Measles and rubella elimination country profile: Italy

Source: Measles and rubella elimination Annual Status Update report, 2016 Definition used for an outbreak Two or more confirmed cases which are temporally related (with onset of rash in cases occurring between 7 and 18 days after exposure) and epidemiologically or virologically linked or both Measles elimination status Rubella elimination status Total population 59 801 004 < 1 year old 500 080 < 5 years old 2 505 835 Demographic information, 2016 Source: World Population Prospects: The 2015 Revision, New York, United Nations National plan of action Does the country have a national plan of action? Yes Is it updated? Yes Source: Measles and rubella elimination Annual Status Update report, 2016 Measles and rubella elimination country profile Italy Measles and rubella immunization schedule, 2016 Source: Immunization schedule, WHO, Data and Statistics, Immunization Monitoring and Surveillance (http://www.who.int/immunization/monitoring_surveillance/data/en/) MMR = measles-mumps-rubella-containing vaccine; MCV1 = first dose measles-containing vacccine; MCV2 = second dose measles-containing vaccine; RCV = rubella-containing vaccine Measles and rubella cases and immunization coverage, 2007–2016 Source: Disease incidence and immunization coverage, WHO, Data and Statistics, Immunization Monitoring and Surveilance (http://www.who.int/immunization/monitoring_surveillance/data/en/) MCV1 = first dose of measles-containing vaccine MCV2= second dose of measles-containing vaccine Confirmed measles cases by month of onset, 2012-2016 Source: CISID2 2016 2015 endemic 2016 endemic 2015 endemic 2016 endemic Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/6thRVC Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/6thRVC 0 10 20 30 40 50 60 70 80 90 100 0 1000 2000 3000 4000 5000 6000 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Measles Rubella Coverage MCV1 Coverage MVC2 0 50 100 150 200 250 300 350 400 450 J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N 2012 2013 2014 2015 2016 Vaccine Schedule MCV1 MMR 13-15 months MCV2 MMR 5-6 years Year of introduction MCV2 2004 RCV 1972 Measles vaccination in school No Measles and rubella elimination country profile Italy ©WHO 2018 Information on CRS, 2016 1 imported case, laboratory confirmed Source: Measles and rubella elimination Annual Status Update report, 2016 CRS = congenital rubella syndrome Measles cases by first subnational level, 2016 1dot=1case Source:  Measles and rubella elimination Annual Status Update report, 2016 Measles genotypes by first subnational level, 2016 Source: MeaNS 2016 Note: The dots in the maps are placed randomly within the administrative regions. Map disclaimer: The boundaries and names shown and the designations used on the maps 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 and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. Measles cases by age group and vaccination status, 2016 Source:  Measles and rubella elimination Annual Status Update report, 2016 Sources of infection, 2016 Measles Rubella Imported 38 0 Import-related 22 0 Unknown/ Not reported 56 5 Endemic 750 25 Source:  Measles and rubella elimination Annual Status Update report, 2016 •B3 •D8 •H1 •D4 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% < 1 year 1-4 years 5-9 years 10-14 years 15-19 years 20-29 years 30 + 0 doses 1 dose 2 or more doses Unknown Suspected measles cases Confirmed measles cases Discarded as non- measles Measles incidence Genotypes detectedLabora- tory Epi- linked Clincally Total 2012 ND ND ND ND ND ND 10.4 D4,D8 2013 2 389 1 241 667 350 2 258 153 40.7 B3,D4,D8,D9 2014 1 728 1 014 414 266 1 694 119 27 B3,D8,D9,H1 2015 335 161 44 48 253 87 3.9 B3.D4,D8 2016 910 619 112 135 866 72 13.6 B3, D8, H1 Measles incidence, epidemiologic and virologic characteristics, 2012-2016 Measles surveillance and laboratory performance indicators, 2012-2016 Source: Measles and rubella elimination Annual Status Update report, 2012-2016, and internal communication from country Incidence calculated per 1 million population ND = Data not available; NA= Not applicable Source: ASU 2012-2016, MeaNS 2012-2016 and laboratory accreditation results 2012-2016, and internal communication from country ND = Data not available; NA= Not applicable A proficient laboratory is WHO accredited and/or has an established quality assurance programme with oversight by a WHO accredited laboratory Rubella incidence, epidemiologic and virologic characteristics, 2012-2016 Rubella surveillance and laboratory performance indicators, 2012-2016 Source: Measles and rubella elimination Annual Status Update report, 2012-2016, and internal communication from country Incidence calculated per 1 million population ND = Data not available; NA= Not applicable Source: ASU 2012-2016, RubeNS 2012-2016 and laboratory accreditation results 2012-2016, and internal communication from country ND = Data not available; NA= Not applicable A proficient laboratory is WHO accredited and/or has an established quality assurance programme with oversight by a WHO accredited laboratory Surveillance performance indicators and targets a. Rate of discarded cases: at least 2 discarded measles or rubella cases per 100 000 population b. % cases with adequate laboratory investigation: ≥ 80% c. % origin of infection known: ≥ 80% d. Rate of viral detection: ≥ 80%  Measles and rubella elimination country profile Italy Discarded non- measles rate % 1st sub- national unit with ≥ 2 discarded cases % cases with adequate laboratory investiga- tion % origin of infection known # specimen tested for measles % positive for measles Rate of viral detection % WHO and proficient labs 2012 ND ND ND ND ND ND ND ND 2013 0.3 0% 12.3% 93.3% ND ND 20.5% ND 2014 0.2 0% 12.4% 95.7% 174 71.3% ND ND 2015 0.1 0% 21.6% 98.4% 248 64.9% ND 26% 2016 0.1 0% 16% 93.5% 721 85.9% 32.5% 18% Suspected rubella cases Confirmed measles cases Discarded as non- rubella Rubella incidence Genotypes detected Laboratory Epi- linked Clincally Total 2012 ND ND ND ND ND ND 5.9 ND 2013 116 7 35 24 66 28 1.2 ND 2014 139 6 7 13 26 28 0.4 1E 2015 54 12 2 10 24 25 0.4 1G 2016 81 15 0 15 30 23 0.5 ND Discarded non- rubella rate % 1st sub- national unit with ≥ 2 discarded cases % cases with adequate laboratory investiga- tion % origin of infection known # specimen tested for rubella % positive for rubella Rate of viral detection % WHO and proficient labs 2012 ND ND ND ND ND ND ND ND 2013 0.1 0% ND 68.2% ND ND ND ND 2014 0.1 0% 31.9% 76% 157 1.9% ND ND 2015 0 0% 25.5% 66.7% 37 32.4% ND 32% 2016 0 0% 13.2% 83.3% 41 36.6% ND 17% RVC comments, based on 2016 reporting The Regional Verification Commission for Measles and Rubella Elimination (RVC) appreciates the supplemental documents provided with the ASU and commends Italy on implementing several surveillance and immunization initiatives, including putting into practice the National Plan of Vaccine Prevention and establishing a national network of measles and rubella regional laboratories with a comprehensive national accreditation programme. The RVC urges the national health authorities to consider further measures to improve the subnational vaccination coverage in all administrative territories and to improve the rate of viral detection of measles and rubella through the submission of specimens for genotyping. Source: Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report (www.euro.who.int/6thRVC) ©WHO 2018