VIII: MEASLES ELIMINATION IN THE EUROPEAN REGION

Tuesday, 28th of June 2011

VIII: MEASLES ELIMINATION IN THE EUROPEAN REGION

What Will It Take to Achieve Measles Elimination in the World Health Organization European Region: Progress From 2003–2009 and Essential Accelerated Actions

1. 1.   Rebecca Martin1, Steven Wassilak2, Nedret Emiroglu1, Amra Uzicanin2,

Sergei Deshesvoi1, Dragan Jankovic1, Ajay Goel1 and Nino Khetsuriani2

+ Author Affiliations

1. 1.    ¹World Health Organization Regional Office for Europe, Copenhagen, Denmark; Vaccine Preventable Diseases and Immunization Programme
2. 2.    ²US Centers for Disease Control and Prevention, Atlanta, Georgia
3. Correspondence: Rebecca Martin, PhD, Vaccine Preventable Diseases & Immunization, Div of Communicable Diseases, Health Security & Environment, WHO European Region, Scherfigsvej 8, DK-2100, Copenhagen 0, Denmark (e-mail: rma@euro.who.int).

Abstract

Background. The Member States of the  European Region (EUR) of the World Health Organization (WHO) have made great progress towards achieving the goal of measles elimination by 2010.

Methods. Measles surveillance and vaccine coverage data from 2003–2009 reported to WHO were analyzed. A review of feasibility of reaching the elimination goal by the 2010 target date was conducted in 2009.

Results. From 2003–2009, the measles incidence decreased dramatically and coverage with 2 doses of measles vaccine increased among wide age groups of susceptible persons. With the decrease of disease incidence and the reduction of outbreaks in the eastern part of EUR, the proportion of reported cases in the western part increased. In 2009, outbreaks in 5 countries accounted for 89.6% of reported cases. Challenges to reach the 2010 goal include ongoing outbreaks with reestablished endemicity in some countries, decreased demand for vaccines with an increased focus on the measles vaccine safety, and population groups with limited access to immunization services.

Conclusions. Measles elimination in EUR is attainable, albeit not by 2010. EUR countries should ensure political commitment and resources to protect the gains made to date and address these challenges to sustain the progress and achieve the elimination goal.

http://jid.oxfordjournals.org/content/204/suppl_1/S325.abstract

 

Molecular Genotyping and Epidemiology of Measles Virus Transmission in the World Health Organization European Region, 2007–2009

1. 1.   Annette Mankertz1,  Mick N. Mulders2, Sergey Shulga3, Jacques R. Kremer4,

Kevin E. Brown5, Sabine Santibanez1, Claude P. Muller4, Nina Tikhonova3,

Galina Lipskaya6, Dragan Jankovic2, Nino Khetsuriani7, Rebecca Martin2 and

Eugene Gavrilin2

+ Author Affiliations

1. 1.    ¹World Health Organization European Regional Reference Laboratory, Robert Koch-Institute, Division of Viral Infection, Berlin, Germany
2. 2.    ²World Health Organization Regional Office for Europe, Copenhagen, Denmark
3. 3.    ³World Health Organization European Regional Reference Laboratory, G.N. Gabrichevsky Research Institute, Moscow, Russian Federation
4. 4.    ⁴World Health Organization European Regional Reference Laboratory, Institute of Immunology, Centre de Recherche Public de la Santé/Laboratoire National de Santé, Luxembourg
5. 5.    ⁵World Health Organization Global Specialised Laboratory, Centre for Infections, Health Protection Agency, London, United Kingdom
6. 6.    ⁶Moscow State University, Moscow, Russian Federation
7. 7.    ⁷United States Centers for Disease Control and Prevention, Atlanta, Georgia
8. Correspondence: Annette Mankertz, PhD, National Reference Centre for Measles, Mumps, and Rubella / World Health Organization European Regional Reference Laboratory, FG12 “Viral Infections,” Robert-Koch Institute, Nordufer 20, D-13353 Berlin, Germany (mankertza@rki.de).

Abstract

Background. In 2002, the World Health Organization (WHO) adopted a goal to eliminate measles in the European Region by 2010. Measles elimination is defined as the interruption of indigenous measles virus (MV) transmission. The molecular epidemiology of MV transmission in the WHO European Region was studied through the investigation of reported cases and outbreaks to monitor the region's progress toward its measles elimination goal.

Methods. National and regional laboratories  performed molecular characterization of MV detected between 2007 and 2009 in the WHO European Region. To document indigenous transmission and importations into the region, we analyzed genotyping results and epidemiological data on measles outbreaks reported by the member states.

