WHO Epidemiological Brief: a monthly publication on vaccine‐preventable diseases and immunization data and analysis: No. 16, August 2011

Issue 15, April 2011 No. 16 (August 2011)  Summary    Measles outbreaks   For the period January – June 2011, of the 49 coun‐ tries in the European Region that reported measles  data, 39 countries reported a total of 24 493 cases of  measles. In the first six months of 2011, 49% of all  cases in the Region were reported in March and  April, 2011. Due to spread from countries that are  experiencing large measles outbreaks, countries  measles‐free for many years are now challenged  with re‐occurrence of the disease.       Rotavirus surveillance   In 2010, through the WHO/Europe established senti‐ nel surveillance network for rotavirus in six coun‐ tries, 6207 children with acute diarrhoea were en‐ rolled and tested for rotavirus.  Of these, 2337 (38%)  were rotavirus positive.  This proportion on a coun‐ try‐level ranged from 27% (Azerbaijan) to 48%  (Ukraine).  The proportion of children who were ro‐ tavirus positive increased  from 24% among infants  aged 0‐5 months to 45% among children aged 12‐59  months. Based on these data, it is evident that rota‐ virus accounts for a substantial proportion of diar‐ rhoea hospitalizations in all countries within the  WHO/Europe network.      Importation of wild poliovirus and response  As part of the continued response to the wild poliovi‐ rus outbreak in 2010, seven Member States con‐ ducted synchronized supplementary immunization  activities (SIAs) between February and June 2011.  Fifteen rounds of SIAs with mOPV or tOPV targeted  more than 18 million children. The European Re‐ gional Certification Commission for Poliomyelitis  Eradication met  in Copenhagen August 23‐24, 2011  and decided that Region maintains its polio‐free  status.     Note:  Measles, rubella, polio and rotavirus surveil‐ lance data for January—June 2011 by Member  Highlights in in the WHO European Region:  ∗ measles outbreaks  ∗ rotavirus surveillance  ∗ importation of wild poliovirus and response measures  A monthly publication on vaccine‐preventable diseases  and immunization data and analysis    Measles outbreaks in the WHO European Region    Summary   As of 1 August (data for the period January‐June  2011) 49 of 53 Member States of the European Re‐ gion reported 24 493 confirmed measles cases    (Table 3). A quarter of the cases (5984) had date of  onset in April. The monthly reported number of cases  decreased to 1981 (8.1%) in June.    From January – June 2011, 57% of the measles cases  were reported from France (14 025 cases, incidence  222.8 per million), Spain (2589 cases, incidence 55  per million), Romania (2142 cases, incidence 101.3  per million), Germany (1343 cases, incidence 16.2 per  million) and the former Yugoslav Republic of  Mace‐ donia (721 cases, incidence 352.7 per million).              Of the 24 493 confirmed measles cases reported from  January ‐ June 2011, 64% of cases were less than 20  years of age. The distribution of measles cases by age  group differs by Member State. When cases were  analysed by age group, 25% were in children aged  less than 5 years (8.9% in infants).     In the European Region, previously measles‐free  countries are experiencing sporadic outbreaks. These  countries, with high level of measles control, include  Belarus, Czech Republic, Estonia, Finland, Lithuania,  Luxembourg, Slovakia, and Turkey. In Bulgaria, Roma‐ nia, Serbia and the former Yugoslav Republic of Ma‐ cedonia, measles outbreaks occurred after reintro‐ duction of measles virus in unimmunized and under‐ immunized populations, mostly within Roma commu‐ nities.   