A MONTHLY NEWSLETTER OF THE WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR EUROPE Issue 12, November 2009 Tenth meeting of the European Technical Advisory Group of Experts on Immunization: Outcomes and recommendations The European Advisory Group on Expanded Programme on Immunization (EAG / EPI) was established in the WHO European Region in the early 1990s to facilitate the development of the Regional immunization programme. Since then, many countries in the Region have undergone major health care reforms. Thus, the European Technical Advisory Group of Experts on Immunization (ETAGE) was established to respond to changes in health systems and disease epidemiology. The main goal of ETAGE is to provide independent review and expert technical input to the WHO European Region s immunization programme, with the objective of facilitating and accelerating achievements of the regional targets. The members of the ETAGE are appointed by the WHO Regional Director for Europe based on their technical expertise and experience. ETAGE meets at least once a year. In 2009, it held its tenth meeting on 29 30 September at the WHO Regional Office for Europe in Copenhagen, Denmark. Representatives of National Immunization Technical Advisory Groups from selected Member States, the European Centre for Disease Prevention and Control (ECDC), the European Union wide surveillance network for vaccine-preventable diseases (EUVAC) and WHO Regional Office for Europe, participated in the meeting. The main topics for discussion included the status and nature of reporting systems for surveillance of vaccine preventable diseases in the Region, the most recent recommendations from the Strategic Advisory Group of Experts (SAGE), the availability and recommendations for use of vaccine against pandemic (H1N1) 2009 influenza, the status of the Targeted Diseases and Immunization (TDI) Strategic Plan 2010 2015 and the likelihood of achieving the 2010 Regional measles elimination goal. The meeting resulted in following principle recommendations: * Surveillance of vaccine preventable diseases (VPDs): ETAGE recommended the establishment of a Working Group which includes representatives from WHO, ECDC and selected Member States to rationalize and harmonize requirements and mechanisms for reporting vaccine preventable diseases to WHO and ECDC. Activities of the Working Group should be focused on establishing a common platform for Member States for reporting surveillance data, with open access to both organizations. In addition, a core variable dataset should be defined from which both organizations can then add other variables. Experience gained through the operation of EUVACNET should be reviewed and utilized. * National Immunization Technical Advisory Groups (NITAGs): the WHO Regional Office for Europe should continue development of NITAG support and strengthening tools and procedures to establish an effective system of immunization information sharing and exchange, both between Member States and with the WHO Regional Office. * Pandemic (H1N1) 2009 vaccination: ETAGE endorsed the SAGE recommendations that immunization against pandemic (H1N1) 2009 influenza should not alter existing plans for immunizing target groups with seasonal influenza vaccination or delay /adjust routine immunization schedules for other antigens. It also endorsed the SAGE recommendations on prioritization of groups for receipt of pandemic (H1N1) 2009 influenza vaccine. * Measles elimination by 2010: ETAGE acknowledged the successful efforts made by many Member States to eliminate measles in accordance with the Regional 2010 elimination goal. It noted, however, that a number of Member States, particularly in western Europe, were not only unlikely to meet the 2010 target, but posed a significant threat for exporting measles virus to other Member States. ETAGE recommendations from October 2008 and March 2009 should continue to be followed up by the WHO Regional Office for Europe and Member States.
