Measles and rubella elimination country profile: Romania

Measles elimination status Rubella elimination status Total population 19 372 734 < 1 year old 177 469 < 5 years old 887 025 Demographic information, 2016 Source: World Population Prospects: The 2015 Revision, New York, United Nations National plan of action Does the country have a national plan of action? ND Is it updated? ND Source: Measles and rubella elimination Annual Status Update report, 2016 ND= Data not available Measles and rubella elimination country prole Romania 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 = rst dose measles-containing vacccine; MCV2 = second dose measles-containing vaccine; RCV = rubella-containing vaccine 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 = rst dose of measles-containing vaccine MCV2= second dose of measles-containing vaccine Denition used for an outbreak Source: Measles and rubella elimination Annual Status Update report, 2016 Increasing number of cases over the expected number of cases at that period of time, in that area 2015 endemic 2016 endemic Source:European Regional Verication Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/6thRVC 2015 endemic 2016 endemic Source:European Regional Verication Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/6thRVC 0 10 20 30 40 50 60 70 80 90 100 0 5000 10000 15000 20000 25000 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Measles Rubella Coverage MCV1 Coverage MVC2 Conrmed measles cases by month of onset, 2012-2016 Source: CISID2 2016 Vaccine Schedule MCV1 MMR 12 months MCV2 MMR 5 years Year of introduction MCV2 1979 RCV 2002 Measles vaccination in school No 0 200 400 600 800 1000 1200 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 Measles and rubella elimination country prole Romania ©WHO 2018 Information on CRS, 2016 4 endemic cases, clinically compatible Source: Measles and rubella elimination Annual Status Update report, 2016 CRS = congenital rubella syndrome Measles cases by rst subnational level, 2016 1dot=1case Measles genotypes by rst subnational level, 2016 Source: MeaNS 2016 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. • B3 • D8 • H1 • D4 Sources of infection, 2016 Measles Rubella Imported 0 0 Import-related 3 0 Unknown/ Not reported 0 0 Endemic 2432 13 Measles cases by age group and vaccination status, 2016 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% < 1 year 1-4 years 5-9 years 10-14 years 15-19 years 20-29 years 30 + 0 doses 1 dose 2 or more doses Unknown Supplementary immunization activities Year Target age Vaccine used % Coverage 2016 9 months - 9 years MMR 46% 2016 1 - 15 years MMR ND Source: Supplementary immunization activities, WHO, Data and Statistics, Immunization Monitoring and Surveillance (http://www.who.int/immunization/monitoring_surveillance/data/en/) ND=Data not available; MMR = measles-mumps-rubella vaccine Suspected measles cases Conrmed measles cases Discarded as non- measles Measles incidence Genotypes detected Labora - tory Epi- linked Clincally Total 2012 ND 3 918 3 390 142 7 450 ND 347.6 D4,D8 2013 1 391 884 247 28 1159 281 53.5 D4,D8 2014 164 49 3 7 59 106 2.8 ND 2015 55 4 0 3 7 48 0.3 B3 2016 2 493 1 363 1 058 14 2 435 65 123.2 B3 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, and internal communication from country ND = Data not available; NA= Not applicable A procient 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, and internal communication from country 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, and internal communication from country ND = Data not available; NA= Not applicable A procient laboratory is WHO accredited and/or has an established quality assurance programme with oversight by a WHO accredited laboratory Surveillance performance indicators and targets Measles and rubella elimination country prole Romania 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 procient labs 2012 18.3 ND 56.7% 100% ND ND ND 100% 2013 1.2 40.5% 80.2% 100% ND ND 76.7% 100% 2014 0.5 14.3% 14.3% 88.1% 133 27.8% 0 100% 2015 0.3 0% 94.5% 100% 52 7.7% 0 100% 2016 0.3 0% 57% ND 1 572 85.4% 72.5% 100% Suspected rubella cases Conrmed measles cases Discarded as non- rubella Rubella incidence Genotypes detected Laboratory Epi- linked Clincally Total 2012 ND 5 599 15 213 0 20 812 ND 974.6 2B 2013 461 105 11 29 145 334 6.6 ND 2014 182 22 1 7 30 158 1.4 ND 2015 108 0 0 8 8 100 0.4 ND 2016 229 12 0 1 13 218 0.7 ND 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 procient labs 2012 ND ND ND ND ND ND ND 100% 2013 1.3 40.5% 91.3% 100% ND ND 33.3% 100% 2014 0.7 25% 95.6% 0 190 7.4% 0 100% 2015 0.5 11.9% 92.5% 0 100 0% 0 100% 2016 1.1 14.3% 93.4% ND 226 5.3% ND 100% RVC comments, based on 2016 reporting The Regional Verication Commission for Measles and Rubella Elimination (RVC) acknowledges the eorts being made to improve vaccination coverage in Romania, particularly in vulnerable communities, and recognizes that eorts are challenged by the current political climate. The proposed new legislation on immunization is expected to go some way towards mitigation of current challenges to achieve high universal vaccination coverage, but other, innovative, measures will probably also be required. The RVC believes that in order to end the current measles outbreak, greater eorts are needed to increase the vaccination coverage in infants and children aged 9 months to 5 years by strengthening supplementary immunization activities. The RVC urges the health authorities and public health system to strengthen measles and rubella surveillance and to improve its quality, including improving the rate of viral detection of rubella. Source: Regional Verication Commission for Measles and Rubella Elimination (RVC) meeting report (www.euro.who.int/6thRVC) ©WHO 2018