Page No. 1 of 8  In countries where measles has been reported after   its absence for many years (ie. 2 cases in 2010 in  Lithuania, zero cases in the Czech Republic) most  cases were reported in adults (>20 years). In Lithua‐ nia (7 cases in 2011) and Czech Republic (23 cases in  2011) all cases were in adults. Considering that rou‐ tine immunization coverage in these countries has  been high for a long period of time (Lithuania  ranged between 96 ‐ 98% over past 10 years, Czech  Republic 92 ‐ 99% over the past 10 years, for first  dose of measles containing vaccine) we do not ex‐ pect to see further spread of disease into children  and adolescents. However, the unimmunized and  children younger than one year are at high risk and  WHO will follow up with the country surveillance  systems to monitor the situation.     The predominant genotype remains D4 “Enfield”  variant, or derivatives thereof. Sporadically, other  genotypes have also been reported in the Region  through the measles sequence database MeaNS  (http://www.who‐measles.org), including B3, D8,  D9, G3. The US and Canada have had importations  from Europe with the same genotype profile.     Between January to June 2011, 42.9% of confirmed  cases were in individual not vaccinated against mea‐ sles, 7.5% in those who had received one dose of  measles vaccine, while 47.3% of the reported cases  were missing data on vaccination status. There is a  strong need to ensure that vaccination status of  cases is captured and reported by Member States,  particularly as the Region begins the process to ver‐ ify interruption of measles transmission in countries  in 2012.   Rotavirus surveillance in WHO European Region  Rotavirus vaccines effectively protect against severe  diarrhoea due to rotavirus.  In the WHO European  Region, four countries (Austria, Belgium, Finland  and Luxembourg) have included rotavirus vaccine in  their routine immunization schedule.   Information  on the burden of disease due to rotavirus diarrhoea,  which is needed to make informed decisions about  the use of rotavirus vaccine, is lacking in some coun‐ tries in the WHO European Region.   As part of a  WHO global initiative, WHO/Europe has established  a sentinel surveillance network for rotavirus to ad‐ dress these knowledge gaps and provides technical  support to participating countries.   Since 2006, the  network has grown to include six countries  (Armenia, Azerbaijan, Georgia, the Republic of  Moldova, Tajikistan, and Ukraine).       In the sentinel hospitals , all children <5 years of age  hospitalized with acute gastroenteritis are eligible  for enrolment.  Information on demographics,  symptoms and history of illness are obtained using a  case report form and faecal samples are tested by  enzyme immunoassay (EIA) for rotavirus antigen.          In 2010, 6207 children from six countries were en‐ rolled and tested (Table 1) and  2337(38%) were  positive for rotavirus.  At a country‐level, the pro‐ portion positive ranged from 27% in Azerbaijan to  48% in Ukraine.  The proportion of children who  were positive for rotavirus increased from 24%  among infants aged 0‐5 months to 45% among chil‐ dren aged 12‐59 months.    The proportion of diar‐ rhoea due to rotavirus varied seasonally peaking  during February to April.      Based on these data, rotavirus accounts for a sub‐ stantial proportion of diarrhoea hospitalizations in  all countries within the WHO/Europe network.  As  several of these countries consider the introduction  of rotavirus vaccine, it will be important to maintain  ongoing surveillance in order to describe the epide‐ miology of rotavirus in the absence of vaccination  and how it changes once a vaccine has been intro‐ duced.  This report summarizes data collected via  the network in 2010 and it is expected that future  updates will be reported via Epidemiological Brief  on a quarterly basis.     Page No. 2 of 8  Page No. 3 of 8  Table 1.   