* Regional Targeted Diseases and Immunization (TDI) Strategic Plan 2010 2015: ETAGE recommended that the draft Regional TDI Strategic Plan should be finalized as a working document for distribution. ETAGE expected that the document would be open for periodic review and possible revision until 2015. * Projected funding gap for TDI in 2010 2011: ETAGE recommended that a partner meeting for mobilization of resources for immunization and VPD surveillance in the European Region should be held as soon as possible. * Improvement of pre-service and in-service training for vaccinology and surveillance of VPDs: ETAGE recommended to the WHO Regional Office for Europe to develop a platform to share best practices and provide advice on national training activities to the Member States. Meeting report Global measles management meeting The global measles management meeting was held on 14 16 October 2009 at WHO headquarters to review progress on regional measles elimination and /or mortality reduction, to evaluate the feasibility of global measles eradication and to compare regional experiences with proposed indicators for monitoring progress towards measles elimination. Participants included WHO headquarters and Regional Offices staff and representatives from partner agencies. In regard to global measles eradication, it was noted that five of six WHO regions now have measles elimination goals. In 2009, the Regional Committee for Africa agreed to adopt actions for achieving measles elimination by 2020 and the Regional Committee for South-East Asia passed a resolution urging Member States to mobilize political, societal and financial support towards elimination of measles. As a milestone towards global measles eradication, WHO headquarters proposed the following interim 2015 goals: 1. achieve 90% first-dose measles vaccination coverage nationally and 80% in every district; 2. reduce measles mortality by 95% compared to 2000 estimates; and 3. reduce annual measles incidence to 5 per million population. Regarding indicators for monitoring progress towards measles elimination, it was proposed that: 1. while incidence should continue to be monitored, establishing a target of <1 per million population as indicative of progress should not be used as it is sometimes mistakenly confused with having achieved elimination; 2. absence of endemic virus is the definition of measles elimination, not an indicator of progress towards measles elimination; 3. the discarded measles rate from the second administrative level (e.g. state, region or province) should be used to monitor representativeness of surveillance sensitivity throughout a country or area; 4. adequacy of investigation should be restated as at least 80% of all reported suspected cases should have an adequate investigation initiated within 48 hours of notification ; and 5. travel history should be added to the list of core variables included in an adequate investigation to better identify imported virus /cases. Indicators for monitoring progress towards measles elimination are being finalized through consultations within WHO and with partners. Issue 12, November 2009 page 2
French epidemiological bulletin Measles in Europe The occurrence of measles still persists in Europe and the WHO 2010 elimination goal is fast approaching. The authors of the report (1) reviewed the epidemiological situation of measles in relation to the elimination date of 2010. Data was obtained from national surveillance institutions from 32 European countries in 2008, with 7 822 measles cases reported. The most cases came from the following six countries affecting the general population: Austria, France, Germany, Italy, Switzerland and the United Kingdom. The vaccination status was available for 7 060 (90%) of the cases and most cases were not vaccinated or were partially vaccinated. The differences in measles incidence rates in different countries can be attributed to the levels of success of national immunization programs and the rate of coverage. As recommended by WHO, achieving the goal to eliminate measles is based on maintaining immunization coverage of 95% with two vaccine doses and targeting susceptible individuals within the general population and among high risk groups. Although measles vaccination has been in effect across Europe since the 1980s, countries with high incidence rates have reported suboptimal immunization coverage and countries without indigenous cases reported good coverage. The continuous occurrence of outbreaks in Europe reveals gaps in vaccination coverage and jeopardizes the success of eliminating measles by the target date. In combination to being more vigilant and improving surveillance systems to allow for further case confirmation, the recommendation of this epidemiological assessment is to get policy-makers and European public health authorities to be more committed to strengthening immunization programs, identify obstacles in confronting anti-measles vaccination and explore methods for targeting hard-to-reach vulnerable populations. 