Measles and rubella elimination country profile: Ireland

Measles elimination status Rubella elimination status Total population 4 761 657 < 1 year old 63 588 < 5 years old 337 794 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 Ireland 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 Surveilleance (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 An outbreak may be defined as two or more linked cases of the same illness or the situation where the observed number of cases exceeds the expected number 2016 interrupted 2017 eliminated 2016 eliminated 2017 eliminated Confirmed measles cases by month of onset, 2013-2017 Source: CISID 2017 Vaccine Schedule MCV1 MMR 12 months MCV2 MMR 4-5 years Year of introduction MCV2 1992 RCV 1971 Measles vaccination in school Yes 0 10 20 30 40 50 60 70 80 90 100 0 50 100 150 200 250 300 350 400 450 500 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 0 5 10 15 20 25 30 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 Measles and rubella elimination country profile Ireland ©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 0 0 Import-related 1 0 Unknown/ Not reported 0 0 Endemic 24 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 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 ND 33 10 8 51 43 10.5 D4, D8 2014 92 20 5 8 33 59 6.5 B3, D8 2015 71 2 0 0 2 69 0.2 D8 2016 197 43 0 0 43 154 8.7 B3, D8 2017 285 23 0 2 25 260 5.3 B3 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 and communication with the country Incidence calculated per 1 million population ND = Data not available; NA= Not applicable * This case was weakly positive for IgM 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 Ireland 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 0.9 12.5% 73% 86% ND ND 100% ND 2014 1.3 25% 95% 52% 23 9.1% 67% ND 2015 2 63% 99% 100% 333 9.3% 100% 100% 2016 3.4 50% 100% 100% 768 12.0% 100% 100% 2017 5 87.5% 100% 100% 299 7.7% 100% 100% Suspected rubella cases Confirmed rubella cases Discarded as non- rubella Rubella incidence Genotypes detected Laboratory Epi- linked Clinically Total 2013 ND 0 0 0 0 ND 0 ND 2014 12 1* 0 2 3 9 0.4 ND 2015 23 0 0 3 3 20 0.4 ND 2016 15 0 0 1 1 14 0.2 ND 2017 16 0 0 0 0 16 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 2013 0.2 ND NA NA ND ND 0% ND 2014 0.2 ND 83.3% 67% 1780 0% 0% ND 2015 0.4 ND 91% 67% 241 0% 0% 100% 2016 0.3 ND 93% 0% 415 0% 0% 100% 2017 0.3 0% 100% 0% 866 0% 0% 80.1% RVC comments, based on 2017 reporting The Regional Verification Commission for Measles and Rubella Elimination (RVC) concluded that endemic transmission of measles remained interrupted in 2017 and verified that measles has been eliminated. The RVC commends the national verification committee for measles and rubella elimination (NVC), national health authorities and public health system on this achievement. It also concluded that endemic transmission of rubella remained interrupted in 2017 and confirmed that rubella elimination has been sustained. The RVC is greatly concerned over the low vaccination coverage reported for Dublin and considers this a potential threat to maintaining elimination status. Further clarification is requested from the NVC on the status of confirmed measles cases as per currently available data on surveillance quality RVC cannot clearly determine decisions are these imported or endemic cases. The RVC would appreciate better consistency between number of suspected cases and number of reported tests. ©WHO 2019 Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/7thrvc