Distribution of  diarrhoea cases by age group and members States, 2010,  WHO European Region   (Data reported by regional Rotavirus sentinel surveillance network members)   Country/ Site Age group  (months) Number of acute  diarrhoea  hospitalizations in  children <5 years  eligible* for  enrollment Number of children  meeting the case  definition that were  enrolled* with a case  report form completed  and specimen collected Number of total  eligible enrolled  (with CRF and  specimen collected)  acute diarrhoea   cases that were  Number of eligible  enrolled acute  diarrhoea cases  that tested  positive* for  rotavirus among  % Positive  for  rotavirus ARMENIA All <59m 1588 1577 1577 578 37% 0 to 5 191 191 33 17% 6 to 11 365 365 127 35% 12 to 23 479 479 231 48% 24 to 59 542 542 187 35% Unknown 0 0 0 MOLDOVA All <59m 1184 1069 1069 469 44% 0 to 5 40 40 2 5% 6 to 11 97 97 15 15% 12 to 23 497 497 215 43% 24 to 59 435 435 237 54% Unknown 0 0 0 AZERBAIJAN All <59m 1244 1140 1140 305 27% 0 to 5 0 0 0 6 to 11 0 0 0 12 to 23 0 0 0 24 to 59 0 0 0 Unknown 0 0 0 GEORGIA All <59m 852 665 616 197 32% 0 to 5 37 36 13 36% 6 to 11 131 125 49 39% 12 to 23 211 204 67 33% 24 to 59 286 251 68 27% Unknown 0 0 0 TAJIKISTAN All <59m 2807 731 730 269 37% 0 to 5 155 155 43 28% 6 to 11 272 272 129 47% 12 to 23 233 232 77 33% 24 to 59 59 59 15 25% Unknown 12 12 5 42% UKRAINE All <59m 1517 1179 1075 519 48% 0 to 5 104 97 31 32% 6 to 11 217 195 93 48% 12 to 23 377 341 179 52% 24 to 59 474 435 213 49% Unknown 7 7 3 43% TOTAL All <59m 9192 6361 6207 2337 38% 0 to 5 527 519 122 24% 6 to 11 1082 1054 413 39% 12 to 23 1797 1753 769 44% 24 to 59 1796 1722 720 42% Unknown 19 19 8 42% Table 2. Characteristics and results of synchronized supplementary immunization activities (SIAs)  in five central Asian republics, Azerbaijan and the Russian Federation Synchronized polio supplementary immuniza‐ tion activities in 2011    To effectively close any remaining immunity gaps  and to prevent the transmission of wild poliovi‐ rus across borders in the future, coordinated  supplementary immunization activities were  conducted in the first half of 2011.     For the first time since Operation MECACAR  (1995‐2007),  seven countries conducted syn‐ chronized SIAs: Kyrgyzstan, Tajikistan, Turkmeni‐ stan and Uzbekistan conducted two rounds each  with trivalent OPV (tOPV); Kazakhstan and the  Russian Federation conducted two rounds of  subnational SIAs with monovalent OPV type 1  (mOPV1) and tOPV to halt transmission of wild  poliovirus in high‐risk territories. Azerbaijan im‐ plemented two rounds with tOPV in districts bor‐ dering the Russian Federation.     In total, more than 18 million children were  reached with polio vaccines in 15 rounds of SIAs.   Final results of the synchronized SIAs conducted  in 2011 are presented in Table 2.    High administrative coverage was reported and  confirmed by independent monitoring uniformly  conducted in Kyrgyzstan, Tajikistan, Turkmeni‐ stan and Uzbekistan.   The European Regional  Certification Commission for Poliomyelitis Eradi‐ cation met in Copenhagen on August 23‐24,  2011. Taking into account the control and sur‐ veillance status of the Region, the Commission   decide that wild poliovirus transmission has been  successfully interrupted and the region will  maintain its polio free status.  A summary of the  Commission’s recommendations will be pre‐ sented in the next issue of Epidemiological Brief.  Page No. 4 of 8  Country Round SIA dates (2011) Type of campaign (NID / SNID) Type of vaccine (mOPV, tOPV) Target population (years) Estimated target population Total number of children vaccinated (reported data) Reported Coverage (%) Coverage by Independent Monitoring (%)* Azerbaijan Round 1 25-30 April SNID tOPV < 6 32,033 31,164 97.3% 100.0% Round 2 23-29 May SNID tOPV < 6 31,928 31392 98.3% N/A Kazakhstan Round 1 21-25 February SNID mOPV < 7 411,653 406,922 98.9% 89.5% Round 2 3-7 May NID tOPV < 15 1,710,321 1,677,825 98.1% N/A Round 3 16-20 May SNID mOPV 7-15 383,920 383,318 99.8% N/A Kyrgyzstan Round 1 18-23 April NID tOPV < 15 1,690,188 1,605,311 95.0% 96.1% Round 2 23-28 May NID tOPV < 15 1,583,463 1,518,541 95.9% 94.2% Tajikistan Round 1 18-22 April NID tOPV < 5 1,000,294 993,566 99.3% 96.0% Round 2 23‐27 May NID tOPV < 5 1,024,272 1,016,078 99.2% 98.1% The Russian Federation Round 1 4-9 April SNID tOPV 6m-15yrs 1,394,121 1,389,809 99.7% N/A Round 2 3-7 May SNID tOPV 6m-15yrs 1,393,975 1,390,176 99.7% N/A Turkmenistan Round 1 25-30 April NID