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

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 2002. 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 2004 2007, 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% - 94.9% 80% - 89.9% < 80% No Data Figure 3. IPV3/OPV3 coverage at sub-national level, 2007 >= 95% 90% - 94.9% 80% - 89.9% < 80% No Data Data source: WHO UNICEF Joint Reporting Form, 2006 and 2007

Regional and country updates Meeting of the WHO Regional Office for Europe Expert Technical Advisory Group of Experts on Immunization (ETAGE), 25 26 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, 25 26 March 2009. 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, 20-26 April 2009. A full report of the proceedings, including ETAGE recommendations will be on the Regional Office s immunization website at http://www.euro.who.int/vaccine/publications/20050603_1 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 (http://www.habbo.com/) 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, 28 29 April 2009. 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 22 23 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 20 26 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 (http://www.euro.who.int/vaccine/20081217_10) 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

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 http://www.euro.who.int/vaccine/eiw/20081205_33). More information For more information and guidance regarding the planning for European Immunization Week 2009 please visit our web site www.euro.who.int/eiw and the campaign web site www.euro.who.int/eiw2009 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 vaccine@euro.who.int. EURO Quick Stats Countries with a high incidence rate of in 2008 2009, WHO European Region, January 2007 February 2009 600 500 France Germany Switzerland United Kingdom Italy Number of cases 400 300 200 100 0 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 2007 2008 2009 Month and Year The above graph shows a curve for the five countries with the highest incidence in 2008. 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

