WHO Epidemiological Brief: a monthly publication on vaccine-preventable diseases and immunization data and analysis: No. 29, December 2012

Issue 15, April 2011 No. 29 (December 2012)  A monthly publication on vaccine‐preventable diseases and immunization data and analysis  (251.1)  followed  by  Romania  (155.1).  The  incidence  of reported measles  in the Region  is shown  in figure  1. Three countries reported zero cases for the whole  period  ‐ Albania, Armenia and Hungary. Of  the  total  cases, 8,256  (40%)  cases were  laboratory‐confirmed  and 2,019 (10%) cases were epidemiologically linked.   During the first ten months of 2012, a total of 1,271  sequences were submitted to the Measles Nucleotide  Sequence database  (MeaNS2) by  the  countries  from  the WHO European Region. The genotypes  identified  in  the  Region  included  D4  (n=478),  B3  (n=505),  D8  (n=273), D9 (n=12) and H1 (n=3).   Completeness and timeliness of reporting  Completeness of measles reporting during the first 10  months  of  2012  was  86.4%.  Only  six  countries  (Iceland, Kyrgyzstan, Netherlands, Tajikistan, Ukraine  and  Uzbekistan)  did  not  attain  the  required  80%  completeness  level while  two  counties  (Bosnia  and  No. 29 (December 2012)  The  following  epidemiological  report  provides  an  overview  of  selected  epidemiological  characteristics  of measles and rubella  in the WHO European Region  for  the  first  ten  months  of  2012.  The  report  also  provides  information on acute  flaccid paralysis  (AFP)  surveillance. The analyses of these diseases are based  on cases with disease onset dates during this period.1    Measles in 2012 (January‐October)  Incidence ‐ notifications and laboratory data   For  the  first  ten months of 2012  there were 20,719  measles cases reported by  51 (96%) countries of the  WHO  European  Region.  Of  the  total,  87%  of  cases  (n=17,956)  were  reported  from  four  countries:  Ukraine  (n=11,298;  55%),  Romania  (n=3,318;  16%),  the  Russian  Federation  (n=1,834;  9%)  and  the  UK  (n=1,506;  7%).    The  highest  incidence  per  million  population  for  this  period was  reported  in  Ukraine  ________________________________________________  1Where these dates were unavailable, cases with the date of notification reported during this period were included.   2Measles Nucleotide Sequence database (MeaNs). http://www.hpa‐bioinformatics.org.uk/Measles   Figure 1. Incidence of reported measles per million inhabitants, WHO European Region,   January‐October 2012  Page No. 1 Page No. 2   No. 29 (December 2012)  Herzegovina and San Marino) did not submit reports.  Timeliness  of  reporting measles  cases  for  the  same  period was  74.2% with  15  countries  submitting  less  than  80%  of  monthly  reports  in  a  timely  manner  (monthly summary table 3).  Age distribution  The  age‐group  was  known  in  99.8%  (n=20,684)  of  cases.  Overall,  10%  were  aged  <1  year,  23%  were  aged 1‐4, 39% were aged 5‐19  years and 28% were  ≥20  years.  Figure  2  shows  the  age  distribution  of  reported measles cases during the first ten months of  2012.   Figure 2. Age‐distribution of reported measles cases  in the WHO European Region, January‐October 2012  (n=20,684)                          N.B. Discarded cases are not included  Vaccination status  Vaccination  status  was  known  in  17,851  (86%)  of  reported measles cases. Of  these, 9,417  (53%) were  unvaccinated and 8,434  (47%) were vaccinated with  at  least  one  measles  vaccine  dose.  Most  of  the  vaccinated  cases  (80%) were  reported  from Ukraine  (n=6,760).   Hospitalisation and mortality  Data on hospitalisation  status was available  for 78%  (n=16,143) of all reported measles cases. There were  13,307  reported  hospitalised  cases  in  connection  with  measles,  amounting  to  82%  of  all  cases  with  known  hospitalisation  status.  During  this  period  no  measles‐related deaths were reported.   Imported cases  Importation  status was  known  in  32%  of  cases.  Of  these,  255  were  reported  as  imported  cases,  amounting  to  4%  of  all  cases  with  a  known  importation  status.  The  remaining  cases  were  believed  to  have  been  infected  within  their  own  country.      Measles in October 2012 (Monthly report)  Incidence ‐ notifications   During  October  2012,  40  countries  reported  174  measles cases. Of these, 77% (n=134) were reported  from  three  countries:  UK  (n=77;  44%),  Italy  (n=32;  18%)  and  France  (n=25;  14%).  