Measles and rubella elimination country profile: Netherlands

Measles elimination status Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/6thRVC Rubella elimination status Total population 16 979 729 < 1 year old 176 844 < 5 years old 889 360 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 Measles and rubella elimination country profile The Netherlands 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 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 Confirmed measles cases by month of onset, 2012-2016 Source: CISID2 2016 Source:European Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report: www.euro.who.int/6thRVC 2015 eliminated 2016 eliminated 2015 eliminated 2016 eliminated Source: Measles and rubella elimination Annual Status Update report, 2016 Definition used for an outbreak 2 or more molecularly/epidemiologically linked cases Vaccine Schedule MCV1 MMR 14 months MCV2 MMR 9 years Year of introduction MCV2 1987 RCV 1974 Measles vaccination in school No 0 10 20 30 40 50 60 70 80 90 100 0 500 1000 1500 2000 2500 3000 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Measles Rubella Coverage MCV1 Coverage MVC2 0 100 200 300 400 500 600 700 800 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 profile The Netherlands ©WHO 2018 Information on CRS, 2016 No cases reported Source: Measles and rubella elimination Annual Status Update report, 2016 CRS = congenital rubella syndrome Measles cases by first subnational level, 2016 1dot=1case Source:  Measles and rubella elimination Annual Status Update report, 2016 Measles genotypes by first 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. Measles cases by age group and vaccination status, 2016 Source:  Measles and rubella elimination Annual Status Update report, 2016 Sources of infection, 2016 Measles Rubella Imported 4 0 Import-related 1 0 Unknown/ Not reported 1 0 Endemic 0 0 Source:  Measles and rubella elimination Annual Status Update report, 2016 •B3 •D8 •H1 •D4 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 Suspected measles cases Confirmed measles cases Discarded as non- measles Measles incidence Genotypes detectedLabora- tory Epi- linked Clincally Total 2012 ND 10 0 0 10 ND 0.1 B3,D4,D8 2013 4 881 882 1 749 ND 2 631 270 155 D8 2014 153 109 31 ND 140 116 7.7 B3,D8,H1 2015 65 7 0 ND 7 60 0.4 B3, D8 2016 59 5 1 ND 6 53 0.4 D8 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 Netherlands 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 100% 100% ND ND ND ND 2013 45.5% ND ND 1.5% ND ND 56.7% ND 2014 75.8% ND ND 17% ND 42 32% ND 2015 92% ND ND 71% ND 7 71% ND 2016 ND ND ND 83.3% ND ND ND ND Suspected rubella cases Confirmed measles cases Discarded as non- rubella Rubella incidence Genotypes detected Laboratory Epi- linked Clincally Total 2012 ND 1 0 0 1 ND 0.1 ND 2013 196 19 38 ND 57 190 3.4 ND 2014 2 2 0 ND 0 2 0.1 1E 2015 7 1 0 0 1 6 0.1 ND 2016 51 0 0 ND 0 51 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 0% 100% ND ND ND ND 2013 1.6 ND 37% 5.3% ND ND 1.5% ND 2014 99.7% ND ND 50% ND 1 0.4% ND 2015 100% ND ND 100% ND 1 ND ND 2016 ND ND ND NA ND 0 NA ND 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 the Netherlands in 2016, and confirmed that measles and rubella elimination has been sustained. The RVC commends the National Verification Committee (NVC), national health authorities and public health system on this achievement, but is concerned about the quality of surveillance, based on information provided in the ASU. The RVC urges the national health authorities to make further efforts to strengthen measles and rubella surveillance to the level considered adequate (with a rate of measles and rubella discarded cases ≥2/100 000) and to improve the way in which surveillance performance is presented in the ASU to facilitate better documentation of the elimination status. Source: Regional Verification Commission for Measles and Rubella Elimination (RVC) meeting report (www.euro.who.int/6thRVC) ©WHO 2018