The State of Measles and Rubella in the WHO European Region

Transcription

1 The State of Measles and Rubella in the WHO European Region Mark Muscat Vaccine-preventable Diseases and Immunization Rome, Italy, June 2016

2 All six WHO Regions have measles elimination goals 2

3 Annual reported cases, and MCV1* & MCV2** coverage, % reduction in reported measles cases * MCV1 coverage: coverage with first dose of measles-containing vaccine as estimated by WHO and UNICEF. **MCV2 estimates are only available from 2000 when global data collection started; however, some countries have introduced the vaccine earlier. Source: WHO/IVB database,

4 WHO/UNICEF Estimates of MCV1 coverage, countries have low MCV1 coverage 4

5 Measles case distribution by month and WHO regions, AFR SEAR AMR EMR EUR WPR Jan 2009 Apr Jul Oct Jan 2010 Apr Jul Oct Jan 2011 Apr Jul Oct Jan 2012 Apr Jul Oct Jan 2013 Apr Jul Oct Jan 2014 Apr Jul Oct Jan 2015 Apr Jul Oct Jan 2016 Apr This is surveillance data, hence for the last month, the data may be incomplete. Note: India started submitting monthly measles data from 2014 onwards. Source: surveillance DEF file Data in HQ as of 9 May

6 Reported measles incidence rate* - April 2015 to March 2016 (12 month period) 5 WHO Regions still endemic for measles <1 (91 countries or 47%) 1 - <5 (32 countries or 16%) 5 - <10 (32 countries or 16%) 10 - <50 (27 countries or 14%) 50 (13 countries or 7%) No data reported (11 countries or 6%) to WHO HQ Not applicable *Rate per population The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part 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. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved. Source: surveillance DEF file Data in HQ as of 9 May

7 Rubella-containing vaccine coverage by WHO region, Over half the world's children are not vaccinated against rubella Source: WHO/UNICEF coverage estimates 2014 revision. July 2015 Immunization Vaccines and Biologicals, (IVB), World Health Organization. 194 WHO Member States. Date of slide: 16 July

8 Countries with rubella vaccine in the national immunization programme and planned introductions in 2016 Data source: WHO/IVB Database, as of 12 April 2016 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization 8

9 Estimates of the median incidence of congenital rubella syndrome per 100,000 live births by country, 2016 Vynnycky E, et al. (2016) Using Seroprevalence and Immunisation Coverage Data to Estimate the Global Burden of Congenital Rubella Syndrome, : A Systematic Review. PLoS ONE 11(3): e doi: /journal.pone

10 WHO European Region 10

11 Number of measles cases and coverage with measles-containing vaccine, WHO European Region, Number of cases Immunization coverage (%) Data source: WHO/UNICEF JRF and CISID (as of 10 February 2014) 11

12 Measles in the WHO European Region, 1993, and * Bulgaria France Ukraine Georgia 7868 Russian Kyrgyzstan Federation % REDUCTION *Data extracted 04 June

13 Top 10 countries with measles cases, WHO European Region, 2015* Kyrgyzstan Bosnia and Herzegovina Germany Kazakhstan Russian Federation Georgia % of cases in the Region in 4 countries (n=27 085) France 373 Serbia 368 Turkey 342 Austria countries reported zero cases *Data extracted 04 June

14 Highest incidence countries for measles per million inhabitants WHO European Region, 2015* 10countries Highest incidence of >10 per million inhabitants Kyrgyzstan Bosnia and Herzegovina 1203 Kazakhstan 133 Georgia 108 Croatia 51 Serbia 42 Austria 36 Germany 30 Montenegro 24 Lithuania 18 WHO European Region 34 Armenia *Data extracted 04 June

15 Monthly distribution of measles cases, WHO European Region, 2015* Number of reported measles cases Other Kazakhstan Germany Bosnia and Herzegovina Kyrgyzstan 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec *Data extracted 04 June