For  October,  no  reports  were  submitted  from  13  (26%)  countries:  Andorra,  Austria,  Bosnia  and  Herzegovina,  Kazakhstan,  Kyrgyzstan,  Monaco,  Republic  of  Moldova, Romania, Russian Federation, San Marino,  Turkmenistan, Ukraine and Uzbekistan.    Rubella in 2012 (January‐October)  Incidence ‐ notifications and laboratory data   For  the  first  ten months of 2012  there were 28,023  rubella cases  reported by 43 countries. Of  the  total,  99%  of  cases  (n=27,675)  were  reported  from  four  countries:  Romania  (n=20,772;  74%),  Poland  (n=5,001; 18%), Russian Federation  (n=960; 3%) and  Ukraine  (n=942;  3%).    The  highest  incidence  per  million  population  for  this  period  was  reported  in  Romania  (970.8)  followed  by  Poland  (130.5).  Ten  countries reported zero cases for the whole period  ‐  Albania, Cyprus, Estonia, Finland, Malta and Slovakia.  Of the total cases, 6,766 (24%) cases were laboratory ‐confirmed  and  15,195  (54%)  cases  were  epidemiologically  linked. Rubella virus genotypes 1G  and 2B were detected.    Completeness and timeliness of reporting Completeness of reporting rubella during the first 10  months of 2012 was 67.7%. Nine countries (Armenia,  Austria,  Croatia,  Iceland,  Kyrgyzstan,  Netherlands,  Tajikistan, Ukraine and Uzbekistan) did not attain the  required  80%  completeness  level  and nine  counties  did  not  submit  reports.  Timeliness  of  reporting  measles  cases  for  the  same period was 60.6%, with  15  countries  submitting  less  than  80%  of  monthly  reports  in  a  timely  manner  (monthly  summary      table 4).    Page No. 3   No. 29 (December 2012)  Age distribution  The  age‐group  was  known  in  96%  (n=27,026)  of  cases. Overall, 2% were aged <1 year, 4% were aged   1‐4,  73% were  aged  5‐19  years  and  21% were  ≥20  years. Figure 3 shows the age distribution of reported  rubella cases during this period.  Figure 3. Age‐distribution of  reported  rubella  cases  in the WHO European Region, January‐October 2012  (n=27,026)    Vaccination status  Vaccination status was known  in 21,698 cases (77%).  Of  these,  21,078  (97%) were  unvaccinated  and  619  (3%)  were  vaccinated  with  at  least  one  dose  of  rubella vaccine.   Imported cases  Importation  status  was  known  in  75%  of  rubella  cases. Of these, 31 were reported as imported cases,  amounting  to  0.1%  of  all  cases  with  a  known  importation  status.  The  remaining  cases  were  believed  to  have  been  infected  within  their  own  country.     Rubella in October 2012 (Monthly report)  Incidence ‐ notifications   During  October  2012  there were  281  rubella  cases  reported  by  30  countries.  Of  these,  90%  of  cases  (n=253)  were  reported  from  two  countries:  Poland  (n=239, 85%) and the Russian Federation (n=14, 5%).  For  October,  no  reports  were  submitted  from  23  (43%) countries: Andorra, Armenia, Austria, Belgium,  Bosnia  and  Herzegovina,  Croatia,  Denmark,  France,  Germany,  Israel,  Italy,  Kazakhstan,  Kyrgyzstan,  Monaco,  Republic  of  Moldova,  San  Marino,  Serbia,  Slovenia,  Tajikistan,  Turkey,  Turkmenistan,  Ukraine  and Uzbekistan.     Acute flaccid paralysis surveillance  Among  the 42 countries with AFP  surveillance  there  were  1,404  AFP  cases  reported  for  the  first  ten  months of 2012  (weeks 1‐46). These  included 1,381  cases under 15 years of age, with most cases  (65 %;  n=902)  reported  from  five  countries:  Russian  Federation  (25%;  n=358),  Uzbekistan  (14%;  n=193),  Turkey  (12%;  n=162),  Ukraine  (8%;  n=107)  and  Kazakhstan  (6%;  n=82).  No  polio‐compatible  cases  were  reported.  Four  countries,  namely  Andorra,  Ireland, Malta  and  Slovenia,  reported  zero  cases  of  AFP.    Comments  Measles and Rubella  Overall, measles and  rubella  reporting has  improved  in 2012  (see  tables 3  and 4),  compared  to previous  years.    However,  adequate  monthly  reporting  of  measles  and  rubella  cases  is  still  delayed  and  incomplete  from  a  few  countries.  To  verify measles  and  rubella elimination,  it  is necessary  to determine  whether  the  national  surveillance  system  provides  timely  and  complete  information  based  on  pre‐ established  quality  criteria.  The  elimination  level  targets  of  80%  completeness  and  timeliness  of  measles  and  rubella  monthly  reporting  will  be  monitored  by National  Verification  Committees  and  the Regional Verification Commission. It  is therefore,  essential  that  all  countries  submit  complete  and  timely  monthly  reporting  (including  zero  reporting)  by  the 25th day of  the  following month  to  the WHO  Regional Office  for Europe or to ECDC  in the case of  EU countries.    