EUVAC.NET A surveillance network for vaccine-preventable diseases Mark Muscat EUVAC.NET Co-ordinator Department of Epidemiology Statens Serum Institut Denmark Email: mmc@ssi.dk Viral Hepatitis Prevention Board Meeting 15-16 November 2007 Athens, Greece 1
EUVAC.NET Aim To operate a Community surveillance network for vaccine-preventable infectious diseases (VPD) using epidemiological and laboratory surveillance methods 2
The Main Objectives To develop standardised surveillance methods To identify strengths and weaknesses in surveillance systems for VPD To disseminate and exchange information on VPD occurrence To detect and report on outbreaks in EU 3
EUVAC.NET s main collaborating partners Public health and surveillance institutions of all 27 EU Member States + Croatia, Iceland, Norway, Switzerland and Turkey Hub Department of Epidemiology 4
Historic landmarks Countries participating 15 EU member states + Iceland, Norway and Switzerland Malta Croatia 11 new EU member states + Turkey EU funding period* 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 DG SANCO Establishment of EUVAC.NET Establishment of ECDC *Gaps funded solely by Statens Serum Institut 5
VPD Surveillance Varicella A Rubella Mumps A A Pertussis A Measles M 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Data collected Data to be collected Data being collected A = Annual data M = Monthly data 6
WHO European Region strategic plan 2005-2010 The revised objectives for 2010 are: To eliminate endemic measles To eliminate endemic rubella To prevent congenital rubella syndrome (<1 per 100 000 live births) 7
Key strategies for measles and rubella elimination 1. Achieve and sustain >95% coverage with two doses of measles through high-quality routine immunization services 2. Provide a second opportunity for measles immunization to susceptible groups 3. Provide rubella vaccination opportunities, to all susceptible children, adolescents and women of child bearing age 4. Strengthen surveillance systems 5. Improve the availability of information for health professionals and the public on the benefits and risks associated with immunization EUVAC.NET actively contributes to the measles elimination plan through its measles surveillance activities 8
Standardizing and harmonizing surveillance systems EUVAC.NET s collaboration with ECDC on: EU case definitions Data variables for reporting Hub 9
EUVAC.NET: Case definitions on website 10
Strengthening surveillance systems Percentage of data with known status, 2001-2006* (19 case-base reporting countries 2001-2006) 100% 90% Hospitalisation status Importation status Outbreak status Vaccination status 80% Map: Case-base reporting countries, 2001-2006 70% % known data 60% 50% 40% 30% 20% 10% 0% 2003 2004 2005 2006* *Provisional 11
Strengthening surveillance systems Molecular epidemiology : a useful and a necessary component of an enhanced surveillance system required in the measles elimination phase. plays an important role in documenting the interruption of endemic measles transmission. Amplification by RT-PCR and agarose gel electrophoresis Photo source: Department of Virology, Statens Serum Institut 12
EUVAC.NET reporting on measles surveillance Public health and surveillance institutions of all 27 EU Member States + Croatia, Iceland, Norway, Switzerland and Turkey Data Management Graphic reports Scientific publications Annual reports 13
VPD outbreak notification on website 14
VPD outbreak information sharing in Forum site 15
VPD outbreak information sharing in Forum site 16
Reported measles cases by year, 2001-2006 (19 case-base reporting countries 2001-2006) 25000 23765 Germany 20000 Ireland no. of reported measles cases 15000 10000 7428 13696 Italy Other Total Map: Case-base reporting countries, 2001-2006 5000 1496 1442 4226 0 2001 2002 2003 2004 2005 2006* Data source: EUVAC.NET * Provisional data 17
Reported incidence of indigenous measles per 100,000 inhabitants by country, 2006 (n=7,827) No. of countries >1 7 0.1-1.0 8 <0.1 17 1.14 1.08 2.49 Germany: 2,282 cases Zero cases 11 Romania: 3,169 cases 4.34 Data source: EUVAC.NET 18
