Measles and rubella elimination country profile: Republic of North Macedonia

Measles elimination status Rubella elimination status Total population 2 083 160 < 1 year old 24 092 < 5 years old 118 345 Demographic information, 2017 Source: World Population Prospects: The 2017 Revision, New York, United Nations Measles and rubella surveillance National case-based surveillance for measles and CRS Lab confirmation for diagnosis of measles and CRS Source: WHO/UNICEF Joint Reporting Form on Immunization, 2017 Measles and rubella elimination country profile Republic of North Macedonia 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 (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 Unusual increase of cases for that region and period. In case of measles this will mean two epi-linked cases 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 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 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 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 2013 2014 2015 2016 2017 N u m b e r o f ca se s 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 Republic of North Macedonia ©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 17 0 Unknown/ Not reported 1 0 Endemic 0 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 •D4 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 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 2017 25 18 0 1 19 6 9.2 ND 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 Republic of North Macedonia 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 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 1.0 3.2% NA NA 3 0% NA 100% 2017 0 3.2% 100% 100% 25 72% 100% 100% Suspected rubella cases Confirmed rubella cases Discarded as non- rubella Rubella incidence Genotypes detected Laboratory Epi- linked Clinically Total 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 2017 4 0 0 0 0 4 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 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 2017 0 3.2% 100% NA 4 0% NA 100% 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. Surveillance performance and sensitivity need to be strengthened and better documented. ©WHO 2019 Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/7thrvc