1. Muscat Mark, Bang Henrik, Glismann Steffen, Mølbak Kåre. Évaluation épidémiologique de la rougeole en Europe en 2008 [An epidemiological assessment of measles in Europe, 2008]. Available online: Bulletin Épidémiologique Hebdomadaire. 2009; (39-40):436-40 (accessed 24 November 2009) WHO Regional Office for Europe new publication New surveillance guidelines New WHO surveillance guidelines for measles, rubella and congenital rubella syndrome in the European Region have been published. The document provides technical advice on the design and implementation of surveillance programmes and the monitoring and evaluation of surveillance systems in the context of elimination of these diseases by 2010. The new guidelines reveal the importance of disease surveillance and monitoring in connection to elimination to provide information for public health actions and guide the planning, implementation and evaluation of public health interventions and systems when needed. The surveillance guidelines identify areas within surveillance systems that need strengthening and provide evidence that demonstrates the relevance and quality of the information obtained. The full surveillance guideline is available at http:/ /www.euro.who.int/document / E93035.pdf. Issue 12, November 2009 page 3
Immunize now Measles outbreak in low-vaccination coverage community of Austria WHO put in place its strategic plan to eliminate measles in the European Region by the year 2010. The outbreak investigation conducted in this study (1) signifies that measles eradication is still a high public health priority in Europe. A trivalent measles, mumps, rubella (MMR) vaccine was introduced in Austria in 1994 using a twodose schedule with the first dose at 15 months and the second dose at six years of age. From 2004 to 2007, Austria was considered to be a low to moderate incidence country, but with the measles outbreak in 2008 with at least 394 cases in the Austrian province of Salzburg, Austria s status changed to a high incidence country. The results of this study in the Austrian province of Styria identified 37 cases of measles between 2 March and 10 May 2009. The virus was spread from the general population to the susceptible anthroposophic community; 12 cases from the general population and 25 belonging to the anthroposophic community. Among the cases, the age group of 10 14 year olds was most affected in the general population and 5 9 year olds in the anthroposophic community. Of the 37 outbreak cases none had received both doses of MMR vaccines: two cases from the general population had received one vaccine dose, all cases from the anthroposophic community and 10 cases from the general population were completely unvaccinated. The authors of this article justify introducing supplementary MMR vaccination campaigns targeting those over 10 years of age in Styria as a result of the shift in age distribution of measles, mumps and rubella. 1. Kasper S, Holzmann H, Aberle SW, Wassermann-Neuhold M, Gschiel H, Feenstra O, Allerberger F, Schmid D. Measles outbreak in Styria, Austria, March-May 2009. Euro Surveill. 2009;14 (40):pii=19347. Available online: http: / / www.eurosurveillance.org /ViewArticle.aspx? ArticleId=19347 (accessed 16 November 2009). Confirmed rubella outbreak in Bosnia and Herzegovina The preliminary report by Novo et al. (1) informs about the ongoing rubella outbreak in Bosnia and Herzegovina. The authors identified 342 clinically diagnosed cases between 24 March and 31 July 2009 in five municipalities in Republika Srpska (RS), one of the two entities in the country. Immunization of rubella was introduced in Bosnia and Herzegovina in the 1980s. A two-dose regimen of measles, mumps and rubella (MMR) vaccine was implemented in 1999 to 2000 with the first dose at 12 months (now 11 months since 2008) and the second dose at 7 years of age and no later than 14 years. The Public Health Institute of Republika Srpska declared a rubella outbreak on 28 May 2009 in three municipalities