Based on the reports of measles and rubella received  in October 2012, there were no significant changes in  the epidemiological situation of these diseases in the  Region,  as  compared  to  the  previous  month  (September 2012, see Epi‐Brief 28).         Page No. 4   No. 29 (December 2012)  Monthly summary table 1: Reported measles cases for last 12 months, November 2011 — October 2012 (data as of 1 December 2012) Nov Dec Jan Feb Mar Apr May Jun July Aug Sep Oct Albania 3 214 691 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Oct Andorra 67 722 0 0 0 0 0 0 0 0 0 0 0 0 - - Aug Armenia 3 098 784 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Oct Austria 8 405 570 4.2 35 12 6 3 1 0 2 2 4 1 4 0 - Sep Azerbaijan 9 309 301 1.7 16 0 0 0 0 1 1 0 0 0 0 0 14 Oct Belarus 9 568 453 1.1 11 0 1 5 0 3 0 0 1 1 0 0 0 Oct Belgium 10 741 129 8.3 89 25 3 18 13 3 9 4 9 5 0 0 0 Oct Bosnia and Herzegovina 3 755 478 0 0 - - - - - - - - - - - - No Report Bulgaria 7 449 799 0.3 2 1 0 0 0 0 0 0 0 1 0 0 0 Oct Croatia 4 397 338 0.2 1 0 - 0 0 0 1 0 0 0 0 0 0 Oct Cyprus 1 116 113 0.9 1 0 0 0 1 0 0 0 0 0 0 0 0 Oct Czech Republic 10 522 894 2.2 23 0 2 4 2 - 7 2 3 1 2 0 0 Oct Denmark 5 570 660 0.4 2 0 0 1 0 0 0 1 0 0 0 0 0 Oct Estonia 1 340 887 4.5 6 0 0 0 0 0 4 2 0 0 0 0 0 Oct Finland 5 381 049 1.7 9 3 0 0 2 0 3 0 0 0 0 1 0 Oct France 63 103 600 17.4 1096 122 144 107 127 142 112 104 92 77 33 11 25 Oct Georgia 4 330 693 6.5 28 1 1 1 0 3 3 6 1 6 2 4 0 Oct Germany 82 140 752 2.2 181 22 5 13 10 11 22 51 22 13 10 2 0 Oct Greece 11 392 891 0.2 2 0 0 0 0 0 0 1 1 0 0 0 0 Oct Hungary 9 964 621 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Oct Iceland 324 050 0 0 0 0 - 0 - 0 - 0 - 0 0 0 Oct Ireland 4 527 814 23.0 104 7 5 2 2 4 10 51 10 2 4 3 4 Oct Israel 7 545 524 20.4 154 4 2 3 14 21 5 26 52 25 1 1 0 Oct Italy 60 686 264 11.9 724 57 53 63 122 89 100 105 58 28 6 11 32 Oct Kazakhstan 16 240 343 3.3 54 - - 1 11 8 20 12 1 1 0 0 - Sep Kyrgyzstan 5 405 749 0 0 - 0 - - - 0 - - - - - - Apr Latvia 2 242 757 1.3 3 0 0 1 2 0 0 0 0 0 0 0 0 Oct Lithuania 3 311 227 0.6 2 0 0 - 0 0 2 0 0 0 0 0 0 Oct Luxembourg 514 108 3.9 2 0 0 0 0 1 0 0 1 0 0 - 0 Oct Malta 418 134 0 0 0 0 0 0 0 0 - 0 0 0 0 0 Oct Monaco 37 785 - 1 - - 1 0 0 0 0 0 0 0 - - Aug Montenegro 632 157 0 0 - - - - 0 0 0 0 0 0 0 0 Oct Netherlands 16 647 522 0.7 11 0 0 0 0 1 4 1 1 2 2 0 0 Oct Norway 4 917 917 0.8 4 0 0 0 0 1 0 0 0 0 2 1 0 Oct Poland 38 307 380 2.1 80 0 0 2 4 10 26 21 6 9 0 1 1 Oct Portugal 10 679 646 0.6 6 0 1 0 0 0 0 4 0 0 1 0 0 Oct Republic of Moldova 3 555 765 3.1 11 0 - 7 3 0 1 0 0 0 0 0 - Sep Romania 21 445 408 199.7 4282 393 571 729 108 732 317 806 338 157 77 54 - Sep Russian Federation 142 822 544 16.5 2361 211 316 609 386 356 279 130 43 23 8 - - Aug San Marino 29 332 - 0 - - - - - - - - - - - - No Report Serbia 9 842 939 0 0 0 0 0 0 - 0 0 0 0 0 0 0 Oct Slovakia 5 470 405 0.4 2 0 0 0 0 0 0 0 0 2 0 0 0 Oct Slovenia 2 035 215 1.0 2 0 0 1 0 1 0 0 0 0 0 0 0 Oct Spain 46 366 600 15.9 735 203 108 60 69 89 64 59 53 20 4 2 4 Oct Sweden 9 427 367 3.3 31 3 0 2 17 1 4 1 1 0 1 1 0 Oct Switzerland 7 694 595 7.9 61 0 3 2 3 5 11 22 6 4 4 0 1 Oct Tajikistan 6 982 372 1.0 7 0 0 - 0 4 0 - 3 - - 0 0 Oct The former Yugoslav Republic of Macedonia 2 063 819 3.4 7 0 2 0 3 1 0 1 0 0 0 0 0 Oct Turkey 73 689 680 0.8 56 0 - 2 0 0 0 0 7 21 4 6 16 Oct Turkmenistan 5 099 686 0 0 0 0 0 0 0 0 0 0 0 0 - - Aug Ukraine 45 242 024 274.9 12438 131 1009 2309 1999 2095 1797 1695 1191 - 212 - - Aug United Kingdom 62 439 828 25.6 1598 63 29 39 111 148 190 293 194 153 149 152 77 Oct Uzbekistan 27 802 722 0 0 - - 0 0 0 0 - 0 - - - - Jun Total/Averages 899 321 103 26.95 24238 1258 2261 3985 3010 3730 2994 3400 2098 552 526 250 174 1 Source: "World Population Prospects: The 2008 Revision", New York, United Nations and updates provided by Member States. Month of last report 2012 Total measles cases Nov 11- Oct 12 Country Total Population1 Incidence Rate per 1 million population Nov11-Oct 12 2011 -2012 (Year and month of Rash onset) Page No. 5   No. 29 (December 2012)  Monthly summary table 2: Reported rubella cases for last 12 months, November 2011 — October 2012 (data as of 1 December 2012) Nov Dec Jan Feb Mar Apr May Jun July Aug Sep Oct Albania 3 214 691 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Oct Andorra 67 722 0 0 0 