Measles and rubella elimination country profile: Turkey

Measles elimination status Rubella elimination status Total population 80 745 020 < 1 year old 1 314 452 < 5 years old 6 728 071 Demographic information, 2017 Source: World Population Prospects: The 2017 Revision, New York, United Nations Measles and rubella surveillance National case-based surveillance for measles, rubella and CRS Lab confirmation for diagnosis of measles, rubella and CRS Source: WHO/UNICEF Joint Reporting Form on Immunization, 2017 Measles and rubella elimination country profile Turkey Measles and rubella immunization schedule, 2017 Source: Immunization schedule, WHO, Data and Statistics, Immunization Monitoring and Surveillance (http://www.who.int/immunization/monitoring_surveillance/data/en/) MMR = measles-mumps-rubella vaccine; MCV1 = first dose measles-containing vaccine; MCV2 = second dose measles-containing vaccine; RCV = rubella-containing vaccine Measles and rubella cases and immunization coverage, 2008–2017 Source: Disease incidence and immunization coverage (WUENIC), WHO, Data and Statistics, Immunization Monitoring and Surveillance and communication with the country (http://www.who.int/immunization/monitoring_surveillance/data/en/) MCV1 = first dose of measles-containing vaccine MCV2= second dose of measles-containing vaccine Definition used for an outbreak Source: Measles and rubella elimination Annual Status Update report, 2017 2 or more laboratory-confirmed cases which are temporally related (with dates of rash onset occurring between 7 and 18 days apart for measles, and between 12 and 46 days apart for rubella) and epidemiologically or virologically linked, or both Confirmed measles cases by month of onset, 2013-2017 Source: CISID 2017 Vaccine Schedule MCV1 MMR 12 months MCV2 MMR 6 years Year of introduction MCV2 1998 RCV 2006 Measles vaccination in school Yes 2016 endemic 2017 endemic 2016 interrupted 2017 interrupted 0 200 400 600 800 1000 1200 1400 1600 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 2013 2014 2015 2016 2017 N um be r of c as es Month and year Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/7thrvc Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/7thrvc 0 10 20 30 40 50 60 70 80 90 100 0 1000 2000 3000 4000 5000 6000 7000 8000 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 % co ve ra ge Nu m be r o f c as es Year Measles Rubella MCV1 coverage MCV2 coverage Measles and rubella elimination country profile Turkey ©WHO 2019 Information on CRS, 2017 No cases reported Source: Measles and rubella elimination Annual Status Update report, 2017 CRS = congenital rubella syndrome Measles cases by first subnational level, 2017 Source: Measles and rubella elimination Annual Status Update report, 2017 Measles genotypes by first subnational level, 2017 Source: MeaNS 2017 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. Sources of infection, 2017 Measles Rubella Imported 11 0 Import-related 3 0 Unknown/ Not reported 29 2 Endemic 41 0 Source: Measles and rubella elimination Annual Status Update report, 2017 Measles cases by age group and vaccination status, 2017 Source: Measles and rubella elimination Annual Status Update report, 2017 Note: Excludes imported cases Supplementary immunization activities Year Target age Vaccine used % Coverage 2012-2017 All ages (refugees) MMR 90% (2017)* 2013-2017 <15 years (children in high-risk districts) M&MMR 13 678 (2017)** 2012-2017 1980-1991 birth cohort - Military personnel - Healthcare workers M&MMR M&MMR 63 633 (2017)** 17 117 (2017)** 2013-May 2017 40-66 months (children in kindergarten) MMR 45.8% (2016) 2013-March 2017 9-11 months M 81 247 (2017)** Source: Supplementary immunization activities, WHO, Data and Statistics, Immunization Monitoring and Surveillance (http://www.who.int/immunization/monitoring_surveillance/data/en/) and communication with the country MMR = measles-mumps-rubella vaccine; M = measles vaccine ND = Data not available * Includes routine doses and SIA doses **Number of vaccination doses provided 1dot=1case •B3 •D8 •H1 •D9 0 20 40 60 80 100 < 1 1-4 5-9 10-14 15-19 20-29 30 + % o f c as es Age group (years) 0 doses 1 dose 2 or more doses Unknown Suspected measles cases Confirmed measles cases Discarded as non- measles Measles incidence Genotypes detected Laboratory Epi- linked Clinically Total 2013 17 809 7389 16 0 7405 10 404 87.3 D4,D8 2014 4876 562 3 0 565 4311 7.4 B3,D8,H1 2015 3492 342 0 0 342 3150 4.3 B3,D8 2016 2217 9 0 0 9 2208 0.1 D8 2017 2642 79 5 0 84 2558 0.9 B3,D4,D8 Measles incidence, epidemiologic and virologic characteristics, 2013-2017 Measles surveillance and laboratory performance indicators, 2013-2017 Source: Measles and rubella elimination Annual Status Update report, 2013-2017 Incidence calculated per 1 million population ND = Data not available; NA= Not applicable Source: ASU 2013-2017 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, 2013-2017 Rubella surveillance and laboratory performance indicators, 2013-2017 Source: Measles and rubella elimination Annual Status Update report, 2013-2017 Incidence calculated per 1 million population ND = Data not available; NA= Not applicable Source: ASU 2013-2017 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 Turkey Discarded non- measles rate % 1st sub- national unit with ≥ 2 discarded cases % cases with adequate laboratory investigation % origin of infection known # specimen tested for measles % positive for measles Rate of viral detection % WHO and proficient labs 2013 13.6 85.2% 99.8% 47.9% 32 640 24.6% 50% 100% 2014 5.6 67.9% 99.5% 50.8% 8198 11.7% 50% 100% 2015 3.9 64.2% 100% 23.1% 4370 9.7% 87.5% 100% 2016 2.8 59.3% 100% 66.7% 3067 3.4% 50% 100% 2017 3.3 66.7% 103.9% 65.5% 2829 2.8% 83.3% 84.8% Suspected rubella cases Confirmed rubella cases Discarded as non- rubella Rubella incidence Genotypes detected Laboratory Epi- linked Clinically Total 2013 ND 81 0 0 81 ND 1 NA 2014 136 39 0 0 39 97 0.5 NA 2015 135 16 0 0 16 132 0.2 1H 2016 300 7 0 0 7 293 0.1 1H 2017 2642 2 0 0 2 2640 0 ND Discarded non- rubella rate % 1st sub- national unit with ≥ 2 discarded cases % cases with adequate laboratory investigtion % origin of infection known # specimen tested for rubella % positive for rubella Rate of viral detection % WHO and proficient labs 2013 13.6 ND 100% ND 4710 2.2% ND 100% 2014 5.6 ND 100% ND 2947 2.1% ND 100% 2015 3.9 ND 100% ND 2950 1.6% ND 100% 2016 2.8 ND 100% ND 2660 2.7% ND 100% 2017 3.3 66.7% 99.3% 0% 2708 0.1% ND 86.9% RVC comments, based on 2017 reporting The Regional Verification Commission for Measles and Rubella Elimination (RVC) commends Turkey on the improved quality of surveillance compare to previous years and on the high quality of the ASU. However, the RVC would appreciate if more data on the temporal and spatial (subnational) development of immunization coverage in Turkey would be included in next annual status update, to allow better understanding of population immunity. The RVC is concerned regarding the possible size of the susceptible population in some parts of country, and the risk of future outbreaks. In the same time, the RVC highly commend the efforts and achievements of Turkey in the provision of immunization services to refugees. ©WHO 2019 Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/7thrvc