Changes in indigenous incidence of measles per 100,000 inhabitants from 2005 to 2006 Austria Denmark Latvia Poland Spain Germany UK Luxembourg Estonia Sweden Malta Turkey Italy Greece Italy Belgium Ireland Belgium Rest Switzerland Romania Switzerland Rest <0.1 0.1-1.0 >1 0.1-1.0 <0.1 19
Measles in Europe Highlights 2006 Still a problem in many European counties Large outbreaks at national level Anti-vaccination lobbying Identified susceptible groups: Unvaccinated persons Increasing age groups Imported cases Hard-to-reach communities 20
Mumps suveillance at national level Case-based data from mandatory reports Aggregated data from mandatory reports Sentinel surveillance clinician-based No national surveillance 21
Countries with mandatory reporting systems for mumps providing data for 2000-2005 (n=24) All clinical, laboratory confirmed and epidemiologically- linked cases were included 24 countries 22
No. of reported mumps cases in 24 EUVAC.NET countries, 2000-2005 (n=837,839) No. of reported mumps cases 220,000 200,000 180,000 160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0 Romania Italy Other United Kingdom Poland Total 2000 2001 2002 2003 2004 2005 23
Pertussis data collection previous contract 19 countries participated 1998-2002 1998-2001 No data provided Report is available at: http:///graphics/euvac/pdf/pertussis.pdf 24
No. of reported pertussis cases in 14 EUVAC.NET participating countries, 1998-2002 (n=77,419) 20000 The Netherlands Italy Norway Other Total No. of reported pertussis cases 18000 16000 14000 12000 10000 8000 6000 4000 2000 0 1998 1999 2000 2001 2002 Note: No data from Spain and Sweden 2002. Denmark provided data only on population 0-2 years of age. Only data from former East Germany was available for this period. 25
No. of reported pertussis cases in 14 EUVAC.NET participating countries by country, 1998-2002 (n=77,419) Austria Denmark Germany Greece Iceland Ireland Italy Malta The Netherlands Norway Portugal Spain Sweden United Kingdom No. of reported pertussis cases 0 5000 10000 15000 20000 25000 30000 26
Countries with mandatory reporting systems for varicella providing data for 2000-2005 (n=14) All clinical, laboratory confirmed and epidemiologically- linked cases were included 14 countries 27
No. of reported varicella cases in 14 EUVAC.NET participating countries, 2000-2006 (n=3,421,957) Poland Italy Hungary Romania Czech Republic Bulgaria Other Total No. of reported chickenpox cases 650,000 600,000 550,000 500,000 450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0 2000 2001 2002 2003 2004 2005 2006 Year 28
Childhood vaccination schedules on website 29
MMR vaccination schedules overview on website 30
National Plans of Action on website Measles Measles and Rubella/congenital rubella Such national plans provide essential guidelines towards the elimination of measles and rubella and are therefore highly commendable. The "national plans" page on the euvac.net website serves as a source of information and inspiration to countries that have not yet published such a document. 31
References The EUVAC-NET survey: national measles surveillance systems in the EU, Switzerland, Norway, and Iceland. S. Glismann, T. Ronne, J.E. Schmidt. Eurosurveillance 2001;6:105-10. The EUVAC-NET project: creation and operation of a surveillance community network for vaccine-preventable diseases. S. Glismann, T. Rønne. Eurosurveillance 2001;6:94-8. The EUVAC-NET survey: national pertussis surveillance systems in the European Union, Switzerland, Norway, and Iceland. J.E. Schmidt, A.E. Tozzi, L. Rava, S. Glismann. Eurosurveillance 2001; 6: 98-104. World Health Organization. Eliminating measles and rubella and prevention congenital rubella infection, WHO European Region strategic plan 2005-2010. Available from: http://www.euro.who.int/document/e87772.pdf Measles surveillance annual report 2005. EUVAC.NET. Available from: http:///graphics/euvac/pdf/annual_2005.pdf Measles surveillance annual report 2006. EUVAC.NET. Available from: http:///graphics/euvac/pdf/annual_2006.pdf EUVAC.NET. Home page. http:// 32
σας ευχαριστούμε Statens Serum Institut, Copenhagen, Denmark 33