16 Age distribution and vaccination status of measles cases, 2015* Age known in cases (35%) Number of reported measles cases Unknown number of doses Vaccinated 2 doses Vaccinated 1 dose Unvaccinated < Age group (years) *Data extracted 04 June

17 Age distribution of measles cases in the six selected countries in 2015 with data on age* % of % reported of of reported measles measles cases cases cases 40% 40% 40% 30% 30% 30% 10% 10% 10% 0% 0% 0% Turkey Turkey (n=342) Turkey (n=342) 31% 31% 29% 31% 29% 24% 29% 24% 24% 8% 8% 3% 4% 8% 3% 4% 2% 2% <1 < % 4% % Age Age group group (years) (years) < Age group (years) % of of reported measles cases cases % of reported measles cases 40% 40% 40% Germany (n=2381)* Germany (n=2381)* Germany (n=2381)* 30% 30% 30% 16% 17% 16% 12% 13% 17% 14% 12% 13% 14% 16% 17% 10% 8% 8% 10% 12% 13% 14% 10% 8% 0% 0% <1 < % Age Age group group (years) (years) < Age group (years) % of of reported measles cases cases % of reported measles cases Italy Italy (n=259)* (n=259)* Italy (n=259)* 40% 40% 40% 33% 33% 30% 33% 30% 30% 24% 24% 21% 21% 24% 21% 10% 8% 10% 8% 6% 8% 6% 8% 10% 1% 1% 8% 6% 8% 0% 0% <1 <1 1% % Age Age group group (years) (years) < Age group (years) % of % of reported measles cases 40% 30% 10% 10% 0% 0% 25% 25% Kazakhstan Ukraine Kazakhstan Ukraine (n=977) (n=2340) (n=977) (n=2340) 13% 13% 10% 10% 10% 10% 2% 3% 0% 2% 3% 0% < <1 1 4Age group 5 9 (years) Age group (years) % of of reported measles cases cases % of reported measles cases 40% 40% 40% Bosnia and Serbia (n=304)(n=2238)* Bosnia Bosnia and Serbia Herzegovina and Serbia Herzegovina (n=304) (n=2238)* (n=2238)* 30% 30% 30% 21% 21% 15% 14% 16% 21% 15% 15% 12% 14% 16% 15% 15% 12% 14% 16% 15% 10% 7% 7% 12% 10% 10% 7% 0% 0% <1 < % Age Age group group (years) (years) < Age group (years) % of of reported measles cases cases % of reported measles cases 40% 40% 40% 30% 30% 30% Russian Federation (n=639)* Russian Russian Federation Federation (n=639)* (n=639)* 34% 34% 34% 17% 17% 17% 9% 8% 10% 10% 9% 8% 7% 5% 7% 10% 9% 8% 5% 7% 5% 0% 0% <1 < % Age Age group group (years) (years) < Age group (years) *Data extracted 04 June For 2345 cases from Bosnia and Herzegovina, 2 cases from Germany and 1 case from Russian Federation, the age group was unknown. 17

18 Measles outbreaks occurred in several susceptible populations Roma and Sinti communities Susceptible adults Unvaccinated adolescents Traveller communities Unvaccinated children Health care workers Orthodox protestant communities Followers of anthrposophy Ultra orthodox Jewish communities 18

19 Main public settings for measles outbreaks Health-care settings Proportion of measles among health care workers in selected countries, 2014 Laboratory confirmed measles outbreak cases in Latvia (n= 31) Other 58% HCW 42% Measles outbreak cases in Czech Republic (n=171) Bulgaria Croatia Czech Republic Denmark France Greece Latvia Italy Netherlands Spain Switzerland Other 60% HCW 40% Measles outbreak cases in Spain (n=120) Other 75% HCW 25% Further reading: WHO EpiBrief, 2014, 2:1 9 data/assets/pdf_file/0020/254234/epibrief_2_2014-rev3-with-data.pdf?ua=1 19

20 Main public settings for measles outbreaks Educational facilities Universities Anthroposophic Schools Schools Austria France Germany Ireland Italy Spain Switzerland UK Kindergardens Day care centres 20

