Measles and rubella elimination country profile: Malta

Measles elimination status Rubella elimination status Total population 439 248 < 1 year old 4254 < 5 years old 21 617 Demographic information, 2018 Source: World Population Prospects: The 2019 Revision, New York, United Nations Measles and rubella surveillance National case-based surveillance for measles and rubella Lab confirmation for diagnosis of measles and rubella Source: WHO/UNICEF Joint Reporting Form on immunization, 2018 Measles and rubella elimination country profile Malta Measles and rubella immunization schedule, 2018 Source: WHO/UNICEF Joint Reporting Form on immunization, 2018 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, 2009–2018 Source: WHO/UNICEF Joint Reporting Form on immunization, 2018 and WHO/UNICEF Estimates of National Immunization Coverage (WUENIC), 2018 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, 2018 2017 eliminated 2018 eliminated Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: http://www.euro.who.int/8thRVC 2017 eliminated 2018 eliminated Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: http://www.euro.who.int/8thRVC Confirmed measles cases by month of onset, 2014-2018 Source: CISID, 2018 Vaccine Schedule MCV1 MMR 13 months MCV2 MMR 3 years Year of introduction MCV2 1989 RCV 1985 Measles vaccination in school Yes 2 or more confirmed cases which are temporally related (with dates of rash onset occurring be- tween 7 and 18 days apart for meales, and 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 1 2 3 4 5 6 7 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 % c o ve ra ge N u m b er o f ca se s Year Measles Rubella Coverage MCV1 Coverage MCV2 0 1 2 3 4 5 6 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 2014 2015 2016 2017 2018 N u m b er o f ca se s Month and year Measles and rubella elimination country profile Malta Information on CRS, 2018 No cases reported Source: Measles and rubella elimination Annual Status Update report, 2018 CRS = congenital rubella syndrome Measles cases by first subnational level, 2018 Source: Measles and rubella elimination Annual Status Update report, 2018 Measles genotypes by first subnational level, 2018 Source: MeaNS, 2018 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, 2018 Measles Rubella Imported 4 0 Import-related 2 0 Endemic 0 0 Unknown/ Not reported 0 0 Source: Measles and rubella elimination Annual Status Update report, 2018 Measles cases by age group and vaccination status, 2018 Source: Measles and rubella elimination Annual Status Update report, 2018 Note: Excludes imported cases 1dot=1case •B3 •D8 •H1 •D9 0 10 20 30 40 50 60 70 80 90 100 <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 2 Suspected measles cases Confirmed measles cases Discarded as non- measles Measles incidence Genotypes detected Laboratory Epi- linked Clinically Total 2014 0 0 0 0 0 0 0 NA 2015 3 2 0 0 2 1 2 ND 2016 0 0 0 0 0 0 0 NA 2017 1 0 0 0 0 1 0 NA 2018 13 6 0 0 6 7 12.6 B3,D8 Measles incidence, epidemiologic and virologic characteristics, 2014-2018 Measles surveillance and laboratory performance indicators, 2014-2018 Source: Measles and rubella elimination Annual Status Update report, 2014-2018 Incidence calculated per 1 million population ND = Data not available; NA= Not applicable Source: Measles and rubella elimination Annual Status Update report, 2014-2018 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, 2014-2018 Rubella surveillance and laboratory performance indicators, 2014-2018 Source: Measles and rubella elimination Annual Status Update report, 2014-2018 Incidence calculated per 1 million population ND = Data not available; NA= Not applicable Source: Measles and rubella elimination Annual Status Update report, 2014-2018 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 Malta 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 2014 6.6 NA 100% NA 28 0% NA ND 2015 10.3 NA 100% 0% 46 4.4% 0 100% 2016 100% NA 100% NA 43 0% NA 100% 2017 9.6 NA 100% NA 1 0% NA 100% 2018 1.5 NA 100% ND 13 46.2% ND 100% Suspected rubella cases Confirmed rubella cases Discarded as non- rubella Rubella incidence Genotypes detected Laboratory Epi- linked Clinically Total 2014 0 0 0 0 0 0 0 NA 2015 2 0 0 0 0 2 0 NA 2016 0 0 0 0 0 0 0 NA 2017 0 0 0 0 0 0 0 NA 2018 0 0 0 0 0 0 0 NA 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 2014 ND NA ND NA 1799 0.2% NA ND 2015 100% NA ND NA 1610 0% NA 100% 2016 100% NA 100% NA 1061 0% NA 100% 2017 164.9 NA 100% NA 0 0% NA NA 2018 0 NA 100% NA 0 0% NA NA RVC comments, based on 2018 reporting The RVC concluded that endemic transmission of both measles and rubella remained interrupted in Malta in 2018 and confirmed that measles- and rubella-elimination have been sustained. The RVC is concerned over delayed immunization with both MRCV doses before school enrolment and urges more efforts to increase vaccination coverage in pre-school children. Further clarifications are needed from the NVC regarding the high rubella surveillance sensitivity reported in this year’s ASU without adequate data on surveillance indicators. Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: http://www.euro.who.int/8thRVC © World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 3 Document number: WHO/EURO:2020-1504-41254-56144