in the Banja Luka region: Dubica, Kotor Varos and Prijedor and two municipalities in the East Sarajevo region: Pale and Sokolac. Dubica reported 44 cases between 24 March and 15 May 2009 and the outbreak appears to be over. Outbreaks are still ongoing in Kotor Varos, Prijedor and East Sarajevo with cases reported as 117, 116 and 65 respectively as of 15 September 2009. Most of the cases were teenagers born between 1990 and 1994 and were male (45%). Only five of the 116 cases in Prijedor had received one dose of MMR and the vaccination status in the other municipalities is still being investigated. There is no information on the occurrence of congenital rubella infection in connection to the current outbreak. Prior to the war in Bosnia and Herzegovina (1992 1995) MMR vaccine coverage was 93.6%. In the last 2 years of the war, coverage was 56.8%. The age group that is currently affected by the ongoing measles outbreak were born during the war and most of them are unvaccinated. This outbreak emphasizes the need to revise legislation to permit MMR vaccination of children above 14 years of age and improve surveillance of congenital rubella syndrome. The outbreaks have resulted with the Minister of Health and Social Welfare and the Public Health Institute of Republika Srpska initiating the following immediate actions: to improve coverage with the second MMR vaccine dose in children less than 14 years, and to alert the Regional Public Health Institutes and primary care providers of the outbreak and initiate supplementary immunization of children and young adults with measles and rubella vaccine or rubella vaccine. 1. Novo A, Huebschen JM, Muller CP, Tesanovic M, Bojanic J. Ongoing rubella outbreak in Bosnia and Herzegovina, March-July 2009 preliminary report. Euro Surveill. 2009;14(39):pii=19343. Available online: http: / / ww w.eurosurveillance.org / ViewArticle.aspx?ArticleId=19343 (accessed 16 November 2009). Issue 12, November 2009 page 4
Pandemic (H1N1) 2009 update In the past month, the pandemic (H1N1) 2009 influenza activity in the European Region remained at a high level. Significant progress has been made towards producing, testing, researching and deploying pandemic (H1N1) 2009 influenza vaccines. It is reported that over 150 million doses of vaccines have been distributed in countries around the world with over 100 million doses administered, a large proportion of them in the European Region. Countries have strengthened their reporting systems to ensure rapid detection of any adverse event following immunization (AEFI) and response. As anticipated, the majority of side effects reported are locally mild or system reactions, including swelling, redness or pain at the injection site, which usually resolves spontaneously a short time after vaccination. In addition, fever, headache, fatigue and muscle aches occurring shortly after vaccine administration have also been reported, but less frequently. These symptoms also resolve spontaneously, usually within 48 hours. In addition, a variety of allergic reactions have been observed. To date, less than ten suspected cases of Guillain-Barré Syndrome have been reported in people who have received vaccine. This number of cases is within the expected number of normal background rates of this illness in the population. However, it is reassuring that all reported cases are being investigated. Approximately 41 deaths have been reported in persons who have been vaccinated. All of these deaths, reported to WHO, have been promptly investigated. To date, while some investigations are still ongoing, the results of the completed investigations have shown no direct link to pandemic vaccine as the cause of death. The information about types of pandemic (H1N1) 2009 vaccines used by countries, and internet links to AEFI reports from several countries and to summaries of product characteristics of pandemic (H1N1) 2009 vaccines are available at the Uppsala Monitoring Centre web site: http://www.who-umc.org/ DynPage.aspx?id=85898 In the European Region, all eight GAVIeligible countries (Armenia, Azerbaijan, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Ukraine, and Uzbekistan) have expressed interest in receiving donated vaccine from the WHO stockpile. Deployment of vaccine will commence in December using a phased approach. WHO and the United Nations Children s Fund (UNICEF) are working to secure supplies of the vaccine for countries in the Region who are not eligible to receive donated vaccines, who do not produce pandemic vaccines, and who do not have an advanced vaccine purchase agreement with manufacturers. Issue 12, November 2009 page 5