tOPV < 5 604,225 598,437 99.0% 99.4% Round 2 30 May‐       4 June NID tOPV < 5 616,803 611,133 99.1% 99.2% Uzbekistan Round 1 18-23 April NID tOPV < 5 + 1 province < 15 3,058,796 3,071,031 100.4% 96.1% Round 2 23-28 May NID tOPV < 5 + 1 province < 15 2,987,557 2990544 100.1% 97.0% *Post-campaign house-to-house independent monitoring results N/A - not available Table 3. Classification of reported suspected measles cases, January—Jun 2011 (data as of 1 Aug 2011) Epi Brief Issue 16                                                                                                                                                                                                                                                                              Page  5         La b co nf ir m ed Ep i- Li nk C li ni ca l2 D is ca rd ed C om pl et e- ne ss T im el in es s M on th o f la st re po rt La bo ra to ry in ve st ig at io n ra te de te ct io n ra te So ur ce o f in fe ct io n Albania 3 184 761 0.0 0 0 0 0 0 0 100% 67% Jun - 0.00 - Andorra 67 722 0.0 0 0 0 0 0 0 100% 33% Jun - 0.00 - Armenia 3 099 249 0.0 0 0 0 0 15 0 83% 100% Jun 100.0% 0.48 100.0% Austria 8 407 841 5.9 69 19 5 45 0 19 83% 83% Jun 37.5% NA NA Azerbaijan 9 035 054 0.0 0 0 0 0 7 0 83% 83% May 100.0% 0.08 100.0% Belarus* 9 541 951 0.3 3 3 0 0 0 0 50% 50% May 100.0% 0.00 0.0% Belgium 10 741 473 37.9 434 251 66 117 22 27 50% 50% Jun 69.2% NA NA Bosnia and Herzegovina* 3 752 989 - - - - - - - - - No Report - NA NA Bulgaria* 7 450 501 19.6 146 124 0 22 0 0 100% 50% Jun 84.9% NA NA Croatia 4 402 729 0.2 2 1 1 0 0 1 83% 50% Jun 100.0% 0.00 100.0% Cyprus 888 534 0.0 0 0 0 0 0 0 100% 100% Jun - 0.00 - Czech Republic 10 442 510 2.4 29 24 0 5 0 4 100% 100% Jun 82.8% NA NA Denmark 5 491 148 14.0 78 71 7 0 0 1 100% 100% Jun 100.0% NA NA Estonia 1 338 887 1.5 7 7 0 0 0 5 100% 100% Jun 100.0% NA NA Finland 5 364 898 3.0 19 19 0 0 0 3 100% 100% Jun 100.0% NA NA France 62 916 416 222.8 14025 4532 772 8721 146 9 83% 50% Jun 40.9% NA NA Georgia* 4 184 100 6.0 25 7 3 15 0 0 100% 83% Jun 31.8% NA NA Germany 81 935 976 16.2 1343 728 509 106 1 16 67% 67% Jun 87.2% NA NA Greece 11 203 121 2.9 37 32 1 4 0 5 100% 83% Jun 91.7% NA NA Hungary 9 953 518 0.0 2 2 0 0 0 2 100% 100% Jun 100.0% 0.00 100.0% Iceland 335 063 0.0 0 0 0 0 0 0 100% 83% Jun - 0.00 - Ireland 4 656 634 17.2 87 41 13 33 3 7 100% 100% Jun 68.8% NA NA Israel* 7 397 700 1.2 9 5 0 4 0 0 100% 100% Jun 55.6% NA NA Italy 60 280 504 2.9 174 0 0 174 0 0 33% 17% Apr 0.0% NA NA Kazakhstan* 15 868 221 1.9 30 24 0 6 0 0 50% 17% Mar 80.0% NA NA Kyrgyzstan 5 617 475 31.3 176 43 0 133 0 0 17% 0% May 24.4% NA NA Latvia 2 231 358 0.4 1 1 0 0 0 0 50% 33% Jun 100.0% 0.00 100.0% Lithuania 3 228 015 1.2 7 7 0 0 0 3 100% 83% Jun 100.0% NA NA Luxembourg 497 368 6.0 5 5 0 0 0 2 83% 83% Jun 100.0% NA NA Malta 411 349 4.9 2 2 0 0 0 0 100% 100% Jun 100.0% NA NA Monaco 37 785 - - - - - - - - - No Report - NA NA Montenegro* 626 067 8.0 5 5 0 0 0 0 83% 67% Jun 100.0% NA NA Netherlands 16 710 858 1.9 46 29 16 1 0 15 50% 33% Jun 96.7% NA NA Norway 4 895 307 6.5 38 38 0 0 0 6 50% 50% Jun 100.0% NA NA Poland 37 995 500 0.5 19 13 0 6 14 1 100% 67% Jun 75.8% 0.04 100.0% Portugal 10 752 590 0.0 0 0 0 0 0 0 100% 50% Jun - 0.00 - Republic of Moldova 3 549 163 0.0 0 0 0 0 0 0 50% 17% Mar - 0.00 - Romania 21 107 516 101.3 2142 765 1316 61 133 4 33% 0% Jun 94.8% NA NA Russian Federation 139 872 928 0.9 139 136 2 1 26 19 100% 100% Jun 100.6% NA 49.7% San Marino 29 332 - - - - - - - - - No Report - NA NA Serbia* 9 855 875 35.1 346 71 13 262 0 0 100% 67% Jun 21.3% NA NA Slovakia 5 417 394 0.0 2 2 0 0 0 2 100% 100% Jun 100.0% 0.00 100.0% Slovenia 2 029 418 2.0 8 8 0 0 0 4 100% 100% Jun 100.0% NA NA Spain 45 724 660 55.0 2589 2018 327 244 2 75 100% 100% Jun 90.9% NA NA Sweden 9 335 463 0.5 21 21 0 0 0 16 100% 100% Jun 100.0% 0.00 100.0% Switzerland 7 622 415 73.2 597 385 76 136 83 39 100% 100% Jun 76.8% NA NA Tajikistan* 7 203 979 - - - - - - - - - No Report - NA NA The former Yugoslav Republic of Macedonia* 2 044 005 352.7 721 50 241 