0 0 0 0 0 0 0 0 0 - - Aug Armenia 3 098 784 0.3 1 - - 0 0 0 0 0 1 - - - - Jun Austria 8 405 570 1.2 10 1 0 2 1 0 1 2 - 0 3 0 - Sep Azerbaijan 9 309 301 1.2 11 0 0 1 0 0 0 0 0 0 0 1 9 Oct Belarus 9 568 453 1.0 10 0 0 0 0 1 1 1 5 0 2 0 0 Oct Belgium 10 741 129 0 0 - - - - - - - - - - - - No Report Bosnia and Herzegovina 3 755 478 0 0 - - - - - - - - - - - - No Report Bulgaria 7 449 799 2.1 16 1 1 1 2 4 1 2 2 1 0 0 1 Oct Croatia 4 397 338 0 0 - - - - - - - - 0 - - - Jul Cyprus 1 116 113 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Oct Czech Republic 10 522 894 0.7 7 2 0 0 1 1 1 1 0 0 1 0 0 Oct Denmark 5 570 660 0 0 0 0 - - - - - - - - 0 0 Oct Estonia 1 340 887 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Oct Finland 5 381 049 0 0 - 0 0 0 0 0 0 0 0 0 0 0 Oct France 63 103 600 0 0 - - - - - - - - - - - - No Report Georgia 4 330 693 17.5 76 3 8 10 7 11 7 9 2 7 4 1 7 Oct Germany 82 140 752 0 0 - - - - - - - - - - - - No Report Greece 11 392 891 0 0 0 0 0 0 0 0 - - 0 0 0 0 Oct Hungary 9 964 621 0.9 9 1 0 0 2 1 5 0 0 0 0 0 0 Oct Iceland 324 050 0 0 0 0 - - - 0 - 0 0 0 0 0 Oct Ireland 4 527 814 3.1 14 1 1 0 2 0 1 4 2 1 2 0 0 Oct Israel 7 545 524 0.1 1 0 0 0 0 0 0 1 0 0 0 0 - Sep Italy 60 686 264 0.2 14 12 2 - - - - - - - - - - No Report Kazakhstan 16 240 343 0.7 12 - - 2 2 - 2 2 2 1 1 0 - Sep Kyrgyzstan 5 405 749 0.4 2 - 0 - 2 - 0 - - - - - - Apr Latvia 2 242 757 3.6 8 0 0 0 0 0 1 3 2 1 1 0 0 Oct Lithuania 3 311 227 0 0 0 0 - 0 0 0 0 0 0 0 0 0 Oct Luxembourg 514 108 1.9 1 0 0 0 - 1 0 0 0 0 0 - 0 Oct Malta 418 134 0 0 0 0 0 0 0 0 - 0 0 0 0 0 Oct Monaco 37 785 - - - - 0 0 0 0 0 0 0 0 - - Aug Montenegro 632 157 0 0 - - - - 0 0 0 0 0 0 0 0 Oct Netherlands 16 647 522 0.1 1 0 0 0 0 - 1 - 0 0 0 - 0 Oct Norway 4 917 917 0.2 1 0 0 0 1 0 0 0 0 - 0 0 0 Oct Poland 38 307 380 140.8 5392 205 186 174 279 695 1071 1027 731 405 211 169 239 Oct Portugal 10 679 646 0.2 2 0 0 0 0 0 0 0 1 0 0 1 0 Oct Republic of Moldova 3 555 765 0 0 0 0 - - - - - - - - - - No Report Romania 21 445 408 1155.2 24774 1573 2429 2924 7021 7697 1874 899 299 36 7 6 9 Oct Russian Federation 142 822 544 6.7 961 - 1 65 121 166 178 155 126 79 35 21 14 Oct San Marino 29 332 - - - - - - - - - - - - - - No Report Serbia 9 842 939 0 0 - - - - - - - - - - - - No Report Slovakia 5 470 405 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Oct Slovenia 2 035 215 0 0 - 0 0 0 0 0 0 0 0 0 0 - Sep Spain 46 366 600 1.3 58 - 2 4 12 15 13 8 2 2 0 0 0 Oct Sweden 9 427 367 5.4 51 1 0 - - 0 1 6 27 16 0 0 0 Oct Switzerland 7 694 595 1.6 12 0 1 0 1 3 1 0 0 2 1 1 2 Oct Tajikistan 6 982 372 0.1 1 0 0 - 0 0 0 - 1 - - - - Jun The former Yugoslav Republic of Macedonia 2 063 819 1.5 3 1 0 1 0 0 0 1 0 0 0 0 0 Oct Turkey 73 689 680 0 0 - - - - - - - - - - - - No Report Turkmenistan 5 099 686 0 0 - - 0 0 0 0 0 0 0 0 - - Aug Ukraine 45 242 024 20.8 942 - - 0 207 303 432 - - - - - - Apr United Kingdom 62 439 828 1.0 65 0 0 3 19 17 9 8 5 4 0 0 0 Oct Uzbekistan 27 802 722 0 0 - - 0 0 0 0 - 0 - - - - Jun Total/Averages 899 321 103 36.09 32455 1801 2631 3187 7680 8915 3600 2129 1208 555 268 200 281 1 Source: "World Population Prospects: The 2008 Revision", New York, United Nations and updates provided by Member States. 2011 -2012 (Year and month of Rash onset) Month of last report 2012 Country Total Population1 Incidence Rate per 1 million population Nov 11-Oct 12 Total Rubella cases Nov 11- Oct 12 La b co nf ir m ed Ep i- Li nk C li ni ca l2 C om pl et e- ne ss T im el in es s M on th o f la st re po rt La bo ra to ry in ve st ig at io n ra te de te ct io n ra te So ur ce o f in fe ct io n Albania 3 226 922 0 0 0 0 0 1 0 100% 90% Oct 100% 0.03 100% Andorra 67 726 0 0 0 0 0 0 0 80% 40% Aug - 0.00 - Armenia 3 107 085 0 0 0 0 0 21 0 100% 100% Oct 95.2% 0.68 100% Austria 8 418 180 1.9 17 12 0 5 0 1 80% 80% Sep 70.6% NA NA Azerbaijan 9 417 527 1.6 16 1 0 15 70 1 100% 100% Oct 100% NA NA Belarus 9 536 760 0.7 10 10 0 0 0 3 100% 100% Oct 100% 0.00 100% Belgium 10 770 406 5.5 61 34 5 22 43 2 100% 100% Oct 52.5% NA NA Bosnia and Herzegovina* 3 747 213 - - - - - - - - - No Report - NA NA Bulgaria 7 401 269 0 1 1 0 0 0 1 100% 100% Oct 100% 0.00 100% Croatia 4 388 603 0 1 0 1 0 0 1 100% 20% Oct - 0.00 100% Cyprus 1 128 260 0.9 1 1 0 0 0 0 100% 100% Oct 100% 0.00 0.0% Czech Republic 10 547 860 0.9 21 21 0 0 0 12 90% 90% Oct 100% 0.00 66.7% Denmark 5 589 464 0.2 2 2 0 0 0 1 100% 100% Oct 100% 0.00 100% Estonia 1 339 829 3.0 6 6 0 0 1 2 100% 100% Oct 100% NA NA Finland 5 397 248 0.4 6 5 0 1 0 4 100% 90% Oct 83.3% 0.00 66.7% France 63 417 636 12.5 830 383 69 