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 3 207 639 0.0 0 0 0 0 1 0 100% 100% 0 0 0 0 0 0 100% 100% Andorra 74 725 0.0 0 0 0 0 0 0 50% 50% 0 0 0 0 0 0 50% 50% Armenia 2 995 890 0.0 0 0 0 0 0 0 50% 50% 1 1 (100%) 0 0 1 0 50% 50% Austria 8 391 254 0.0 0 0 0 0 0 0 50% 0% - - - - - - 0% 0% Azerbaijan 8 533 620 0.0 - - - - - - 0% 0% - - - - - - 0% 0% Belarus 9 635 397 0.0 0 0 0 0 0 0 50% 50% 0 0 0 0 0 0 50% 50% Belgium 10 480 390 1.7 3 (100.0) 2 0 1 0 0 100% 50% - - - - - - 0% 0% Bosnia and Herzegovina 3 940 397 0.0 - - - - - - 0% 0% - - - - - - 0% 0% Bulgaria 7 583 684 0.0 0 0 0 0 0 0 100% 100% - - - - - - 0% 0% Croatia 4 550 273 1.3 1 (100.0) 0 0 1 0 1 100% 100% - - - - - - 0% 0% Cyprus 863 624 0.0 0 0 0 0 0 0 100% 100% 0 0 0 0 0 0 100% 100% Czech Republic 10 183 437 0.0 0 0 0 0 0 0 100% 100% - - - - - - 0% 0% Denmark 5 453 204 8.8 8 (100.0) 8 0 0 0 1 100% 50% - - - - - - 0% 0% 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 0.0 0 0 0 0 0 0 100% 100% - - - - - - 0% 0% France 61 945 596 33.7 348 (100.0) 132 25 191 1 8 100% 0% - - - - - - 0% 0% Georgia 4 360 801 16.5 12 (100.0) 1 0 11 0 0 100% 0% - - - - - - 0% 0% Germany 82 534 214 12.0 165 (100.0) 102 52 11 0 5 100% 100% - - - - - - 0% 0% Greece 11 171 744 0.0 0 0 0 0 0 0 50% 50% - - - - - - 0% 0% Hungary 10 000 165 0.0 0 0 0 0 0 0 100% 100% - - - - - - 0% 0% Iceland 303 495 0.0 0 0 0 0 0 0 100% 100% - - - - - - 0% 0% Ireland 4 380 073 9.6 7 (88.0) 1 0 6 1 0 100% 100% 13 13 (100%) 0 0 13 0 100% 100% Israel 7 044 501 0.0 - - - - - - 0% 0% - - - - - - 0% 0% Italy 58 945 700 0.0 0 0 0 0 0 0 100% 0% - - - - - - 0% 0% Kazakhstan 15 531 645 0.0 0 0 0 0 0 0 100% 100% 123 123 (100%) 69 0 54 0 100% 100% Kyrgyzstan 5 376 432 0.0 - - - - - - 0% 0% - - - - - - 0% 0% Latvia 2 265 485 0.0 0 0 0 0 0 0 100% 50% - - - - - - 0% 0% Lithuania 3 371 128 0.0 0 0 0 0 0 0 100% 50% 0 0 0 0 0 0 100% 100% Luxembourg 472 066 0.0 0 0 0 0 0 0 100% 0% - - - - - - 0% 0% Malta 408 212 0.0 0 0 0 0 0 0 100% 50% - - - - - - 0% 0% Monaco 32 819 0.0 - - - - - - 0% 0% - - - - - - 0% 0% Montenegro 597 851 0.0 0 0 0 0 0 0 100% 50% 0 0 0 0 0 0 50% 50% Netherlands 16 450 022 0.0 0 0 0 0 0 0 50% 0% - - - - - - 0% 0% Norway 4 727 260 1.3 1 (100.0) 1 0 0 0 1 100% 100% - - - - - - 0% 0% Poland 38 022 140 2.1 13 (68.0) 9 0 4 6 0 100% 0% - - - - - - 0% 0% Portugal 10 661 632 0.0 0 0 0 0 0 0 50% 0% - - - - - - 0% 0% Republic of Moldova 3 759 599 0.0 0 0 0 0 0 0 50% 0% - - - - - - 0% 0% Romania 21 344 129 0.0 0 0 0 0 72 0 100% 0% - - - - - - 0% 0% Russian Federation 141 780 033 0.2 5 (100.0) 5 0 0 0 0 100% 100% - - - - - - 0% 0% San Marino 31 126 0.0 - - - - - - 0% 0% - - - - - - 0% 0% Serbia 9 879 595 0.0 0 0 0 0 0 0 100% 100% - - - - - - 0% 0% Slovakia 5 392 350 0.0 0 0 0 0 0 0 100% 100% 0 0 0 0 0 0 100% 50% Slovenia 2 001 578 0.0 0 0 0 0 0 0 100% 50% - - - - - - 0% 0% Spain 44 592 771 0.7 5 (100.0) 4 0 1 0 1 100% 100% - - - - - - 0% 0% Sweden 9 159 978 0.7 1 (100.0) 1 0 0 0 1 100% 50% - - - - - - 0% 0% Switzerland 7 512 120 196.5 246 (91.0) 95 18 133 23 3 50% 0% - - - - - - 0% 0% Tajikistan 6 838 716 0.0 - - - - - - 0% 0% - - - - - - 0% 0% The former Yugoslav Republic of Macedonia Population 1 Annualized Incidence Rate per 1 million population 2 039 960 5.9 2 (100.0) 0 0 2 0 0 50% 50% 1 1 (100%) 0 0 1 0 50% 0% Turkey 75 829 891 0.0 - - - - - - 0% 0% - - - - - - 0% 0% Turkmenistan 5 030 972 0.0 0 0 0 0 0 0 50% 50% - - - - - - 0% 0% Ukraine 45 858 834 0.8 6 (100.0) 3 0 3 0 0 100% 100% - - - - - - 0% 0% United Kingdom 61 018 648 22.6 230 (100.0) 230 0 0 0 1 50% 50% - - - - - - 0% 0% Uzbekistan 27 768 983 0.0 - - - - - - 0% 0% - - - - - - 0% 0% /Averages 890 958 925 7.09 1053 (91.0) 594 95 364 104 22 71% 48% 138 138 (100.0) 69 0 69 0 17% 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