430 0 0 100% 83% Jun 10.4% NA NA Turkey 76 582 128 1.2 99 99 0 0 0 6 100% 100% Jun 100.0% NA NA Turkmenistan 5 243 476 0.0 0 0 0 0 0 0 17% 17% May - 0.00 - Ukraine* 45 167 108 0.3 12 12 0 0 0 0 83% 83% May 100.0% 0.00 0.0% United Kingdom 62 230 620 9.8 683 682 1 0 3 73 100% 100% Jun 100.1% NA NA Uzbekistan* 28 110 756 11.2 316 172 0 144 0 0 67% 17% Apr 54.4% NA NA Total/Averages 896 071 408 26.9 24493 10454 3369 10670 455 364 91.7% 76.2% 54.5% 0.05 48.6% Data source : Monthly aggregate and case-based data reported by Member States to WHO/Europe and/or EUVAC.NET. 1 Source: "World Population Prospects: The 2008 Revision", New York, United Nations and updates provided by Member States. Reporting 2 Cases with missing classification are classified as "Clinical". Incidence Rate per 1 million population (Jan-Jun) Surveillance Indicators (Please see page 4 for detail) 3 Imported or import related measles cases included in total measles. * Member States reporting aggregate measles data in years 2010 and 2011. Indicators not meeting target and countries not reporting monthly measles data are highligted in red; NA=Not Applicable; "-" = data not available or can not be calculated due to insufficient denominator Country Total Population1 Classification Total confirmed measles Im po rt at io n3 Table 4. Classification of reported suspected rubella cases, January—Jun 2011 (data as of 1 Aug 2011) Page  6                                                                                                                                                                                                                                                                            Epi Brief Issue  16  La b co nf ir m ed Ep i- Li nk C li ni ca l2 D is ca rd ed C om pl et e- ne ss T im el in es s M on th o f la st re po rt La bo ra to ry in ve st ig at io n ra te D et ec ti on r at e So ur ce o f in fe ct io n Albania 3 184 761 1.6 5 1 0 4 0 0 100% 67% Jun 0.0% - - Andorra 67 722 0.0 0 0 0 0 0 0 100% 33% Jun - 0.00 - Armenia 3 099 249 0.0 0 0 0 0 7 0 100% 100% Mar 93.3% 0.23 214.3% Austria 8 407 841 0.0 1 0 0 1 0 1 83% 33% Jun 100.0% 0.00 100.0% Azerbaijan 9 035 054 0.0 0 0 0 0 6 0 83% 83% May 100.0% 0.07 100.0% Belarus 9 541 951 0.7 7 7 0 0 0 0 50% 50% May 0.0% 0.00 0.0% Belgium 10 741 473 - - - - - - - - - No Report - - - Bosnia and Herzegovina 3 752 989 - - - - - - - - - No Report - - - Bulgaria 7 450 501 4.4 33 1 0 32 0 0 100% 33% Jun 0.0% - - Croatia 4 402 729 0.0 0 0 0 0 0 0 50% 33% Jun - 0.00 - Cyprus 888 534 0.0 0 0 0 0 0 0 100% 83% Jun - 0.00 - Czech Republic 10 442 510 0.0 0 0 0 0 0 0 83% 50% Jun - 0.00 - Denmark 5 491 148 - - - - - - - - - No Report - - - Estonia 1 338 887 0.0 0 0 0 0 0 0 100% 83% Jun - 0.00 - Finland 5 364 898 0.0 1 0 0 1 0 1 100% 67% Jun 100.0% 0.00 100.0% France 62 916 416 - - - - - - - - - No Report - - - Georgia 4 184 100 10.3 43 2 0 41 0 0 100% 83% Jun 0.0% - - Germany 81 935 976 - - - - - - - - - No Report - - - Greece 11 203 121 0.0 0 0 0 0 0 0 67% 33% Apr - 0.00 - Hungary 9 953 518 0.0 0 0 0 0 0 0 100% 50% Jun - 0.00 - Iceland 335 063 0.0 0 0 0 0 0 0 100% 67% Jun - 0.00 - Ireland 4 656 634 0.0 0 0 0 0 0 0 100% 50% Jun - 0.00 - Israel 7 397 700 0.0 0 0 0 0 0 0 100% 33% Jun - 0.00 - Italy 60 280 504 0.0 0 0 0 0 0 0 17% 0% Jan - 0.00 - Kazakhstan 15 868 221 - - - - - - - - - No Report - - - Kyrgyzstan 5 617 475 - - - - - - - - - No Report - - - Latvia 2 231 358 0.0 0 0 0 0 0 0 67% 17% Jun - 0.00 - Lithuania 3 228 015 0.0 0 0 0 0 0 0 83% 50% Jun - 0.00 - Luxembourg 497 368 0.0 0 0 0 0 0 0 100% 50% Jun - 0.00 - Malta 411 349 0.0 0 0 0 0 0 0 100% 83% Jun - 0.00 - Monaco 37 785 - - - - - - - - - No Report - - - Montenegro 626 067 0.0 0 0 0 0 0 0 67% 50% Apr - 0.00 - Netherlands 16 710 858 0.0 0 0 0 0 0 0 33% 0% Mar - 0.00 - Norway 4 895 307 0.0 0 0 0 0 0 0 67% 33% Jun - 0.00 - Poland 37 995 500 0.0 0 0 0 0 0 0 17% 0% Apr - 0.00 - Portugal 10 752 590 0.0 0 0 0 0 2 0 83% 33% Jun 0.0% 0.02 0.0% Republic of Moldova 3 549 163 0.0 0 0 0 0 0 0 50% 17% Mar - 0.00 - Romania 21 107 516 0.0 0 0 0 