378 0 36 100% 100% Oct 62.9% NA NA Georgia 4 305 661 6.0 26 0 0 26 16 0 100% 100% Oct 35.7% NA NA Germany 81 964 400 1.6 154 109 22 23 0 25 100% 100% Oct 82.6% NA NA Greece 11 418 997 0 2 2 0 0 0 2 90% 90% Oct 100% 0.00 100% Hungary 9 947 105 0 0 0 0 0 0 0 100% 100% Oct - 0.00 - Iceland 327 804 0 0 0 0 0 0 0 60% 60% Oct - 0.00 - Ireland 4 579 823 19.2 92 17 50 25 0 4 100% 100% Oct 59.5% NA NA Israel* 7 672 910 19.3 148 75 0 73 0 0 100% 100% Oct 50.7% NA NA Italy 60 819 728 10.0 614 236 145 233 24 3 90% 90% Oct 54.6% NA NA Kazakhstan* 16 407 491 3.3 54 54 0 0 0 0 90% 60% Sep 100% NA NA Kyrgyzstan 5 463 941 0 0 0 0 0 33 0 10% 10% Apr 87.9% 0.60 24.2% Latvia 2 233 986 0.9 3 3 0 0 0 1 100% 100% Oct 100% 0.00 66.7% Lithuania 3 296 148 0 2 2 0 0 0 2 90% 90% Oct 100% 0.00 100% Luxembourg 521 080 3.8 2 2 0 0 0 0 90% 90% Oct 100% NA NA Malta 419 402 0 0 0 0 0 0 0 90% 90% Oct - 0.00 - Monaco 38 222 26.2 1 0 0 1 0 0 80% 0% Aug 0.0% NA NA Montenegro* 632 737 0 0 0 0 0 0 0 80% 20% Oct - 0.00 - Netherlands 16 694 725 0.2 11 11 0 0 0 8 70% 70% Oct 100% 0.00 90.9% Norway 4 951 344 0.2 4 4 0 0 0 3 100% 100% Oct 100% 0.00 100% Poland 38 315 208 1.9 80 51 12 17 0 6 90% 90% Oct 80.9% NA NA Portugal 10 686 443 0.4 5 3 2 0 2 1 100% 100% Oct 100% 0.02 57.1% Republic of Moldova 3 532 010 3.1 11 11 0 0 0 0 90% 40% Sep 100% NA NA Romania 21 397 044 155.1 3318 1689 1575 54 0 0 90% 90% Sep 96.9% NA NA Russian Federation 142 668 224 12.8 1834 1745 79 10 9 1 80% 80% Aug 100% NA NA San Marino 29 486 - - - - - - - - - No Report - NA NA Serbia* 9 834 026 0 0 0 0 0 0 0 90% 50% Oct - 0.00 - Slovakia 5 478 110 0 2 2 0 0 0 2 100% 100% Oct 100% 0.00 100% Slovenia 2 039 627 0 2 2 0 0 0 2 100% 90% Oct 100% 0.00 100% Spain 46 657 472 8.7 424 360 40 24 0 16 100% 100% Oct 93.8% NA NA Sweden 9 477 964 2.2 28 16 12 0 0 7 90% 90% Oct 100% NA NA Switzerland 7 723 812 6.2 58 36 6 16 22 10 100% 80% Oct 78.4% NA NA Tajikistan* 7 086 101 1.0 7 7 0 0 0 0 60% 60% Oct 100% 0.00 0.0% The former Yugoslav Republic of Macedonia* 2 066 356 2.4 5 3 0 2 0 0 100% 80% Oct 60.0% NA NA Turkey 74 546 664 0.1 56 55 1 0 0 47 100% 0% Oct 100% 0.00 83.9% Turkmenistan 5 164 039 0 0 0 0 0 0 0 80% 50% Aug - 0.00 - Ukraine* 44 991 932 251.1 11298 1779 0 9519 0 0 70% 30% Aug 15.7% NA NA United Kingdom 62 806 776 23.2 1506 1506 0 0 0 51 100% 100% Oct 100% NA NA Uzbekistan* 28 124 854 0 0 0 0 0 0 0 50% 20% Jun - 0.00 - Total/Averages 901 823 640 22.7 20719 8256 2019 10444 242 255 86.4% 74.2% 45.5% 0.03 32.3% Data source : Monthly aggregated and case-based data reported by Member States to WHO/Europe and ECDC/TESSy 1 Source: "World Population Prospects: The 2008 Revision", New York, United Nations and updates provided by Member States. D is ca rd ed Surveillance Indicators 3 Imported or import related measles cases included in total measles. * Member States reporting aggregated measles data in year 2012 Indicators not meeting target and countries not reporting monthly measles data are highligted in red; NA=Not Applicable; "-" = data not available or can not be calculated due to insufficient denominator. **In addition to these cases, Russian Federation has reported 261 (total 2095 for Jan-Aug 2012) more cases in aggregate format which will be entered and reported in case-based format before end of the year. Country 2 Cases with missing classification are classified as "Clinical". Total Population1 Total measles cases Im po rt at io n3 Reporting Incidence per 1 million population (Jan-Sep, 2012) Classification Monthly summary table 3. Classification, reporting and performance of measles , January—October 2012 (data as of 1 December 2012) Page No. 6   No. 29 (December 2012)  (Please click here to refer Annex  8 of MR Surveillance guideline)  La b co nf ir m ed Ep i- Li nk C li ni ca l2 D is ca rd ed C om pl et e- ne ss T im el in es s M on th o f la st re po rt La bo ra to ry in ve st ig at io n ra te D et ec ti on r at e So ur ce o f in fe ct io n Albania 3 226 922 0 0 0 0 0 0 0 100% 90% Oct - 0.00 - Andorra 67 726 0 0 0 0 0 0 0 80% 30% Aug - 0.00 - Armenia 3 107 085 0.3 1 1 0 0 38 0 60% 60% Jun 100% 1.22 100% Austria 8 418 180 0.8 9 7 1 1 0 2 70% 70% Sep 25.0% 0.00 66.7% Azerbaijan 9 417 527 1.1 11 1 0 10 13 1 100% 100% Oct 100% NA NA Belarus 9 536 760 1.0 10 9 0 1 0 0 100% 100% Oct 0.0% NA NA Belgium 10 770 406 - - - - - - - - - No Report - NA NA Bosnia and Herzegovina 3 747 213 - - - - - - - - - No Report - NA NA Bulgaria 7 401 269 1.9 14 0 0 14 0 0 100% 100% Oct 0.0% NA NA Croatia 4 388 603 0 0 0 0 0 0 0 10% 10% Jul - 0.00 - Cyprus 1 128 260 0 0 