Quick Euro Stats Monthly measles and rubella reporting in the European Region Measles and rubella remain important global causes of vaccine-preventable morbidity and mortality. Monthly surveillance data received from WHO Member States are used to monitor and respond to outbreaks and to identify areas where additional attention and resources are needed. The WHO Regional Office for Europe monitors the completeness and timeliness of measles and rubella reporting to ensure that every country in the region provides data in a timely manner. Member States are encouraged to report monthly data to WHO either through the Centralized Information System for Infectious Diseases (CISID) and for countries belonging to the European Union, through the dedicated surveillance network to the ECDC. At the elimination stage, it is critical to provide a standardized, up-to-date and complete picture of the epidemiology of measles and rubella and disseminate rapidly essential information about spread of the diseases to health professionals. As incidence rates approach very low levels, more countries will not observe any measles and/ or rubella cases during reporting periods. As such, zero reporting should be implemented by any means in order to provide evidence of a functioning system. Any discrepancies in reporting status should be submitted to measles@euro.who.int and the report will be corrected. Country Bosnia and Herzegovina 2008 2009 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Albania CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT C CT CT Andorra CT CT CT CT CT CT CT CT C CT C C CT C C C C CT CT CT C CT Armenia C CT CT C CT CT CT C C C CT C CT C C CT CT CT CT C CT Austria C CT C C C C C C CT C C C C CT Azerbaijan CT CT CT CT CT CT C C C C C C C C C C C CT Belarus CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT Belgium C C CT C CT C C C CT CT C CT CT C C C CT CT CT CT CT CT CT C Bulgaria C C CT CT CT C C C CT CT CT CT CT C CT C CT C C CT Croatia C CT CT CT CT C C CT CT CT CT CT CT CT C C CT C C CT Cyprus C CT CT CT CT CT CT CT CT CT CT CT CT CT CT C CT CT C CT CT CT Czech Republic C CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT Denmark C CT C CT CT CT C C CT CT CT CT CT C CT CT CT CT CT CT CT CT Estonia C CT C C CT CT C CT CT C CT CT CT CT CT CT CT CT CT CT CT CT Finland C CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT France C C CT C CT C CT C CT C CT C C C CT CT C CT CT CT Georgia CT CT CT CT CT C CT CT C CT CT CT C C C C CT C CT C C CT Germany C C CT C CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT Greece C C CT CT C C C C CT C CT CT C C CT C C C CT CT Hungary C C CT CT CT C CT CT CT CT CT CT CT CT C C CT C C CT CT CT Iceland C C CT C CT C CT CT CT CT CT C CT CT C C CT CT CT CT Ireland CT CT CT C CT C C CT CT CT CT CT CT CT CT C CT CT CT CT CT CT Israel C C C C C C C C C C C C C C C CT Italy CT C C C C C CT C C C C C CT Kazakhstan C C C CT CT CT C CT CT CT C CT Kyrgyzstan C CT CT CT CT CT CT CT CT CT CT C C C CT CT CT CT CT CT CT CT Latvia C CT C CT CT C CT CT CT C CT CT C CT C C CT CT CT C Lithuania C CT CT C CT C C CT CT C CT C CT CT CT CT CT CT CT CT CT Luxembourg C C C C C C C C C C CT C C C C CT C CT C C C Malta C CT CT CT CT C CT CT CT CT CT CT C CT CT CT CT CT CT CT CT Monaco Montenegro C CT CT C CT C C CT C C C C CT C C C C CT CT Netherlands C C C C C C C C C C CT C CT C Norway C CT CT CT CT CT CT CT CT CT CT CT CT CT CT C C C CT CT CT Poland C C C CT C C C C CT C CT CT C C CT C CT C C C C C Portugal C C C C CT C CT C C CT CT C C C C C C C CT Republic of Moldova C CT CT C C C CT CT CT CT CT CT C CT C CT CT CT CT Romania CT C C C C C C C CT C C CT C C C C CT C C C C C Russian Federation CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT San Marino Serbia C C CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT C CT Slovakia C CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT Slovenia C CT CT CT CT CT CT CT CT CT CT CT CT C C C CT CT CT CT CT CT Spain C C CT C C CT C CT C CT C CT CT CT CT C CT CT CT CT CT CT Sweden C C CT C CT CT CT CT CT CT CT CT C CT CT C C C CT CT CT CT Switzerland C C C C CT C C C C CT CT CT C CT CT C CT CT CT CT CT CT Tajikistan C C CT CT CT CT CT C C CT TFYR of Macedonia CT CT CT CT CT CT CT CT C CT CT CT C CT C CT C C C Turkey C C C C C C C C CT C C C CT Turkmenistan C CT CT CT CT CT C CT CT CT CT CT CT Ukraine CT CT CT CT CT C CT CT CT CT CT CT CT CT CT CT CT United Kingdom C C CT C CT C C C C C CT CT CT C CT C CT C C CT C Uzbekistan CT CT CT CT CT CT C CT CT CT C C C CT on time late not received Issue 12, November 2009 page 6