0 0 0 33% 0% Jun - 0.00 - Russian Federation 139 872 928 - - - - - - - - - No Report 100.0% - - San Marino 29 332 - - - - - - - - - No Report - - - Serbia 9 855 875 - - - - - - - - - No Report - - - Slovakia 5 417 394 0.0 0 0 0 0 0 0 100% 83% Jun - 0.00 - Slovenia 2 029 418 0.0 0 0 0 0 0 0 33% 0% Mar - 0.00 - Spain 45 724 660 0.0 0 0 0 0 0 0 83% 50% Jun - 0.00 - Sweden 9 335 463 0.0 0 0 0 0 0 0 100% 67% Jun - 0.00 - Switzerland 7 622 415 0.0 0 0 0 0 13 0 100% 33% Jun 92.3% 0.17 7.7% Tajikistan 7 203 979 - - - - - - - - - No Report - - - The former Yugoslav Republic of Macedonia 2 044 005 1.5 3 0 0 3 0 0 100% 67% Jun 0.0% - - Turkey 76 582 128 - - - - - - - - - No Report - - - Turkmenistan 5 243 476 - - - - - - - - - No Report - - - Ukraine 45 167 108 - - - - - - - - - No Report - - - United Kingdom 62 230 620 0.0 0 0 0 0 0 0 83% 50% May - 0.00 - Uzbekistan 28 110 756 0.7 20 0 0 20 0 0 17% 0% Mar 0.0% 0.00 0.0% Total/Averages 896 071 408 0.1 113 11 0 102 28 2 0.0% 0.0% #DIV/0! 0.00 0.0% Data source : Monthly aggregate and case-based data reported by Member States to WHO/Europe and/or EUVAC.NET. 1 Source: "World Population Prospects: The 2008 Revision", New York, United Nations and updates provided by Member States. Country 2 Cases with missing classification are classified as "Clinical". Surveillance Indicator (Please see page 4 for detail) 3 Imported or import related rubella cases included in total rubella. Indicators not meeting target and countries not reporting monthly rubella data are highligted in red. "-" indicates data not available/applicable or can not be calculated due to insufficient denominator. Total Population1 Classification Total confirmed Rubella Im po rt at io n3Annualized Incidence Rate per 1 million population Reporting Table 5. Measles and rubella laboratory test results, January—May 2011 (data as of 27 Jun 2011) Epi Brief Issue 16                                                                                                                                                                                                                                                                             Page  7            Tested for measles Positive for measles (%) Measles Equivocal Negative for measles Tested for rubella Positive for rubella (%) Rubella Equivocal Negative for rubella % Complete- ness % Timeli- ness Month of last report Albania 19 0 (0.0) 0 19 5 1 (20.0) 0 4 100.0% 83.3% Jun Andorra No Lab Armenia 25 0 (0.0) 0 25 25 0 (0.0) 2 23 100.0% 100.0% Jun Austria 717 42 (6.0) 0 675 2979 2 (0.0) 0 2977 100.0% 100.0% Jun Azerbaijan 13 0 (0.0) 0 13 13 0 (0.0) 0 13 83.3% 50.0% May Belarus 298 44 (15.0) 10 224 222 23 (10.0) 3 196 100.0% 100.0% Jun Belgium 528 274 (52.0) 11 241 35 5 (14.0) 2 22 100.0% 100.0% Jun Bosnia and Herzegovina 0.0% 0.0% No Report Bulgaria 62 33 (53.0) 0 29 37 1 (3.0) 0 36 100.0% 66.7% Jun Croatia 2 2 (100.0) 0 0 2 0 (0.0) 0 2 100.0% 100.0% Jun Cyprus 0 0 0 0 0 0 0 0 100.0% 100.0% Jun Czech Republic 23 9 (39.0) 6 8 36 4 (11.0) 0 32 83.3% 83.3% May Denmark 920 179 (19.0) 20 721 348 11 (3.0) 53 284 100.0% 50.0% Jun Estonia 122 6 (5.0) 2 114 311 3 (1.0) 0 308 100.0% 100.0% Jun Finland 167 22 (13.0) 0 145 164 7 (4.0) 0 157 83.3% 83.3% Jun France 2610 1866 (71.0) 12 732 0 0 0 0 100.0% 83.3% Jun Georgia 24 4 (17.0) 0 20 26 4 (15.0) 3 19 100.0% 66.7% Jun Germany 898 586 (65.0) 4 308 61 4 (7.0) 3 54 100.0% 100.0% Jun Greece 81 22 (27.0) 0 59 132 29 (22.0) 0 103 83.3% 50.0% May Hungary 41 0 (0.0) 0 41 206 6 (3.0) 1 199 100.0% 100.0% Jun Iceland 31 0 (0.0) 0 31 35 0 (0.0) 0 35 100.0% 50.0% Jun Ireland 198 43 (22.0) 10 145 873 3 (0.0) 12 858 100.0% 66.7% Jun Israel 68 16 (24.0) 0 52 343 28 (8.0) 0 315 100.0% 83.3% Jun Italy 0.0% 0.0% No Report Kazakhstan 82 52 (63.0) 3 23 19 0 (0.0) 0 18 100.0% 83.3% Jun Kyrgyzstan 247 79 (32.0) 4 162 247 2 (1.0) 4 239 66.7% 66.7% May Latvia 98 0 (0.0) 0 98 98 1 (1.0) 0 97 83.3% 66.7% May Lithuania 10 6 (60.0) 1 3 9 0 (0.0) 0 9 100.0% 100.0% Jun Luxembourg 71 9 (13.0) 0 62 25 1 (4.0) 1 23 100.0% 100.0% Jun Malta 3 3 (100.0) 