0 0 0 0 0 100% 90% Oct - 0.00 - Czech Republic 10 547 860 0.5 5 4 1 0 0 0 100% 100% Oct 100% 0.00 40.0% Denmark 5 589 464 0 0 0 0 0 0 0 20% 20% Oct - 0.00 - Estonia 1 339 829 0 0 0 0 0 0 0 100% 100% Oct - 0.00 - Finland 5 397 248 0 0 0 0 0 0 0 100% 90% Oct - 0.00 - France 63 417 636 - - - - - - - - - No Report - NA NA Georgia 4 305 661 15.1 65 2 1 62 0 0 100% 90% Oct 0.0% NA NA Germany 81 964 400 - - - - - - - - - No Report - NA NA Greece 11 418 997 0 0 0 0 0 0 0 80% 80% Oct - 0.00 - Hungary 9 947 105 0.7 8 7 0 1 6 1 100% 100% Oct 100% 0.06 92.9% Iceland 327 804 0 0 0 0 0 0 0 60% 60% Oct - 0.00 - Ireland 4 579 823 2.6 12 0 3 9 0 0 100% 100% Oct 11.1% NA NA Israel 7 672 910 0.1 1 0 0 1 0 0 90% 90% Sep 0.0% 0.00 0.0% Italy 60 819 728 - - - - - - - - - No Report - NA NA Kazakhstan 16 407 491 0.7 12 6 3 3 0 0 80% 50% Sep 0.0% 0.00 0.0% Kyrgyzstan 5 463 941 0.4 2 2 0 0 7 0 10% 10% Apr 88.9% 0.13 11.1% Latvia 2 233 986 2.2 8 3 4 1 0 3 100% 100% Oct 100% NA NA Lithuania 3 296 148 0 0 0 0 0 0 0 90% 90% Oct - 0.00 - Luxembourg 521 080 1.9 1 1 0 0 0 0 80% 80% Oct 100% NA NA Malta 419 402 0 0 0 0 0 0 0 90% 90% Oct - 0.00 - Monaco 38 222 0 0 0 0 0 0 0 80% 10% Aug - 0.00 - Montenegro 632 737 0 0 0 0 0 0 0 80% 20% Oct - 0.00 - Netherlands 16 694 725 0.1 1 1 0 0 0 0 60% 60% Oct 0.0% 0.00 0.0% Norway 4 951 344 0 1 1 0 0 0 1 80% 80% Oct 100% 0.00 100% Poland 38 315 208 130.5 5001 0 0 5001 0 0 100% 100% Oct 0.0% NA NA Portugal 10 686 443 0.2 2 0 0 2 0 0 100% 100% Oct 0.0% 0.00 100% Republic of Moldova 3 532 010 - - - - - - - - - No Report - NA NA Romania 21 397 044 970.8 20772 5659 15113 0 0 0 90% 90% Oct 100% NA NA Russian Federation 142 668 224 6.7 960 896 56 8 0 2 100% 100% Oct 1.5% NA NA San Marino 29 486 - - - - - - - - - No Report - NA NA Serbia 9 834 026 - - - - - - - - - No Report - NA NA Slovakia 5 478 110 0 0 0 0 0 2 0 100% 100% Oct 100% 0.04 100% Slovenia 2 039 627 0 0 0 0 0 0 0 90% 90% Sep - 0.00 - Spain 46 657 472 1.0 56 51 1 4 0 10 100% 100% Oct 92.7% 0.00 87.5% Sweden 9 477 964 5.2 50 38 12 0 0 1 80% 80% Oct 100% NA NA Switzerland 7 723 812 1.3 11 11 0 0 28 1 100% 80% Oct 97.4% NA NA Tajikistan 7 086 101 0.1 1 1 0 0 0 0 40% 40% Jun 0.0% 0.00 0.0% The former Yugoslav Republic of Macedonia 2 066 356 1.0 2 0 0 2 0 0 100% 80% Oct 0.0% 0.00 0.0% Turkey 74 546 664 - - - - - - - - - No Report - NA NA Turkmenistan 5 164 039 0 0 0 0 0 0 0 80% 50% Aug - 0.00 - Ukraine 44 991 932 20.9 942 0 0 942 0 0 40% 10% Apr 0.0% NA NA United Kingdom 62 806 776 0.9 65 65 0 0 0 9 100% 100% Oct 100% 0.00 90.8% Uzbekistan 28 124 854 0 0 0 0 0 0 0 50% 20% Jun - 0.00 - Total/Averages 901 823 640 31.0 28023 6766 15195 6062 94 31 67.7% 60.6% 47.1% 0.00 74.9% Data source : Monthly aggregated and case-based data reported by Member States to WHO/Europe and ECDC/TESSy 1 Source: "World Population Prospects: The 2008 Revision", New York, United Nations and updates provided by Member States. Country 2 Cases with missing classification are classified as "Clinical". Surveillance Indicators 3 Imported or import related rubella cases included in total rubella. Indicators not meeting target and countries not reporting monthly rubella data are highligted in red. "-" indicates data not available/applicable or can not be calculated due to insufficient denominator. Total Population1 Classification Total confirmed Rubella Im po rt at io n3 Incidence per 1 million population (Jan-Sep 2012) Reporting Monthly summary table 4. Classification, reporting and performance of rubella, January—October 2012 (data as of 1 December 2012) Page No. 7  No. 29 (December 2012)  (Please click here to refer Annex  8 of MR Surveillance guideline)  Monthly summary table 5. Measles and rubella laboratory test results, January – October 2012 (data as of 1 December 2012) Page No.  8  No. 29 (December 2012)  Tested for measles Positive for measles (%) Measles Equivocal Negative for measles Tested for rubella Positive for rubella (%) Rubella Equivocal Negative for rubella % Complete- ness % Timeli- ness Month of last report Albania 8 0 (0.0) 0 8 1 1 (100.0) 0 0 100% 80.0% Oct Andorra No Lab Armenia 60 0 (0.0) 0 60 60 1 (2.0) 0 59 100% 90.0% Oct Austria 1057 9 (1.0) 0 1048 4642 9 (0.0) 0 4633 100% 100% Oct Azerbaijan 85 1 (1.0) 1 83 85 1 (1.0) 3 81 90.0% 40.0% Sep Belarus 308 19 (6.0) 0 289 303 12 (4.0) 0 289 100% 90.0% Oct Belgium 166 34 (20.0) 4 125 53 9 (17.0) 6 37 100% 100% Oct Bosnia and Herzegovina No Report Bulgaria 44 3 (7.0) 0 41 47 2 (4.0) 0 45 100% 80.0% Oct Croatia 1 1 (100.0) 0 0 1 0 (0.0) 0 1 100% 90.0% Oct Cyprus 1 1 (100.0) 0 0 0 0 0 