21 Rubella in the WHO European Region, 2000 and * Romania 4805 Romania Poland Poland 5899 Poland % REDUCTION *Data extracted 04 June

22 Countries with rubella cases, WHO European Region, 2015* Poland Georgia Germany Italy Romania % of cases in the Region in 1 country (n=2029) Russian Federation 14 Bosnia and Herzegovina 12 United Kingdom 10 Bulgaria other countries countries reported zero cases *Data extracted 04 June

23 Monthly distribution of rubella cases, WHO European Region, Other Number of reported rubella cases Italy Germany Georgia Poland 92% of cases in the Region (n=2259) 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec *Data extracted 04 June

24 Diagnosis classification of reported rubella cases in top four countries, 2015 Number of reported rubella cases Germany (n=91) Clincally compatible Epidemiologically linked Laboratory confirmed Number of reported rubella cases Italy (n=37) Clincally compatible Epidemiologically linked Laboratory confirmed Number of reported rubella cases < Age group (years) Poland (n=2029) Clincally compatible Epidemiologically linked Laboratory confirmed Number of reported rubella cases < Age group (years) Georgia (n=100) Clincally compatible Epidemiologically linked Laboratory confirmed 0 < Age group (years) 0 < Age group (years) 24

25 the challenges 25

26 1. High vaccination coverage 2. Closing Immunity gaps Commitment 3. Highquality surveillance 4. Knowledge and training 26

27 Challenge 1 Reaching and maintaining high vaccination coverage Delayed vaccination Vaccine hesitants Lost to follow up Vaccine refusals Distrust in vaccines Previously not targeted for vaccination Distrust in health authorities Lack of access 27

28 Addressing the challenge Reaching and maintaining high vaccination coverage Strengthen immunization programmes Electronic vaccination registry Reminder and recall systems Champions and experts as advocates 28

29 Challenge 2 Closing immunity gaps Susceptible adults Unvaccinated adolescents Susceptible health care workers Low coverage communities 29

30 Addressing the challenge Supplementary immunization activities Tailoring Immunization Programmes Closing immunity gaps Pre school entry policies Health care workers policies Opportunity vaccination Pre travel vaccination 30

31 Challenge 3 Performing high-quality surveillance Inadequate reporting of suspected cases Sub optimal laboratory testing rate Insufficient genotyping and sequencing Distribution of rubella genotypes year 2015 Measles Lack of national operating procedures for epidemiological and laboratory investigations Rubella 31

32 Addressing the challenge Performing high-quality surveillance Reporting of suspected cases Epidemiological investigation Laboratory confirmation Genotyping and sequencing Establishing national operating procedures for epidemiological and laboratory investigation 32

33 Challenge 4 Knowledge and training Widespread misinformation and myths Lack of education and training on vaccines in medical curricula Vaccine side-effects are worse than the actual disease False contraindications Lack of information Lack of personal knowledge and disease awareness The MMR vaccine causes childhood disorders, including autism Sophistication of anti vaccine lobbying and media skills 33

34 Addressing the challenge Knowledge and training Web based information on diseases and benefits of vaccines Medical curricula Continued medical education Training in communication School based learning Health care workers to promote vaccines Champions and experts as advocates 34

35 Resource mobilization and partnerships 35

36 Verification of Measles and Rubella elimination Regional Verification Commission (RVC) established in th RVC meeting, November 2015 Evaluation of country Annual Status Updates and feedback to countries Meetings with National Verification Committees Modifications to verification process Updating of annual reporting form Messaging and communication 36

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40 Summary Progress has been made toward eliminating measles and rubella WHO European region off track for 2015 goal More action needed: Commitment Maintaining high vaccination coverage Closing immunity gaps High-quality surveillance Fostering partnerships 40

41 Acknowledgements Colleagues at Vaccine-preventable Diseases and Immunization Unit Myriam Ben Mamou Catharina De Kat-Reynen Dragan Jankovic Theodoros Kaloumenos Patrick O Connor Simarjit Singh 41