Results. Since 2007, MV genotype D6 has not  been reported in the WHO European Region, suggesting that its chains of transmission have been interrupted, whereas several other MV genotypes are still circulating. Although several European countries have already interrupted indigenous MV transmission, genotyping showed that 3 endemic MV transmission chains have been reestablished in other countries.

Conclusions. The WHO European Region 2010  goal will not be met, as indigenous transmission of MV has not been interrupted. As the region begins to document its process of elimination verification to monitor progress toward the goal, countries will need to ensure that genotyping is performed in all measles outbreaks.

 

http://jid.oxfordjournals.org/content/204/suppl_1/S335.abstract

 

 

 

Supplementary Immunization Activities to Achieve Measles Elimination: Experience of the European Region

1. 1.   Nino Khetsuriani1,  Sergei Deshevoi2, Ajay Goel2, John Spika2,a, Rebecca Martin2 and

Nedret Emiroglu2

+ Author Affiliations

1. 1.    ¹Global Immunization Division, National Center for Immunization and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
2. 2.    ²World Health Organization Regional Office for Europe, Copenhagen, Denmark
3. Correspondence: Nino Khetsuriani, MD, PhD, Global Immunization Division, National Center for Immunization and Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-05, Atlanta, Georgia 30033 (nck7@cdc.gov).

Abstract

Background. Supplementary immunization  activities (SIAs) using measles-containing vaccine (MCV) have had a substantial impact on reducing mortality associated with measles worldwide.

Methods. To assess impact of SIAs on measles  incidence in the World Health Organization European Region and their role at the final stages of measles elimination efforts in Europe, we reviewed information on SIAs, measles surveillance, and routine vaccination coverage during 2000–2009.

Results. During 2000–2009,  >57 million persons received MCV through SIAs in 16 countries. The Region primarily focused on catch-up campaigns with wider target age groups than in other regions and subsequently relied on routine vaccination rather than periodic follow-up SIAs for the second MCV dose. In addition, the concept of SIAs has been expanded from short-term (<30 days) mass campaigns implemented in other regions to incorporate vaccination efforts over longer periods and outbreak response vaccination. In 2009, 14 of 16 countries that conducted SIAs reported no measles cases or <1 case per 1,000,000 population, reflecting the post-SIA decrease in incidence.

Conclusions. SIAs have made a substantial  contribution to the success of measles elimination efforts and will likely remain an important strategy for interrupting measles virus transmission in the European Region, although specific approaches will vary by country.

http://jid.oxfordjournals.org/content/204/suppl_1/S343.abstract

 

 

 

 

Who Gets Measles in Europe?

1. 1.   Mark Muscat

+ Author Affiliations

1. 1.    Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark
2. Correspondence: Mark Muscat, MD, Dept of Epidemiology, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark. (markmuscat1@gmail.com).

Abstract

Background. Measles outbreaks continue to occur in Europe as a result of suboptimum vaccination coverage. This article aims to describe individuals susceptible to measles, and provide an overview of affected groups and the public settings in which measles transmission occurred in Europe in 2005–2009.

Methods. Individuals susceptible to measles were described and categorized on the basis of factors leading to nonvaccination and vaccine failure. A literature search was conducted to identify affected groups and public settings in which measles transmission occurred.

Results.  Most individuals susceptible to  measles are previously uninfected and unvaccinated. The reasons for nonvaccination in individuals eligible for vaccination ranged from lack of information to poor access to health care. Several outbreaks have emerged in Roma and Sinti, Traveller, anthroposophic, and ultra-orthodox Jewish communities, and immigrants identifying them as being particularly at risk. Public settings for transmission included mostly educational and health care facilities.

Conclusions.  Improved efforts are needed to strengthen immunization programs, identify barriers for measles-containing vaccine uptake, and explore methods to target vulnerable populations that are not being reached with routine immunization delivery services. Specific measures are needed to prevent and control measles in educational and health care facilities. Failure to identify who gets measles and implement the elimination strategies raises concerns for the successful and sustainable elimination of measles in Europe.

http://jid.oxfordjournals.org/content/204/suppl_1/S353.abstract

 

 

Progress Toward Measles Elimination in the Russian Federation, 2003–2009

1. 1.   G. Onishchenko1, E. Ezhlova1, A. Gerasimova2, O. Tsvirkun2, S. Shulga2,

G. Lipskaya3, T. Mamayeva2, V. Aleshkin2 and N. Tikhonova2

+ Author Affiliations

1. 1.    ¹Federal Service on Consumers Rights Protection and Human Well-being (Rospotrebnadzor)
2. 2.    ²G. N. Gabrichevsky Research Institute For Epidemiology and Microbiology
3. 3.    ³A. N. Belozersky Institute of Physical-Chemical Biology, State University, Russian Federation
4. Correspondence: Olga Tsvirkun, PhD, G. N. Gabrichevsky Institute for Epidemiology and Microbiology, Admiral Makarov St 10, Moscow 125212, Russian Federation (o.tsvirkun@gabrich.ru).