0 80.0% 40.0% Aug Czech Republic 73 27 (37.0) 4 42 16 1 (6.0) 0 15 100% 100% Oct Denmark 670 12 (2.0) 11 647 401 48 (12.0) 18 335 100% 60.0% Oct Estonia 128 5 (4.0) 1 122 474 4 (1.0) 2 468 100% 100% Oct Finland 574 23 (4.0) 0 551 573 2 (0.0) 0 571 100% 90.0% Oct France 679 208 (31.0) 4 458 0 0 0 0 90.0% 80.0% Sep Georgia 98 0 (0.0) 1 97 99 2 (2.0) 7 90 100% 70.0% Oct Germany 242 57 (24.0) 1 183 31 1 (3.0) 0 30 100% 90.0% Oct Greece 8 0 (0.0) 0 8 122 18 (15.0) 0 104 80.0% 40.0% Aug Hungary 67 4 (6.0) 0 63 379 13 (3.0) 0 365 100% 100% Oct Iceland 44 0 (0.0) 0 44 86 2 (2.0) 0 84 90.0% 60.0% Sep Ireland 372 37 (10.0) 9 326 1531 5 (0.0) 7 1519 100% 80.0% Oct Israel 245 65 (27.0) 0 180 744 62 (8.0) 0 682 90.0% 90.0% Sep Italy 169 119 (70.0) 2 48 87 49 (56.0) 0 38 50.0% 0.0% May Kazakhstan 203 54 (27.0) 1 148 284 6 (2.0) 3 274 100% 100% Oct Kyrgyzstan 292 0 (0.0) 0 292 285 7 (2.0) 2 276 100% 100% Oct Latvia 318 15 (5.0) 7 296 312 17 (5.0) 8 287 100% 70.0% Oct Lithuania 8 2 (25.0) 3 3 7 0 (0.0) 0 7 100% 100% Oct Luxembourg 76 0 (0.0) 0 76 72 0 (0.0) 1 71 100% 100% Oct Malta 14 0 (0.0) 0 14 947 6 (1.0) 0 941 80.0% 50.0% Aug Monaco No Lab Montenegro No Lab Netherlands 34 4 (12.0) 0 30 32 0 (0.0) 0 32 50.0% 20.0% May Norway 69 10 (14.0) 0 59 32 1 (3.0) 0 31 100% 100% Oct Poland 156 50 (32.0) 4 102 62 12 (19.0) 0 50 100% 90.0% Oct Portugal 36 11 (31.0) 0 21 0 0 0 0 100% 100% Oct Republic of Moldova 57 11 (19.0) 0 46 57 2 (4.0) 0 55 100% 100% Oct Romania 5598 3259 (58.0) 50 2289 9916 6366 (64.0) 207 3343 100% 100% Oct Russian Federation 7218 2195 (30.0) 7 5016 5227 899 (17.0) 8 4320 100% 100% Oct San Marino No Lab Serbia 82 1 (1.0) 0 72 143 1 (1.0) 0 133 100% 90.0% Oct Slovakia 9 5 (56.0) 0 4 2 0 (0.0) 0 2 100% 90.0% Oct Slovenia 51 6 (12.0) 1 44 27 0 (0.0) 0 27 100% 100% Oct Spain No Report Sweden No Report Switzerland 44 37 (84.0) 1 6 13 13 (100.0) 0 0 100% 100% Oct Tajikistan 59 14 (24.0) 1 44 61 1 (2.0) 1 59 90.0% 40.0% Sep The former Yugoslav Republic of Macedonia 18 3 (17.0) 1 14 174 5 (3.0) 1 168 90.0% 20.0% Sep Turkey 657 4 (1.0) 4 649 657 21 (3.0) 16 620 40.0% 40.0% Oct Turkmenistan 46 0 (0.0) 0 41 46 0 (0.0) 0 41 80.0% 50.0% Aug Ukraine 924 503 (54.0) 12 409 569 151 (27.0) 1 417 100% 100% Oct United Kingdom 6439 1661 (26.0) 0 4778 1561 63 (4.0) 0 1498 100% 100% Oct Uzbekistan 12 0 (0.0) 0 12 12 0 (0.0) 0 12 100% 100% Oct Total / Average 27519 8470 (31%) 130 18888 30233 7813 (26%) 291 22110 91.9% 77.4% Data source : Aggregated monthly data provided by regional measles and rubella laboratory network. Country Specimen* (Serum, Oral Fluid, Swab, Urine and other) *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. Reporting Contact us: Vaccine‐preventable Diseases and Immunization Programme WHO Regional Office for Europe Tel.: +45 39 17 13 31  Email: vaccine@euro.who.int   Web site: http://www.euro.who.int Page No. 9  No. 29 (December 2012)  P ol io C om pa tib le Pe nd in g D is ca rd ed W ild P ol io ca se s VD PV /V A PP N on p ol io A FP r at e3 A de qu at e St oo l co lle ct io n Su rv . I nd ex 5 P ol io C om pa tib le Pe nd in g D is ca rd ed W ild P ol io ca se s VD PV /V A PP N on p ol io A FP r at e3 A de qu at e St oo l co lle ct io n Su rv . I nd ex 5 % C om pl et en es s % T im el in es s W ee k of la st re po rt Albania 4 4 0 0 0 4 0 0 0.56 100.0 0.56 6 6 0 0 0 6 0 0 0.96 100.0 0.96 91.30 69.57 46 Andorra 0 0 0 0 0 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0 0 0 0.00 0.0 0.00 80.43 8.70 37 Armenia 21 21 1 0 0 21 0 0 3.37 90.5 0.90 26 26 2 0 2 24 0 0 4.22 96.2 0.96 102.17 102.17 48 Austria* 2 2 0 0 0 2 0 0 0.16 0.0 0.08 1 1 0 0 0 1 0 0 0.09 100.0 0.09 95.65 52.17 44 Azerbaijan* 37 37 0 0 0 37 0 0 1.88 97.3 1.00 34 34 0 0 6 28 0 0 1.53 97.1 0.97 100.00 100.00 46 Belarus 46 46 3 0 0 46 0 0 3.18 78.3 0.85 39 39 2 0 9 30 0 0 2.28 92.3 0.95 47.83 47.83 44 Belgium 3 3 0 0 0 3 0 0 0.17 0.0 0.00 2 2 0 0 0 2 0 0 0.12 0.0 0.00 93.48 26.09 47 Bosnia and Herzegovina* 8 8 1 0 0 8 0 0 1.44 50.0 0.75 10 4 0 0 7 3 0 0 0.61 100.0 0.61 63.04 39.13 45 Bulgaria 12 12 0 0 0 12 0 0 1.16 91.7 1.00 9 9 0 0 9 0 0 0 0.00 88.9 0.00 69.57 69.57 43 Croatia 0 0 0 0 0 0 0 0 0.00 0.0 0.00 2 2 0 0 0 2 0 0 0.34 0.0 0.17 95.65 17.39 47 Cyprus 4 4 0 0 0 4 0 0 2.05 100.0 1.00 3 3 0 0 1 2 0 0 1.14 100.0 1.00 93.48 93.48 47 Czech Republic 8 8 0 0 0 8 0 0 0.54 75.0 0.47 3 3 0 0 0 3 0 0 0.22 66.7 0.22 80.43 71.74 46 Estonia 0 0 0 0 0 0 0 0 0.00 0.0 0.00 1 1 0 0 0 1 0 0 0.52 0.0 0.00 89.13 89.13 47 Georgia* 10 10 1 0 0 9 0 1 1.26 100.0 1.00 13 13 1 0 2 10 0 1 1.55 100.0 1.00 100.00 100.00 46 