Table 1. Classification of reported suspected measles and rubella cases, January October 2009 (data as of 30 Nov 2009) Country Total Population 1 Annualized Incidence Rate per 1 million population Total conf. measles (% of suspected measles cases) Measles Lab confirmed Classification Epi-Link Clinical 2 Discarded Importation 3 Monthly Reporting % Complet e- ness Total Rubella (%) Lab confirmed Rubella Classification Epi-Link Clinical 2 Discarded Monthly Reporting Total % suspected Timeliness % % Complete-Timelinesness Albania 3 207 639 0.0 0 0 0 0 1 0 100% 90% 0 0 0 0 0 0 100% 90% Andorra 74 725 0.0 0 0 0 0 0 0 100% 50% 0 0 0 0 0 0 100% 50% Armenia 2 995 890 0.0 0 0 0 0 0 0 100% 60% 4 4 (100%) 3 0 1 0 100% 60% Austria 8 391 254 6.0 42 (100.0) 10 0 32 0 1 50% 10% - - - - - - 0% 0% Azerbaijan 8 533 620 0.0 0 0 0 0 13 0 60% 10% 5 0 (0%) 0 0 0 5 30% 0% Belarus 9 635 397 0.0 0 0 0 0 0 0 60% 60% 0 0 0 0 0 0 60% 60% Belgium 10 480 390 3.1 27 (93.0) 21 2 4 2 4 100% 70% - - - - - - 0% 0% Bosnia and Herzegovina 3 940 397 2.4 8 (100.0) 0 0 8 0 0 20% 10% 74 74 (100%) 4 0 70 0 30% 30% Bulgaria 7 583 684 118.4 748 (100.0) 373 317 58 3 1 100% 60% - - - - - - 0% 0% Croatia 4 550 273 0.5 2 (100.0) 1 0 1 0 2 80% 40% - - - - - - 0% 0% Cyprus 863 624 0.0 0 0 0 0 0 0 100% 80% 0 0 0 0 0 0 30% 30% Czech Republic 10 183 437 0.4 3 (75.0) 3 0 0 1 0 100% 100% - - - - - - 0% 0% Denmark 5 453 204 1.8 8 (100.0) 8 0 0 0 1 100% 90% 0 0 0 0 0 0 10% 10% Estonia 1 330 510 0.0 0 0 0 0 0 0 100% 100% 0 0 0 0 0 0 100% 100% Finland 5 292 617 0.2 1 (100.0) 1 0 0 0 1 100% 100% - - - - - - 0% 0% France 61 945 596 25.9 1337 (97.0) 698 89 550 44 32 80% 50% - - - - - - 0% 0% Georgia 4 360 801 6.1 22 (100.0) 2 0 20 0 0 100% 30% 77 77 (100%) 1 0 76 0 100% 30% Germany 82 534 214 8.2 563 (98.0) 382 144 37 10 25 100% 100% - - - - - - 0% 0% Greece 11 171 744 0.2 2 (100.0) 1 0 1 0 0 90% 40% - - - - - - 0% 0% Hungary 10 000 165 0.1 1 (100.0) 1 0 0 0 1 100% 60% - - - - - - 0% 0% Iceland 303 495 0.0 0 0 0 0 0 0 80% 60% - - - - - - 0% 0% Ireland 4 380 073 17.8 65 (92.0) 21 3 41 6 3 100% 90% 22 22 (100%) 1 0 21 0 100% 100% Israel 7 044 501 0.3 2 (100.0) 0 0 2 0 0 40% 10% - - - - - - 0% 0% Italy 58 945 700 2.9 143 (100.0) 0 0 143 0 0 60% 10% - - - - - - 0% 0% Kazakhstan 15 531 645 0.0 0 0 0 0 0 0 50% 40% 306 306 (100%) 69 99 138 0 40% 30% Kyrgyzstan 5 376 432 0.0 0 0 0 0 0 0 100% 80% - - - - - - 0% 0% Latvia 2 265 485 0.0 0 0 0 0 0 0 80% 40% - - - - - - 0% 0% Lithuania 3 371 128 0.0 0 0 0 0 0 0 100% 90% 0 0 0 0 0 0 100% 100% Luxembourg 472 066 0.0 0 0 0 0 0 0 100% 20% - - - - - - 0% 0% Malta 408 212 2.9 1 (100.0) 1 0 0 0 0 90% 80% - - - - - - 0% 0% Monaco 32 819 0.0 - - - - - - 0% 0% - - - - - - 0% 0% Montenegro 597 851 0.0 0 0 0 0 0 0 80% 30% 0 0 0 0 0 0 80% 40% Netherlands 16 450 022 0.7 9 (100.0) 8 0 1 0 1 30% 10% - - - - - - 0% 0% Norway 4 727 260 0.5 2 (100.0) 2 0 0 0 2 90% 60% - - - - - - 0% 0% Poland 38 022 140 5.0 159 (76.0) 85 58 16 50 0 100% 20% - - - - - - 0% 0% Portugal 10 661 632 0.1 1 (33.0) 1 0 0 2 1 80% 10% - - - - - - 0% 0% Republic of Moldova 3 759 599 0.0 0 0 0 0 0 0 70% 50% - - - - - - 0% 0% Romania 21 344 129 0.4 7 (3.0) 7 0 0 211 2 100% 10% - - - - - - 0% 0% Russian Federation 141 780 033 0.8 98 (100.0) 98 0 0 0 0 100% 100% - - - - - - 0% 0% San Marino 31 126 0.0 - - - - - - 0% 0% - - - - - - 0% 0% Serbia 9 879 595 0.1 1 (100.0) 1 0 0 0 0 100% 90% - - - - - - 0% 0% Slovakia 5 392 350 0.0 0 0 0 0 0 0 100% 100% 0 0 0 0 0 0 100% 70% Slovenia 2 001 578 0.0 0 0 0 0 0 0 100% 70% - - - - - - 0% 0% Spain 44 592 771 1.1 40 (100.0) 30 3 7 0 6 100% 90% - - - - - - 0% 0% Sweden 9 159 978 0.4 3 (100.0) 3 0 0 0 3 100% 60% - - - - - - 0% 0% Switzerland 7 512 120 158.9 995 (87.0) 409 86 500 153 13 100% 80% - - - - - - 0% 0% Tajikistan 6 838 716 0.0 0 0 0 0 0 0 70% 50% 131 131 (100%) 0 0 131 0 70% 50% The former