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) 0 1 0 0 0 0 100.0 100.0 Andorra Armenia 8 0 (0.0) 0 8 8 1 (13.0) 0 7 100.0 50.0 Austria 235 0 (0.0) 0 235 827 45 (5.0) 0 782 100.0 100.0 Azerbaijan Belarus 32 0 (0.0) 0 32 32 2 (6.0) 0 30 100.0 100.0 Belgium 15 2 (13.0) 0 13 6 2 (33.0) 2 2 100.0 100.0 Bosnia and Herzegovina Bulgaria 11 0 (0.0) 0 11 11 0 (0.0) 0 11 100.0 50.0 Croatia 1 0 (0.0) 0 1 0 0 0 0 100.0 100.0 Cyprus 0 0 0 0 0 0 0 0 100.0 100.0 Czech Republic 8 1 (13.0) 1 6 21 5 (24.0) 0 16 100.0 50.0 Denmark Estonia 19 0 (0.0) 0 19 82 0 (0.0) 0 82 100.0 100.0 Finland 36 0 (0.0) 0 36 125 0 (0.0) 0 125 100.0 100.0 France Georgia Germany 69 25 (36.0) 1 43 0 0 0 0 100.0 50.0 Greece 18 0 (0.0) 0 18 67 12 (18.0) 0 55 100.0 100.0 Hungary 14 1 (7.0) 0 13 34 1 (3.0) 0 33 100.0 100.0 Iceland Ireland 33 0 (0.0) 0 33 136 0 (0.0) 0 136 100.0 50.0 Israel 17 2 (12.0) 0 15 92 21 (23.0) 0 71 100.0 50.0 Italy Kazakhstan 3 0 (0.0) 0 3 26 24 (92.0) 1 1 50.0 50.0 Kyrgyzstan 33 0 (0.0) 0 33 39 11 (28.0) 1 27 100.0 50.0 Latvia 54 1 (2.0) 0 53 54 1 (2.0) 0 53 100.0 100.0 Lithuania 0 0 0 0 0 0 0 0 100.0 100.0 Luxembourg 34 0 (0.0) 1 33 14 0 (0.0) 0 14 100.0 100.0 Malta Monaco Montenegro Netherlands 41 6 (15.0) 0 35 41 0 (0.0) 0 41 100.0 50.0 Norway 11 2 (18.0) 0 9 4 1 (25.0) 0 3 100.0 100.0 Poland 20 12 (60.0) 0 8 20 4 (20.0) 0 16 100.0 50.0 Portugal 0 0 0 0 0 0 0 0 100.0 100.0 Republic of Moldova 5 0 (0.0) 0 5 5 0 (0.0) 0 5 100.0 100.0 Romania 88 2 (2.0) 1 85 145 4 (3.0) 2 139 100.0 100.0 Russian Federation 372 14 (4.0) 3 355 182 10 (5.0) 4 167 100.0 100.0 San Marino Serbia Slovakia 0 0 0 0 2 2 (100.0) 0 0 100.0 50.0 Slovenia 8 0 (0.0) 0 8 9 0 (0.0) 0 9 100.0 100.0 Spain 18 1 (6.0) 1 13 10 1 (10.0) 0 4 100.0 100.0 Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey 0 0 0 0 0 0 0.0 0.0 Turkmenistan 2 0 (0.0) 0 2 2 0 (0.0) 0 2 100.0 100.0 Ukraine 78 5 (6.0) 1 72 92 34 (37.0) 3 55 100.0 100.0 United Kingdom 1412 318 (23.0) 14 1080 281 0 (0.0) 9 272 100.0 100.0 Uzbekistan 1 0 (0.0) 0 1 1 0 (0.0) 0 1 100.0 100.0 / Average 2697 392 (15%) 23 2279 2368 181 (8%) 22 2159 71.0 51.0 *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 and rubella lab network. Issue 52 March 2009 page Page 5 7