Abstract

Successful implementation of the Russian Federation's national measles elimination program has been ensured by high vaccine coverage (>95%) of the target population (with 2 doses of measles-containing vaccine), case-based laboratory investigation of measles, and active surveillance of measles cases among patients with rashes and/or fever. As a result, the incidence of measles has decreased to <1 case per 1,000,000 population (2007–2009); no circulation of D6 genotype, which was endemic in the Russian Federation, has been observed since the second half of 2007; and the proportion of imported measles cases of different genotypes increased to 19.8% in 2007 from 1% in 2003. To confirm successful elimination of indigenous measles, a documentation system was initiated in the Russian Federation.

http://jid.oxfordjournals.org/content/204/suppl_1/S366.abstract

 

 

 

 

 

 

 

Closer to the Goal: Efforts in Measles Elimination in Germany 2010

 

1. 1.   Anette Siedler1, Annette Mankertz2, Fabian Feil4,  Gabriele Ahlemeyer6,

Angelika Hornig7, Markus Kirchner5, Konrad Beyrer5, Johannes Dreesman5,

Sibylle Scharkus8, Anne Marcic9, Sabine Reiter1, Dorothea Matysiak-Klose1,

Sabine Santibanez2, Gérard Krause3 and Ole Wichmann1

+ Author Affiliations

1. 1.    ¹Department for Infectious Disease Epidemiology, Immunization Unit
2. 2.    ²National Reference Laboratory Measles, Mumps, Rubella
3. 3.    ³Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin
4. 4.    ⁴Ministry of Social Affairs, Women's and Family Issues, Health, and Integration of Lower Saxony
5. 5.    ⁵Governmental Institute of Public Health of Lower Saxony, Hannover
6. 6.    ⁶State Institute of Health and Labour of North-Rhine Westfalia, Duesseldorf
7. 7.    ⁷Ministry of Labor, Social Affairs, Health, Family, and Women of Rhineland-Palatinate, Mainz
8. 8.    ⁸Department for Public Health, Medical, Pharmaceutical and Social Affairs and Hospital Funding, District Government, Koeln
9. 9.    ⁹Ministry of Labor, Social Affairs and Health of Schleswig-Holstein, Kiel, Germany
10. Correspondence: Anette Siedler, PhD, Immunization Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, DGZ-Ring 1, 13086 Berlin, Germany (siedlera@rki.de).

Abstract

Increasing 2-dose vaccination coverage has led to an interruption of endemic measles virus circulation in Germany. However, outbreaks after virus importation still occur and contribute to international transmission chains. Between 2003 and 2009, annual measles incidence ranged between 0.2 and 2.8 per 100,000 population. Immunization gaps have been identified especially in secondary-school students and young adults, which is also reflected by a shift in age distribution of reported measles cases toward older age groups. Stronger political commitment and standardized guidelines for outbreak containment were put in place in Germany in the past years, but the last step toward measles elimination cannot be made until the number of susceptible individuals has been further reduced. In addition to routine childhood vaccination, supplementary immunization activities are needed targeting school students and young adults to close critical immunization gaps. Intensification of public awareness and sound information on vaccinations are necessary to convince skeptics and remind the forgetful.

http://jid.oxfordjournals.org/content/204/suppl_1/S373.abstract

 

 

 

 

Status of Rubella and Congenital Rubella Syndrome Surveillance, 2005–2009, the World Health Organization European Region

1. 1.   Laura A. Zimmerman1,  Mark Muscat2, Dragan Jankovic3, Ajay Goel3,

Henrik Bang2,  Nino Khetsuriani1 and Rebecca Martin3

+ Author Affiliations

1. 1.    ¹Centers for Disease Control and Prevention, Atlanta, Georgia
2. 2.    ²EUVAC.NET, Statens Serum Institute
3. 3.    ³World Health Organization Regional Office for Europe, Copenhagen, Denmark
4. Correspondence: Laura Zimmerman, MPH, CDC, NCIRD, 1600 Clifton Rd, MS E-61, Atlanta, GA 30333 (laz5@cdc.gov).