Yugoslav Republic of Macedonia 2 039 960 1.8 3 (100.0) 0 0 3 0 0 80% 30% 4 4 (100%) 0 0 4 0 50% 20% Turkey 71 517 100 0.1 4 (100.0) 4 0 0 0 0 80% 20% 66 66 (100%) 0 0 66 0 60% 0% Turkmenistan 5 030 972 0.0 0 0 0 0 0 0 40% 40% - - - - - - 0% 0% Ukraine 45 858 834 0.6 23 (100.0) 9 0 14 0 0 80% 80% - - - - - - 0% 0% United Kingdom 61 018 648 22.8 1161 (85.0) 1143 2 16 204 8 90% 40% - - - - - - 0% 0% Uzbekistan 27 768 983 0.0 0 0 0 0 0 0 40% 10% 5 5 (100%) 5 0 0 0 40% 10% Total/Averages 886 646 134 7.42 5481 (89.0) 3323 704 1454 700 107 80% 51% 694 689 (99.0) 83 99 507 5 24% 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 and updates provided by Member States. 2 Cases with missing classification are classified as "Clinical". 3 Imported or import related measles cases included in total measles. Indicators not meeting target and countries not reporitng monthly measles data are highligted in red. Issue 12, November 2009 page 7
Table 2. Measles and rubella laboratory test results, January October 2009 (data as of 30 November 2009) Specimen* (Serum, Oral Fluid, Swab, Urine and other) Reporting Country Tested for measles Positive for measles (%) Measles Equivocal Negative for measles Tested for rubella Positive for rubella (%) % % Rubella Negative Completeness Timeliness Equivocal for rubella Albania 6 0 (0.0) 0 6 1 0 (0.0) 0 1 100.0 80.0 Andorra No Lab Armenia 48 0 (0.0) 0 48 48 4 (8.0) 3 41 90.0 50.0 Austria 1235 20 (2.0) 0 1215 4580 203 (4.0) 0 4377 100.0 100.0 Azerbaijan 19 0 (0.0) 0 19 15 0 (0.0) 1 14 90.0 50.0 Belarus 204 0 (0.0) 0 204 204 2 (1.0) 0 202 90.0 80.0 Belgium 73 30 (41.0) 2 41 28 5 (18.0) 9 14 100.0 100.0 Bosnia and Herzegovina Bulgaria 479 380 (79.0) 0 46 352 1 (0.0) 1 350 100.0 60.0 Croatia 7 0 (0.0) 0 7 3 0 (0.0) 0 3 100.0 80.0 Cyprus 0 0 0 0 0 0 0 0 100.0 100.0 Czech Republic 19 5 (26.0) 2 12 47 7 (15.0) 2 38 100.0 90.0 Denmark Estonia 82 0 (0.0) 0 82 334 1 (0.0) 0 333 100.0 100.0 Finland 150 2 (1.0) 0 148 477 0 (0.0) 0 477 90.0 70.0 France Georgia 13 1 (8.0) 1 11 13 0 (0.0) 1 12 40.0 10.0 Germany 418 172 (41.0) 3 243 58 10 (17.0) 0 48 100.0 30.0 Greece 91 2 (2.0) 0 89 220 41 (19.0) 0 179 100.0 60.0 Hungary 70 2 (3.0) 0 68 241 6 (2.0) 0 235 100.0 100.0 Iceland Ireland 354 15 (4.0) 1 338 889 3 (0.0) 3 883 100.0 40.0 Israel 59 11 (19.0) 0 48 497 113 (23.0) 0 375 100.0 90.0 Italy Kazakhstan 33 0 (0.0) 0 33 113 87 (77.0) 2 24 100.0 90.0 Kyrgyzstan 179 1 (1.0) 3 175 185 22 (12.0) 2 161 80.0 60.0 Latvia 171 1 (1.0) 0 170 208 1 (0.0) 0 207 100.0 90.0 Lithuania 4 0 (0.0) 0 4 4 0 (0.0) 0 4 90.0 90.0 Luxembourg 131 1 (1.0) 3 127 67 3 (4.0) 4 60 100.0 90.0 Malta Monaco No Lab Montenegro No Lab Netherlands 114 11 (10.0) 0 103 109 2 (2.0) 0 107 90.0 30.0 Norway 41 4 (10.0) 0 37 30 5 (17.0) 0 25 100.0 90.0 Poland 100 54 (54.0) 9 37 89 4 (4.0) 1 84 100.0 90.0 Portugal 11 2 (18.0) 0 9 11 3 (27.0) 0 8 100.0 100.0 Republic of Moldova 52 0 (0.0) 0 52 52 1 (2.0) 0 51 100.0 100.0 Romania 278 13 (5.0) 3 262 414 9 (2.0) 5 400 100.0 100.0 Russian Federation 2977 167 (6.0) 5 2795 1344 52 (4.0) 7 1223 100.0 100.0 San Marino No Lab Serbia 57 5 (9.0) 0 52 186 1 (1.0) 0 185 90.0 10.0 Slovakia 2 0 (0.0) 0 2 14 6 (43.0) 0 7 90.0 70.0 Slovenia 29 0 (0.0) 0 29 31 0 (0.0) 0 31 100.0 100.0 Spain 187 53 (28.0) 2 75 71 1 (1.0) 0 41 100.0 100.0 Sweden Switzerland No Lab Tajikistan 11 0 (0.0) 1 10 12 1 (8.0) 0 11 40.0 10.0 The former Yugoslav Republic of Macedonia Turkey Turkmenistan 6 0 (0.0) 0 6 6 0 (0.0) 0 4 100.0 100.0 Ukraine 555 11 (2.0) 2 542 647 298 (46.0) 5 344 100.0 90.0 United Kingdom 6310 1461 (23.0) 64 4785 1457 46 (3.0) 63 1348 100.0 70.0 Uzbekistan 26 0 (0.0) 0 26 31 2 (6.0) 0 29 100.0 70.0 Total / Average 14601 2424 (17%) 101 11956 13088 940 (7%) 109 11936 68.0 55.0 *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 measles and rubella lab network. Issue 12, November 2009 page 8
