Measles and rubella elimination country profile: The former Yugoslav Republic of Macedonia

Measles elimination status Source: Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report (www.euro.who.int/6thRVC) Rubella elimination status 2015 interrupted 2016 eliminated Source: Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report (www.euro.who.int/6thRVC) Total population 2 081 012 < 1 year old 23 191 < 5 years old 117 698 Demographic information, 2016 Source: World Population Prospects: The 2015 Revision, New York, United Nations 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 Definition used for an outbreak Source: Measles and rubella elimination Annual Status Update report, 2016 National plan of action Does the country have a national plan of action? Yes Is it updated? Yes Source: Rubella Elimination Annual Status Update report, 2016 ND = Data not available 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 elimination country profile The former Yugoslav Republic of Macedonia Confirmed measles cases by month of onset, 2012-2016 Source: CISID2 2016 2015 interrupted 2016 interrupted Unusual increase of cases for that region and period. In case of measles this will mean two epi-linked cases 0 10 20 30 40 50 60 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 6 years Year of introduction MCV2 1987 RCV 1982 Measles vaccination in school Yes 0 10 20 30 40 50 60 70 80 90 100 0 100 200 300 400 500 600 700 800 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Measles Rubella Coverage MCV1 Coverage MVC2 Suspected measles cases Confirmed measles cases Discarded as non- measles Measles incidence Genotypes detected Laboratory Epi- linked Clincally Total 2012 ND 3 0 4 7 ND 3.4 ND 2013 16 2 0 2 4 12 1.5 D8 2014 126 49 20 47 116 10 56.2 D8 2015 2 0 0 0 0 2 0 NA 2016 3 0 0 0 0 3 0 NA 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 The former Yugoslav Republic of Macedonia ©WHO 2018 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 ND ND 100% ND 119 44.5% ND ND 2015 ND ND NA NA 2 0% NA 100% 2016 1.01 3.2% NA NA 3 0% NA 100% Suspected rubella cases Confirmed measles cases Discarded as non- rubella Rubella incidence Genotypes detected Laboratory Epi- linked Clincally Total 2012 ND 0 0 0 4 ND 1.9 ND 2013 0 0 0 0 0 0 0 NA 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 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 NA NA NA NA ND 0% NA ND 2014 NA NA NA NA 18 0% NA ND 2015 ND ND NA NA 711 0.1% NA 100% 2016 NA NA NA NA 0 0% NA ND RVC comments, based on 2016 reporting The Regional Verification Commission for Measles and Rubella Elimination (RVC) commends the National Verification Committee (NVC), national health authorities and public health system on sustained interruption of measles and on achieving rubella elimination. However, the RVC requests from the NVC a clarification of the numerator and denominator used to calculate MRCV coverage. The RVC insists that a more comprehensive ASU is critical for precise and in-depth review of the elimination status. The RVC urges the NVC and national health authorities to work towards improvement of the quality of measles, rubella and CRS surveillance and better reporting in the ASU. Source: Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report (www.euro.who.int/6thRVC) No cases reported Source: Measles and rubella elimination Annual Status Update report, 2016 CRS = congenital rubella syndrome Information on CRS, 2016