Measles and rubella elimination country profile: Denmark

Measles elimination status 2015 endemic 2016 interrupted Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/6thRVC Rubella elimination status 2015 endemic 2016 endemic Total population 5 690 750 < 1 year old 58 843 < 5 years old 284 598 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? ND Is it updated? ND Source: Measles and rubella elimination Annual Status Update report, 2016 Measles and rubella elimination country profile Denmark 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 Source: Measles and rubella elimination Annual Status Update report, 2016 Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/6thRVC Definition used for an outbreak 2 epidemiologically linked cases Vaccine Schedule MCV1 MMR 15 months MCV2 MMR 4 years Year of introduction MCV2 1987 RCV 1987 Measles vaccination in school No interrupted eliminated 0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Measles Rubella Coverage MCV1 Coverage MVC2 0 2 4 6 8 10 12 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 Measles and rubella elimination country profile Denmark ©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 (No age group and vaccination status data available) Sources of infection, 2016 Measles Rubella Imported 3 0 Import-related 0 0 Unknown/ Not reported 0 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 ND ND ND ND ND 0.2 ND 2013 ND ND ND ND ND ND 2.5 D8 2014 162 25 2 0 27 138 3.6 B3 2015 186 9 0 0 9 177 1.4 D8,H1 2016 75 3 0 0 3 72 0 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 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 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 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 Denmark 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 ND ND ND ND ND ND ND ND 2014 2.5 0% 100% 89% 682 3.5% 100% ND 2015 0.5 0% 100% 55% 697 1.9% 100% 100% 2016 1.3 ND 100% 100% 75 4.2% 0% 100% 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 0 NA 2013 ND ND ND ND ND ND 0 NA 2014 0 0 0 0 0 0 0 NA 2015 0 0 0 0 0 0 0 NA 2016 0 0 0 0 0 0 0 NA 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 ND ND ND ND ND ND ND ND 2014 NA NA NA NA 0 0% 0 ND 2015 NA NA NA NA ND 0% 0 100% 2016 NA NA NA NA ND 0% 0 ND RVC comments, based on 2016 reporting The Regional Verification Commission for Measles and Rubella Elimination (RVC) commends the national health authorities and public health system on sustained interruption of measles but continues to call for the implementation of WHO resolutions and guidelines recommending establishment of national rubella surveillance. The RVC is eager to learn about introduction of mandatory rubella surveillance in 2017. The RVC would appreciate if the results of a retrospective review for missed rubella cases would be included in the next ASU. The RVC urges strengthening of immunization programme by timely delivery of MRCV, particularly MRCV2, and improving of surveillance sensitivity to the minimum standard of 2 discarded cases per 100 000 population. Source: Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report (www.euro.who.int/6thRVC) ©WHO 2018