Abstract

 Background. The World Health Organization European Region has a goal for rubella elimination and congenital rubella syndrome (CRS) prevention. Although all Member States recommend a rubella-containing vaccine in their national immunization programs, rubella and CRS continue to occur, and surveillance quality varies throughout the region.

 Methods. To describe the status of regional rubella and CRS surveillance and assess progress toward elimination, we reviewed surveillance practices by surveying all 53 Member States and analyzed rubella and CRS surveillance data during 2005–2009.

 Results. Overall, 41 (91%) of 45 responding Member States have nationwide rubella surveillance, and 39 (87%) have nationwide CRS surveillance. During 2005–2009, rubella cases reported in the region decreased by 94% from 206,359 cases to 11,623 cases. The greatest decrease (99%) was observed in newly independent states of the former Soviet Union. In the rest of the region, high rubella incidence was observed in Poland, Romania, Italy, and San Marino during 2005–2008 and in Poland, Bosnia and Herzegovina, and Austria in 2009. A total of 68 CRS cases were reported during 2005–2009.

 Conclusions.  As the foundation to achieving and verifying rubella elimination, high-quality rubella and CRS surveillance needs to be implemented and sustained in all Member States.

http://jid.oxfordjournals.org/content/204/suppl_1/S381.abstract

 

Toward Rubella Elimination in Poland: Need for Supplemental Immunization Activities, Enhanced Surveillance, and Further Integration with Measles Elimination Efforts

1. 1.   Laura Zimmerman1,  Justyna Rogalska2, Kathleen A. Wannemuehler1,

Marzena Haponiuk3, Adam Kosek4,  Ewa Pauch5, Elzbieta Plonska6,

Daniel Veltze7, Miroslaw P. Czarkowski2,  Nilesh Buddh8, Susan Reef1 and

Pawel Stefanoff2

+ Author Affiliations

1. 1.    ¹Global Immunization Division, National Center for Immunization and Respiratory Diseases, Center for Disease Control and Prevention, Atlanta, Georgia
2. 2.    ²Department of Epidemiology, National Institute of Public Health – National Institute of Hygiene, Warsaw
3. 3.    ³Section of Epidemiology and Surveillance, Voyvodship Sanitary-Epidemiological Station, Kielce
4. 4.    ⁴Section of Epidemiology and Surveillance, Voyvodship Sanitary-Epidemiological Station, Krakow
5. 5.    ⁵Section of Epidemiology and Surveillance, Voyvodship Sanitary-Epidemiological Station, Poznan
6. 6.    ⁶Section of Epidemiology and Surveillance, Voyvodship Sanitary-Epidemiological Station, Warsaw
7. 7.    ⁷Section of Epidemiology and Surveillance, Voyvodship Sanitary-Epidemiological Station, Gdansk, Poland
8. 8.    ⁸WHO Regional Office for Europe Consultant, Copenhagen, Denmark
9. Correspondence: Laura Zimmerman, Global Immunization Division, National Center for Immunization and Respiratory Diseases, Center for Disease Control and Prevention, 1600 Clifton Rd, MS E-61, Atlanta, GA 30333 (laz5@cdc.gov).

 

 

Abstract

Background.  All Member States of the World Health Organization (WHO) European Region have endorsed rubella elimination and congenital rubella syndrome (CRS) prevention. However, Poland has continued high levels of reported rubella.

Methods. We reviewed rubella incidence in Poland since 1966 and analyzed national aggregated surveillance data from the period 2003–2008 and case-based data from 4 provinces from the period 2006–2008. We described CRS cases since 1997 and assessed maternal receipt of vaccine. We reviewed national vaccination coverage from 1992 through 2008.

Results.  Since 1966, rubella outbreaks have  occurred every 4–6 years in Poland. Aggregate and case-based data from the period 2003–2008 indicate that rubella virus transmission has occurred across wide age ranges (from <1 year to 60 years), with disproportionately higher percentage of cases among adolescent boys. Of 18 children with reported CRS cases from 1997 through 2008, 15 (83%) of their mothers had not been vaccinated. Measles-mumps-rubella dose 1 vaccination coverage ranged from 97% to 99%.

Conclusions. Poland had the highest incidence of rubella in the WHO European Region in 2007 and 2008. Rubella occurs predominantly in age and sex cohorts historically not included in vaccination recommendations. The risk for CRS continues. To achieve rubella elimination, supplemental immunization activities among adolescent boys are needed, as is integration with measles elimination efforts.

http://jid.oxfordjournals.org/content/204/suppl_1/S389.abstract