0 0 708 5 (1.0) 0 703 100.0% 100.0% Jun Monaco No Lab Montenegro No Lab Netherlands 98 42 (43.0) 0 56 96 2 (2.0) 0 94 100.0% 83.3% Jun Norway 192 67 (35.0) 1 124 20 1 (5.0) 1 18 100.0% 100.0% Jun Poland 35 14 (40.0) 2 19 26 4 (15.0) 1 21 100.0% 100.0% Jun Portugal 5 3 (60.0) 0 0 0 0 0 0 100.0% 100.0% Jun Republic of Moldova 11 0 (0.0) 0 11 11 0 (0.0) 0 11 100.0% 100.0% Jun Romania 1089 793 (73.0) 14 282 320 30 (9.0) 4 286 100.0% 100.0% Jun Russian Federation 2112 285 (13.0) 4 1823 1823 206 (11.0) 6 1611 100.0% 83.3% Jun San Marino No Lab Serbia 163 95 (58.0) 0 68 231 0 (0.0) 0 231 83.3% 16.7% May Slovakia 9 1 (11.0) 0 8 12 6 (50.0) 0 6 100.0% 100.0% Jun Slovenia 38 13 (34.0) 1 24 13 0 (0.0) 0 13 100.0% 100.0% Jun Spain 2801 1463 (52.0) 46 371 24 6 (25.0) 0 11 100.0% 83.3% Jun Sweden 0.0% 0.0% No Report Switzerland 456 414 (91.0) 18 24 14 14 (100.0) 0 0 100.0% 100.0% Jun Tajikistan 9 0 (0.0) 0 9 9 0 (0.0) 0 9 50.0% 16.7% Mar The former Yugoslav Republic of Macedonia 163 50 (31.0) 18 95 99 0 (0.0) 2 97 83.3% 33.3% May Turkey 5367 127 (2.0) 82 5158 4763 200 (4.0) 252 4311 100.0% 66.7% Jun Turkmenistan 5 0 (0.0) 0 5 5 0 (0.0) 0 5 83.3% 83.3% Jun Ukraine 442 39 (9.0) 1 402 946 593 (63.0) 10 343 100.0% 100.0% Jun United Kingdom 2773 761 (27.0) 0 2012 496 5 (1.0) 0 491 100.0% 66.7% Jun Uzbekistan 230 168 (73.0) 13 49 68 1 (1.0) 3 64 100.0% 50.0% Jun Total / Average 23356 7632 (33%) 283 14490 15935 1208 (8%) 363 14348 89.5% 75.9% Data source : Aggregated monthly lab data provided by laboratories of the regional measles and rubella lab network. Country Specimen* (Serum, Oral Fluid, Swab, Urine and other) *Specimen based data are not population based, and should not be interpreted as indicators for epidemiological surveillance. Laboratories may have received more than 1 clinical sample or may have conducted more than 1 test for a given case reported in Table 1. Reporting Contact us: Vaccine‐preventable Diseases and Immunization Programme WHO Regional Office for Europe Tel.: +45 39 17 13 31   Email: vaccine@euro.who.int   Web site: http://www.euro.who.int Page  8                                                                                                                                                                                                                                                                             Epi Brief Issue 16          P ol io C om pa tib le Pe nd in g D is ca rd ed W ild P ol io ca se s VD PV /V A PP N on p ol io A FP r at e3 A de qu at e St oo l co lle ct io n Su rv . I nd ex 5 P ol io C om pa tib le Pe nd in g D is ca rd ed W ild P ol io ca se s VD PV /V A PP N on p ol io A FP r at e3 A de qu at e St oo l co lle ct io n Su rv . I nd ex 5 % C om pl et en es s % T im el in es s W ee k of la st re po rt Albania 13 13 0 0 0 13 0 0 1.79 100.0 1.00 1 1 0 0 0 1 0 0 0.24 100.0 0.2 80.0 36.0 29 Andorra 0 0 0 0 0 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0 0 0 0.00 0.0 0.0 80.0 10.0 25 Armenia 13 13 1 0 0 13 0 0 2.08 61.5 0.62 12 12 2 0 4 8 0 0 2.14 91.7 0.9 96.0 60.0 30 Austria 3 3 0 0 0 3 0 0 0.24 0.0 0.00 1 1 0 0 1 0 0 0 0.00 0.0 0.0 96.0 30.0 30 Azerbaijan 29 29 0 0 0 29 0 0 1.36 100.0 1.00 21 21 0 0 14 7 0 0 0.55 100.0 0.5 83.0 80.0 30 Belarus 41 41 2 0 0 41 0 0 2.92 92.7 0.98 22 22 1 0 4 18 0 0 2.16 81.8 0.9 48.0 50.0 27 Belgium 3 3 0 0 0 3 0 0 0.17 0.0 0.06 1 1 0 0 0 1 0 0 0.09 0.0 0.0 70.0 43.0 29 Bosnia and Herzegovina 6 6 0 0 0 6 0 0 1.05 66.7 0.83 2 2 1 0 1 1 0 0 0.30 50.0 0.1 93.0 56.0 30 Bulgaria 13 13 2 0 0 13 0 0 1.28 92.3 0.92 5 5 0 0 3 2 0 0 0.33 80.0 0.3 16.0 13.0 30 Croatia 0 0 0 0 0 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0 0 0 0.00 0.0 0.0 77.0 16.0 24 Cyprus 7 7 0 0 0 7 0 0 4.56 85.7 0.86 2 2 0 0 2 0 0 0 0.00 100.0 0.0 90.0 93.0 29 Czech Republic 2 2 0 0 0 2 0 0 0.14 100.0 0.14 4 4 0 0 1 3 0 0 0.34 100.0 0.3 74.0 73.0 29 Estonia 0 0 0 0 0 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0 0 0 0.00 0.0 0.0 83.0 86.0 30 Georgia 7 7 0 0 0 7 0 0 0.99 100.0 0.99 8 8 1 0 4 4 0 0 0.96 100.0 1.0 87.0 90.0 29 Germany 11 10 