Table 3. Classification of AFP cases and key AFP surveillance indicators, 2008 2009 Countries doing AFP surveillance in WHO European Region Albania 4 0 0 0.51 100.0 0.51 3 0 3 0 0 1.44 100.0 1.44 92.3 53.8 Andorra 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0.00 0.0 0.00 100.0 46.2 Armenia 21 0 6 3.75 85.7 0.90 2 0 2 0 0 1.36 100.0 1.36 76.9 61.5 Austria 4 0 0 0.32 0.0 0.00 1 0 0 0 0 0.30 0.0 0.30 100.0 84.6 Azerbaijan 30 0 9 1.56 96.7 0.97 17 0 17 0 2 3.36 94.1 3.36 100.0 100.0 Belarus 46 0 1 3.25 82.6 0.87 10 0 7 0 0 2.67 100.0 2.67 15.4 15.4 Belgium 3 0 0 0.17 0.0 0.06 0 0 0 0 0 0.00 0.0 0.00 92.3 92.3 Bosnia and Herzegovina 1 0 1 0.15 0.0 0.00 1 0 1 0 1 0.58 0.0 0.58 100.0 100.0 Bulgaria 15 0 0 1.48 80.0 1.00 4 0 4 1 1 1.48 100.0 1.48 69.2 30.8 Croatia 3 0 2 0.44 66.7 0.30 0 0 0 0 0 0.00 0.0 0.00 100.0 38.5 Cyprus 5 0 0 3.13 100.0 1.00 0 0 0 0 0 0.00 0.0 0.00 100.0 100.0 Czech Republic 8 0 0 0.56 75.0 0.56 2 0 0 0 0 0.53 100.0 0.53 100.0 92.3 Estonia 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0.00 0.0 0.00 100.0 84.6 Georgia 6 0 0 0.79 100.0 0.79 0 0 0 0 0 0.00 0.0 0.00 92.3 84.6 Germany 72 0 1 0.63 38.9 0.29 14 0 10 0 0 0.46 21.4 0.46 100.0 100.0 Greece 16 0 0 1.02 87.5 0.88 0 0 0 0 0 0.00 0.0 0.00 92.3 23.1 Hungary 16 0 1 1.07 68.8 0.88 1 0 1 0 0 0.25 0.0 0.25 100.0 76.9 Ireland 4 0 0 0.44 0.0 0.11 0 0 0 0 0 0.00 0.0 0.00 100.0 38.5 Israel 15 0 0 0.77 13.3 0.36 3 1 0 0 0 0.56 0.0 0.56 100.0 92.3 Italy 68 0 10 0.83 66.2 0.64 15 0 14 0 1 0.68 60.0 0.68 30.8 30.8 Kazakhstan 66 0 9 1.80 97.0 0.98 23 0 9 0 0 2.31 100.0 2.31 100.0 76.9 Kyrgyzstan 24 0 6 1.52 95.8 1.00 0 0 0 0 0 0.00 0.0 0.00 0.0 0.0 Latvia 1 0 0 0.33 100.0 0.33 1 0 1 0 0 1.23 100.0 1.23 100.0 53.8 Lithuania 10 0 5 1.94 70.0 1.00 0 0 0 0 0 0.00 0.0 0.00 84.6 84.6 Malta 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0.00 0.0 0.00 61.5 0.0 Montenegro 0 0 0 0.00 0.0 0.00 1 0 1 0 0 3.20 100.0 3.20 92.3 76.9 Norway 13 0 0 1.45 23.1 0.69 0 0 0 0 0 0.00 0.0 0.00 84.6 69.2 Poland 28 0 4 0.49 82.1 0.43 7 0 7 1 0 0.46 0.0 0.46 76.9 23.1 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 2 0 1 0 0 1.11 100.0 1.11 100.0 100.0 Romania 17 0 0 0.52 94.1 0.52 4 0 5 0 0 0.46 100.0 0.46 76.9 69.2 Russian Federation 363 0 3 1.73 93.9 0.95 91 0 75 7 1 1.61 95.6 1.61 100.0 92.3 Serbia 15 0 1 0.83 86.7 0.72 6 0 5 0 0 1.24 83.3 1.24 84.6 84.6 Slovakia 1 0 0 0.12 0.0 0.12 1 0 2 0 0 0.45 0.0 0.45 61.5 46.2 Slovenia 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0.00 0.0 0.00 100.0 92.3 Spain 35 0 0 0.54 31.4 0.31 5 0 5 0 1 0.28 40.0 0.28 92.3 84.6 Switzerland 6 0 0 0.50 0.0 0.00 1 0 0 0 0 0.32 0.0 0.32 84.6 15.4 Tajikistan 37 0 8 1.45 91.9 0.92 0 0 0 0 0 0.00 0.0 0.00 0.0 0.0 The former Yugoslav Republic of Macedonia Polio AFP Cases Compatible 2008 (Weeks 1-52) 5 0 0 1.34 100.0 1.00 0 0 0 0 0 0.00 0.0 0.00 69.2 53.8 Turkey 170 0 29 0.83 74.1 0.65 33 0 30 1 1 0.60 75.8 0.60 100.0 100.0 Turkmenistan 16 0 2 1.08 93.8 0.94 5 0 4 0 0 1.27 80.0 1.27 92.3 92.3 Ukraine 105 0 10 1.66 97.1 0.98 25 0 25 1 0 1.49 96.0 1.49 84.6 76.9 Uzbekistan 102 0 13 1.19 99.0 1.00 4 0 4 0 2 0.17 100.0 0.17 61.5 61.5 Average/ 1361 0 121 1.05 82.0 0.87 282 1 233 11 10 0.28 87.0 0.25 80.7 62.8 1 Non polio AFP cases per 100 000 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

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 www.euro.who.int/vaccine 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 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. Issue 52 March 2009 page Page 7 9