0.0) (16.0) Malta Moldova (0.0) (0.0) Monaco Montenegro Netherlands (54.0) (0.0) Norway (6.0) (19.0) Poland (21.0) (28.0) Portugal (20.0) Romania (6.0) (1.0) Russian Federation (2.0) (16.0) San Marino Serbia (0.0) (2.0) Slovakia (14.0) Slovenia (0.0) (14.0) Spain (39.0) (7.0) Sweden Switzerland Tajikistan (0.0) (10.0) The former Yugoslav Republic of Macedonia Turkey (1.0) (6.0) Turkmenistan (1.0) (2.0) Ukraine (3.0) (4.0) United Kingdom (27.0) (2.0) Uzbekistan (4.0) (71.0) / Average (17%) (6%) *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 measles and rubella lab network. 6

7 Table 3: Classification of AFP cases and key AFP surveillance indicators, (Weeks 1-52) 2008 (Weeks 1-43 ) Country Polio Compatible Pendig Classification Non-Polio AFP Rate 1 Target 1.00 Surveillance Rates / Index % With 2 Stool Specimens 2 Target 80.0% Surveillance Index 3 Target 0.8 AFP Cases Polio Compatible Pending Classification Hot 4 Cases >90 Days 5 Annualized Non-Polio AFP Rate 1 Target 1.00 Surveillance Rates / Index % With 2 Stool Surveillance Specimens 2 Target 80.0% Index 3 Target 0.8 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 Moldova Montenegro Norway Poland Portugal Romania Russian Federation Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine Uzbekistan Average/ Non polio AFP cases per children under the age of 15 years (annualized for year 2008) 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. 7

8 EURO Immunization Monitor is published by: World Health Regional Office for Europe Division of Health Programmes Communicable Diseases Unit 8 Scherfigsvej 2100 Copenhagen Ø Denmark Chief editor: Dr David Mercer, Surveillance, Monitoring and Evaluation Editors: Mr Ajay Goel, Surveillance, Monitoring and Evaluation Ms Naroesha Jagessar, Advocacy and Community Relations 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 Mr Eric Laurent, Targeted Diseases and Immunization Strengthening Dr Jeffrey V. Lazarus, Advocacy and Community Relations Ms Nathalie Suez-Panama, Advocacy and Community Relations For comments or suggestions please write to vaccine@euro.who.int 8