Measles and rubella elimination country profile: Greece

Measles elimination status 2015 interrupted 2016 eliminated 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 10 919 459 < 1 year old 91 923 < 5 years old 523 839 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 National plan of action Does the country have a national plan of action? ND Is it updated? ND 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 Greece Definition used for an outbreak At least two measles or rubella cases including cases with epidemiological links Source: Measles and rubella elimination Annual Status Update report, 2016 Confirmed measles cases by month of onset, 2012-2016 Source: CISID2 2016 Vaccine Schedule MCV1 MMR 12-15 months MCV2 MMR 4-6 years Year of introduction MCV2 Prior to 1995 RCV Prior to 1995 Measles vaccination in school No 0 10 20 30 40 50 60 70 80 90 100 0 20 40 60 80 100 120 140 160 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Measles Rubella Coverage MCV1 Coverage MVC2 0 1 2 3 4 5 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 Suspected measles cases Confirmed measles cases Discarded as non- measles Measles incidence Genotypes detected Laboratory Epi- linked Clincally Total 2012 ND 3 0 0 3 ND 0.3 ND 2013 0 4 0 0 4 0 0.4 ND 2014 238 1 0 0 1 237 0.1 D8 2015 252 0 0 1 1 251 0.1 ND 2016 339 0 0 0 0 339 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 Measles and rubella elimination country profile Greece ©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 0 ND 100% 100% ND ND ND ND 2013 ND ND 100% ND ND ND ND ND 2014 2.2 ND 100% 100% 238 0.4% ND ND 2015 2.3 ND 99.6% 100% 251 0% ND 0% 2016 3.1 ND 100% NA 339 0% ND 0.5% Suspected rubella cases Confirmed measles cases Discarded as non- rubella Rubella incidence Genotypes detected Laboratory Epi- linked Clincally Total 2012 0 0 0 0 0 0 0 NA 2013 0 0 0 0 0 0 0 NA 2014 679 0 0 0 0 679 0 NA 2015 633 0 0 0 0 633 0 NA 2016 828 0 0 0 0 828 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 NA ND 0% ND ND 2013 ND ND 100% NA ND 0% ND ND 2014 6.3 ND 100% NA 679 0% ND ND 2015 5.9 ND 100% NA 633 0% ND 0% 2016 7.7 ND 100% NA 828 0% ND 0% RVC comments, based on 2016 reporting The Regional Verification Commission for Measles and Rubella Elimination (RVC) concluded that endemic transmission of both measles and rubella remained interrupted in Greece in 2016. Considering the RVC’s conclusions on the interrupted status of measles and rubella transmission in 2014 and 2015, it is pleased to declare that Greece has achieved elimination of both measles and rubella. The RVC commends Greece on this achievement. The RVC also commends the national health authorities on the surveillance and immunization activities carried out for the migrant and refugee population, but urges them to improve measles and rubella surveillance sensitivity and to consider a system of routine collection of MRCV coverage data by subnational levels. The RVC requests the National Verification Com- mittee (NVC) to provide detailed epidemiological information on measles and rubella cases (suspected, discarded and confirmed) and consistent information about the proficiency of laboratories providing measles and rubella investigations in the next ASU. Source: Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report (www.euro.who.int/6thRVC) 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 Greece ©WHO 2018 No cases reported Information on CRS, 2016 Supplementary immunization activities Year Target age Vaccine used % Coverage 2016 1 - < 15 years MMR 83% NA NA Source: Supplementary immunization activities, WHO, Data and Statistics, Immunization Monitoring and Surveillance (http://www.who.int/immunization/monitoring_surveillance/data/en/) NA= Not applicable; MMR = measles-mumps-rubella vaccine Source: Measles and rubella elimination Annual Status Update report, 2016 CRS = congenital rubella syndrome