Measles and rubella elimination country profile: Spain

Measles elimination status 2015 interrupted 2016 eliminated Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/6thRVC Rubella elimination status 2015 eliminated 2016 eliminated Total population 46 064 604 < 1 year old 411 803 < 5 years old 2 042 034 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 ND= Data not available Measles and rubella elimination country profile Spain 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 Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/6thRVC Source: Measles and rubella elimination Annual Status Update report, 2016 Definition used for an outbreak 2 or more confirmed cases which are temporally related (with dates of rash onset occurring between 7 and 18 days apart for measles and with dates of rash onset occurring between 12 and 46 days apart for rubella) and epidemiologically or virologically linked or both 0 10 20 30 40 50 60 70 80 90 100 0 500 1000 1500 2000 2500 3000 3500 4000 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Measles Rubella Coverage MCV1 Coverage MVC2 Confirmed measles cases by month of onset, 2012-2016 Source: CISID2 2016 0 50 100 150 200 250 300 350 400 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 D 2012 2013 2014 2015 2016 Vaccine Schedule MCV1 MMR 12 months MCV2 MMR 3-4 years Year of introduction MCV2 1996 RCV 1978 Measles vaccination in school No Measles and rubella elimination country profile Spain ©WHO 2018 Information on CRS, 2016 No cases reported 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 11 1 Import-related 23 1 Unknown/ Not reported 1 0 Endemic 0 0 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 713 243 148 1 204 ND 25 B3,D4,D8 2013 217 109 14 8 131 86 2.5 B3,D8 2014 339 150 3 6 159 181 3.3 B3,D8 2015 115 32 3 2 37 78 0.8 B3,D8,H1 2016 98 27 8 0 35 63 0.8 B3,D8 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 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 Spain 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 92.6% 54.6% 1 517 73% ND ND 2013 18% 0% 92.2% 96.2% 324 49% 68.8% ND 2014 38% ND 98.8% 96.2% 383 50% 100% ND 2015 17% ND 90.4% 86.5% 158 32% 100% 100% 2016 14% 0% 91.8% 97% 135 33% 100% 100% Suspected rubella cases Confirmed measles cases Discarded as non- rubella Rubella incidence Genotypes detected Laboratory Epi- linked Clincally Total 2012 ND 56 0 8 64 ND 1.1 2B 2013 17 2 0 0 2 16 0 2B 2014 22 3 0 2 5 18 0.0 1J 2015 29 3 1 0 4 25 0.1 2B 2016 10 2 0 0 2 8 0.0 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 91.2% 84% 86 80% ND ND 2013 0 0% 94.1% 100% 26 12% ND ND 2014 0 ND 86.4% 60% 30 37% 100% ND 2015 0.1 ND 93.1% 50% 30 30% ND 100% 2016 0 ND 100% 100% 13 23% ND 100% RVC comments, based on 2016 reporting The Regional Verification Commission for Measles and Rubella Elimination (RVC) concluded that endemic transmission of both measles and rubella remained interrupted in Spain in 2016. The RVC confirmed that rubella elimination has been sustained and, considering the conclusions of the interrupted status of measles transmission in 2014 and 2015, the RVC is pleased to declare that Spain has achieved elimination of measles. The RVC commends Spain on the improvements made in case investigation, laboratory confirmation and genotyping, and providing additional information on rubella through review of CRS cases in hospital registries. The RVC urges the national health authorities to maintain high-quality surveillance and take appropriate measures to ensure high MRCV coverage. Source: Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report (www.euro.who.int/6thRVC) ©WHO 2018