Greece* 24 24 2 0 0 24 0 0 1.43 79.2 0.92 16 16 0 0 16 0 0 0 0.00 87.5 0.00 102.17 93.48 47 Hungary 7 7 0 0 0 7 0 0 0.48 28.6 0.21 12 12 0 0 2 10 0 0 0.76 50.0 0.50 91.30 60.87 47 Ireland 7 7 0 0 0 7 0 0 0.72 14.3 0.31 0 0 0 0 0 0 0 0 0.00 0.0 0.00 52.17 17.39 24 Israel 19 18 0 0 0 19 0 0 0.92 16.7 0.41 7 7 1 0 0 7 0 0 0.37 14.3 0.16 89.13 82.61 46 Italy 64 63 1 0 0 64 0 0 0.75 65.1 0.51 57 57 0 0 16 41 0 0 0.53 64.9 0.38 78.26 36.96 39 Kazakhstan 103 103 1 0 0 103 0 0 2.54 97.1 0.98 82 82 0 0 18 64 0 0 1.70 98.8 1.68 93.48 89.13 46 Kyrgyzstan* 68 65 2 0 0 68 0 0 4.19 100.0 1.00 50 47 1 0 18 32 0 0 2.17 97.9 1.00 76.09 73.91 46 Latvia 1 1 0 0 0 1 0 0 0.32 100.0 0.32 2 2 0 0 0 2 0 0 0.70 100.0 0.70 97.83 82.61 47 Lithuania 10 10 0 0 0 10 0 0 2.04 100.0 1.00 12 10 0 0 0 12 0 0 2.73 80.0 0.90 86.96 86.96 47 Malta 0 0 0 0 0 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0 0 0 0.00 0.0 0.00 60.87 13.04 44 Montenegro* 3 3 0 0 0 3 0 0 2.49 66.7 1.00 2 2 0 0 0 2 0 0 1.85 50.0 0.50 89.13 86.96 46 Norway 12 12 0 0 0 12 0 0 1.31 41.7 0.67 11 11 0 0 6 5 0 0 0.60 27.3 0.44 93.48 34.78 47 Poland 36 36 2 0 0 36 0 0 0.64 80.6 0.57 28 27 1 0 14 14 0 0 0.27 37.0 0.11 95.65 86.96 47 Portugal 8 7 1 0 0 8 0 0 0.50 42.9 0.43 8 7 0 0 0 8 0 0 0.56 28.6 0.32 30.43 21.74 42 Republic of Moldova 8 8 0 0 0 8 0 0 1.35 100.0 1.00 5 5 1 0 0 5 0 0 0.94 100.0 0.94 95.65 91.30 47 Romania 18 18 0 0 0 18 0 0 0.55 100.0 0.55 13 13 0 0 3 10 0 0 0.34 100.0 0.34 100.00 91.30 47 Russian Federation* 361 359 34 0 1 360 0 0 1.65 92.5 0.94 358 357 39 0 114 244 0 0 1.21 93.8 1.14 104.35 104.35 48 Serbia 10 10 1 0 0 10 0 0 0.58 90.0 0.58 13 13 0 0 2 11 0 0 0.71 69.2 0.60 89.13 89.13 46 Slovakia 2 2 0 0 0 2 0 0 0.24 100.0 0.24 2 2 0 0 1 1 0 0 0.14 100.0 0.14 89.13 67.39 46 Slovenia 0 0 0 0 0 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0 0 0 0.00 0.0 0.00 82.61 52.17 39 Spain 34 34 0 0 0 34 0 0 0.49 38.2 0.30 19 19 0 0 2 17 0 0 0.26 36.8 0.22 100.00 78.26 47 Switzerland 6 3 0 0 0 6 0 0 0.52 66.7 0.34 5 4 0 0 0 5 0 0 0.48 0.0 0.12 80.43 36.96 47 Tajikistan* 55 52 0 0 0 55 0 0 2.16 96.2 0.96 59 59 0 0 10 49 0 0 2.12 98.3 1.97 78.26 76.09 46 The former Yugoslav Republic of Macedonia 2 2 1 0 0 2 0 0 0.56 100.0 0.56 3 3 0 0 1 2 0 0 0.63 100.0 0.63 91.30 78.26 46 Turkey 197 196 3 0 0 240 0 1 1.02 80.6 0.87 162 162 3 0 36 126 0 0 0.73 77.2 0.60 78.26 78.26 46 Turkmenistan 33 33 0 0 0 33 0 0 2.25 100.0 1.00 29 29 0 0 4 25 0 0 1.88 100.0 1.88 45.65 45.65 46 Ukraine* 127 127 31 0 0 125 0 2 1.92 97.6 1.00 107 104 21 0 28 78 0 1 1.32 97.1 0.99 84.78 84.78 45 Uzbekistan* 200 197 4 0 0 200 0 0 2.49 96.4 0.96 193 188 1 0 37 156 0 0 2.16 98.9 0.99 80.43 80.43 46 Average/Total 1570 1552 89 0 1 1609 0 4 1.20 87.00 0.91 1404 1381 73 0 364 1038 0 2 0.98 88.00 0.89 80.00 63.00 *Some provinces with a high risk for polio spread after importation, following the 25th and 26th RCC risk assessments in August 2011 and Jun 2012. Nonpolio AFP Rate and Surveillance Index targets for these member states have been revised to 2.0 and 1.6 respectively. *Countries with a high risk for polio spread after importation, following the 25th and 26th RCC risk assessments in August 2011 and Jun 2012. Nonpolio AFP Rate and Surveillance Index targets for these member states have been revised to 2.0 and 1.6 respectively. Monthly summary table 6: Classification of AFP cases, surveillance performance and weekly reporting to WHO EURO by country, 2011-2012, WHO European Region A FP C as es 1 H ot A FP C as es 2 Classification 2011 (1-53 weeks) A FP c as es u nd er 15 y ea r of a ge 2012 (1-46 weeks) 5 Surveillance Index = non-polio AFP rate up to 1.0 x (% AFP cases with atleast 1 adequate specimens within 14 days of onset). 4 two stool specimens collected 24-48 hours apart within 14 days of the onset of paralysis Countries A FP C as es 1 1 AFP case of all ages (Denmark, Finland, France, Iceland, Luxembourg, Monaco, Netherlands, San Marino, Sweden and United Kingdom do not report AFP cases. High quality surveillance (e.g. enterovirus and/or environmental) to detect poliovirus exists in Member States with no AFP surveillance. 2 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). 3 Non-polio AFP cases per 100 000 children under the age of 15 years (annualized for current year). Number of non-polio (discarded) AFP cases X 100000 / total population under 15 years. A FP c as es u nd er 15 y ea rs o f a ge H ot A FP C as es 2 Classification RatesRates Reporting Document number: WHO/EURO:2013-7605-47372-71409 World Health Organization 2013 All rights reserved.