0 0 0 11 0 0 0.10 10.0 0.03 0 0 0 0 0 0 0 0 0.00 0.0 0.0 0.0 0.0 0 Greece 20 20 1 0 0 20 0 0 1.26 40.0 0.60 17 17 2 0 17 0 0 0 0.00 64.7 0.0 48.0 50.0 28 Hungary 13 13 0 0 0 13 0 0 0.88 38.5 0.54 1 1 0 0 1 0 0 0 0.00 0.0 0.0 90.0 56.0 29 Ireland 2 2 0 0 0 2 0 0 0.21 50.0 0.10 4 4 0 0 1 3 0 0 0.52 0.0 0.1 96.0 30.0 30 Israel 11 11 0 0 0 11 0 0 0.55 0.0 0.15 6 6 0 0 0 6 0 0 0.50 0.0 0.1 74.0 76.0 30 Italy 53 53 0 0 0 53 0 0 0.62 58.5 0.39 37 37 1 0 24 13 0 0 0.26 54.1 0.1 6.0 6.0 28 Kazakhstan 113 112 4 0 1 111 1 0 2.95 99.1 0.99 49 49 0 0 26 23 0 0 1.01 98.0 1.0 25.0 23.0 25 Kyrgyzstan 68 64 0 0 0 68 0 0 4.22 96.9 1.00 31 29 0 0 6 25 0 0 2.59 100.0 1.0 9.0 10.0 25 Latvia 5 5 0 0 0 5 0 0 1.61 100.0 1.00 0 0 0 0 0 0 0 0 0.00 0.0 0.0 93.0 86.0 30 Lithuania 10 10 0 0 0 10 0 0 2.10 100.0 1.00 7 7 0 0 4 3 0 0 1.08 100.0 1.0 93.0 86.0 30 Malta 0 0 0 0 0 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0 0 0 0.00 0.0 0.0 83.0 16.0 26 Montenegro 1 1 0 0 0 1 0 0 0.83 100.0 0.83 1 1 0 0 0 1 0 0 1.41 0.0 1.0 87.0 90.0 30 Norway 9 9 0 0 0 9 0 0 0.99 55.6 0.77 3 3 0 0 3 0 0 0 0.00 33.3 0.0 77.0 20.0 27 Poland 47 47 0 0 0 46 0 1 0.82 72.3 0.68 23 23 0 0 11 12 0 0 0.36 52.2 0.2 93.0 73.0 29 Portugal 8 8 0 0 0 8 0 0 0.49 50.0 0.31 4 4 0 0 1 3 0 0 0.31 75.0 0.3 83.0 3.0 26 Republic of Moldova 15 15 3 0 0 15 0 0 2.52 73.3 0.87 5 5 0 0 5 0 0 0 0.00 100.0 0.0 83.0 86.0 29 Romania 16 16 1 0 0 16 0 0 0.50 100.0 0.50 13 13 0 0 1 12 0 0 0.63 100.0 0.6 90.0 90.0 30 Russian Federation 397 390 68 0 0 378 14 5 1.80 94.9 0.95 211 210 15 0 75 134 0 2 1.06 93.3 1.0 74.0 76.0 28 Serbia 20 20 0 0 0 20 0 0 1.15 90.0 0.95 2 2 1 0 1 1 0 0 0.10 100.0 0.1 77.0 76.0 29 Slovakia 1 1 0 0 0 1 0 0 0.12 0.0 0.00 2 2 0 0 1 1 0 0 0.21 100.0 0.2 64.0 60.0 29 Slovenia 0 0 0 0 0 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0 0 0 0.00 0.0 0.0 93.0 80.0 30 Spain 31 31 2 0 0 31 0 0 0.46 45.2 0.34 13 13 0 0 6 7 0 0 0.17 7.7 0.1 96.0 66.0 30 Switzerland 9 9 0 0 0 9 0 0 0.78 33.3 0.43 4 3 0 0 0 4 0 0 0.59 66.7 0.4 74.0 46.0 27 Tajikistan 712 585 0 61 0 193 457 1 7.50 86.7 0.88 28 25 0 0 11 17 0 0 1.10 88.0 0.9 67.0 70.0 29 The former Yugoslav Republic of 7 7 0 0 0 7 0 0 1.95 100.0 1.00 3 3 1 0 2 1 0 0 0.48 100.0 0.5 90.0 86.0 30 Turkey 217 211 6 0 0 240 0 2 1.08 74.4 0.79 119 119 2 0 36 83 0 0 0.70 82.4 0.6 83.0 86.0 30 Turkmenistan 50 50 0 0 0 46 3 1 3.06 100.0 1.00 20 20 0 0 9 11 0 0 1.23 100.0 1.0 38.0 40.0 29 Ukraine 130 125 22 0 0 129 0 1 2.04 96.0 0.98 75 75 13 0 29 46 0 0 1.22 97.3 1.0 90.0 93.0 30 Uzbekistan 146 132 4 0 0 146 0 0 1.84 97.7 0.98 117 115 4 0 61 56 0 0 1.19 94.8 0.9 67.0 63.0 30 Average/Total 2259 2094 116 61 1 1736 475 11 1.66 86.00 0.89 874 865 44 0 365 507 0 2 0.67 0.61 68.0 73.0 53.0 3 Non-polio AFP cases per 100 000 children under the age of 15 years (annualized for year 2009). Number of non-polio (discarded) AFP cases X 100000 / total population under 15 years. A FP c as es u nd er 15 y ea rs o f a ge H ot A FP C as es 2 Classificaion Rates 5 Surveillance Index = non-polio AFP rate up to 1.0 x (% AFP cases with atleast 1 adequate specimens within 14 days of onset). 4 two stool samples collected with 14 days and 48 hours apart. Countries A FP C as es 1 1 AFP case of all ages (Denmark, Finland, France, Iceland, Luxembourg, Monaco, Netherlands, San Marino, Sweden and United Kingdom do not report AFP cases. High quality surveillance (e.g. enterovirus and/or environmental) to detect poliovirus exists in Member States with no AFP surveillance. 2 Hot cases = AFP case reported with a priority code (e.g. less than three doses of polio vaccine/Clinically polio/Recent travel to endemic country/high risk group). Countries infected in 2010 Table 6: Classification of AFP cases, surveillance performance and weekly reporting to WHO EURO by country, 2010-2011, WHO European Region A FP C as es 1 H ot A FP C as es 2 Classificaion 2010 (1-53 weeks) A FP c as es u nd er 15 y ea r of a ge Rates Reporting 2011 (1-30 weeks) © World Health Organization 2011 All rights reserved. Document number: WHO/EURO:2011-7605-47372-69574