Table 3. Classification of AFP cases and key AFP surveillance indicators, 2008 2009 Countries doing AFP surveillance in WHO European Region Pendig Polio Classification AFP Cases Compatible 2008 (Weeks 1-52) Total Surveillance Rates / Index % With 2 Non-Polio AFP Rate Stool Surveillance Index3 Specimens 2 Targ et 1.00 Targ et 0.8 Target 80.0% AFP Polio Cases Compatible Total Hot 4 Cases 2009 (Weeks 1-49) Pending Classification Surveillance Rates / Index % Annualized Total Non-Polio >90 Days 5 AFP Rate 1 Target 1.00 % With 2 Surveillance complete Stool Specimens 2 Target 80.0% Index Target 0.8 ness of weekly reporting Albania 4 0 0 0.51 100.0 0.51 7 0 1 0 0 0.96 100.0 0.96 85.0 61.0 Andorra 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0.00 0.0 0.00 89.0 40.0 Armenia 20 0 0 3.57 85.0 0.90 7 0 7 1 6 1.36 100.0 1.36 67.0 61.0 Austria 4 0 0 0.32 0.0 0.00 4 0 0 0 0 0.34 25.0 0.34 108.0 77.0 Azerbaijan 30 0 0 1.56 96.7 0.97 44 0 16 0 7 2.48 95.5 2.48 87.0 85.0 Belarus 45 0 0 3.18 82.2 0.87 45 0 10 0 1 3.43 100.0 3.43 30.0 30.0 Belgium 3 0 0 0.17 0.0 0.06 5 0 0 0 0 0.31 0.0 0.31 95.0 81.0 Bosnia and Herzegovina 1 0 0 0.15 0.0 0.00 5 0 2 0 0 0.83 60.0 0.83 93.0 73.0 Bulgaria 15 0 0 1.48 80.0 1.00 13 0 14 1 11 1.38 100.0 1.38 79.0 63.0 Croatia 3 0 0 0.44 66.7 0.30 1 0 2 0 2 0.16 100.0 0.16 100.0 24.0 Cyprus 5 0 0 3.13 100.0 1.00 1 0 0 0 0 0.67 100.0 0.67 95.0 91.0 Czech Republic 8 0 0 0.56 75.0 0.56 10 0 1 0 0 0.76 100.0 0.76 81.0 77.0 Estonia 0 0 0 0.00 0.0 0.00 1 0 0 0 0 0.54 100.0 0.54 89.0 85.0 Georgia 6 0 0 0.79 100.0 0.79 12 0 2 0 0 1.74 100.0 1.74 81.0 73.0 Germany 72 0 0 0.63 38.9 0.29 52 0 8 1 2 0.49 32.7 0.49 93.0 89.0 Greece 16 0 0 1.02 87.5 0.88 15 0 2 1 1 1.02 66.7 1.02 83.0 10.0 Hungary 15 0 0 1.00 66.7 0.80 6 0 4 0 2 0.43 0.0 0.43 83.0 51.0 Ireland 4 0 0 0.44 0.0 0.11 0 0 0 0 0 0.00 0.0 0.00 97.0 63.0 Israel 15 0 0 0.77 13.3 0.36 14 0 0 0 0 0.75 21.4 0.75 77.0 73.0 Italy 68 0 0 0.83 66.2 0.64 41 0 8 0 5 0.53 68.3 0.53 20.0 20.0 Kazakhstan 65 0 0 1.78 96.9 0.98 93 0 18 0 1 2.67 98.9 2.67 79.0 63.0 Kyrgyzstan 33 0 0 2.09 97.0 1.00 10 0 6 0 6 0.68 100.0 0.68 4.0 2.0 Latvia 1 0 0 0.33 100.0 0.33 4 0 0 0 0 1.40 100.0 1.40 100.0 40.0 Lithuania 9 0 0 1.75 66.7 1.00 9 0 1 0 0 1.91 100.0 1.91 75.0 73.0 Malta 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0.00 0.0 0.00 73.0 8.0 Montenegro 0 0 0 0.00 0.0 0.00 2 0 1 1 0 1.83 100.0 1.83 87.0 79.0 Norway 13 0 0 1.45 23.1 0.69 5 0 5 2 1 0.59 0.0 0.59 91.0 65.0 Poland 29 0 0 0.50 82.8 0.47 33 0 12 1 4 0.62 45.5 0.62 67.0 14.0 Portugal 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0.00 0.0 0.00 0.0 0.0 Republic of Moldova 10 0 0 1.45 100.0 1.00 7 0 0 0 0 1.11 85.7 1.11 97.0 95.0 Romania 17 0 0 0.52 94.1 0.52 11 0 8 0 0 0.36 100.0 0.36 85.0 83.0 Russian Federation 360 0 0 1.72 93.9 0.95 336 0 129 15 37 1.70 94.6 1.70 93.0 87.0 Serbia 15 0 0 0.83 86.7 0.72 16 0 3 0 1 0.94 93.8 0.94 87.0 83.0 Slovakia 1 0 0 0.12 0.0 0.12 3 0 2 1 1 0.39 66.7 0.39 83.0 67.0 Slovenia 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0.00 0.0 0.00 95.0 71.0 Spain 35 0 0 0.54 31.4 0.31 19 0 4 0 0 0.30 21.1 0.30 91.0 73.0 Switzerland 10 0 0 0.84 0.0 0.00 6 0 0 0 0 0.54 33.3 0.54 57.0 22.0 Tajikistan 37 0 0 1.45 91.9 0.92 34 0 14 0 2 1.42 85.3 1.42 59.0 51.0 The former Yugoslav Republic of Macedonia 5 0 0 1.34 100.0 1.00 7 0 6 0 0 2.04 100.0 2.04 73.0 61.0 Turkey 166 0 0 0.81 75.3 0.64 132 0 68 2 45 0.69 72.7 0.69 91.0 87.0 Turkmenistan 15 0 0 1.02 100.0 1.00 27 0 11 0 0 1.96 92.6 1.96 81.0 79.0 Ukraine 104 0 0 1.64 97.1 0.98 94 0 18 0 1 1.60 94.7 1.60 89.0 85.0 Uzbekistan 102 0 0 1.19 99.0 1.00 93 0 18 1 0 1.16 97.8 1.16 30.0 30.0 Average/Total 1361 0 0 1.05 82.0 0.87 1224 0 401 27 136 0.95 84.0 0.85 76.0 58.0 1 Non-polio AFP cases per 100 000 children under the age of 15 years (annualized for year 2009). Number of non-polio (discarded) AFP cases X 100000 / total population under 15 years. 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 Total number of AFP cases pending final classification 90 days after date of onset. % Timeliness of weekly reporting Issue 12, November 2009 page 9
EURO Immunization Monitor is published by: World Health Organization (WHO) Regional Office for Europe Scherfigsvej 8, DK 2100 Copenhagen Ø, Denmark Website: www.euro.who.int/vaccine Chief editor Dr Rebecca Martin, Targeted Diseases and Immunization Editors Mr Ajay Goel, Surveillance, Monitoring and Evaluation Ms Smiljka de Lussigny, Advocacy and Community Relations Mr Robb Butler, Communicable Diseases Unit Editorial Team Dr Niyazi O. Cakmak, Targeted Diseases and Immunization Dr Nilesh Buddh, Surveillance, Monitoring and Evaluation Ms Titilayo Akindunni, Advocacy and Community Relations For comments or suggestions please write to vaccine@euro.who.int 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. Page 2 Issue 12, 10, 2 November Aug-Sep 2009 2009 page Page 810 9