Next steps towards eliminating measles and rubella in Europe

Campaign poster from the Ministry of Health, Equalities, Care and Ageing, North Rhine-Westphalia, Germany

Lisa, aged 9, blinded from rubella. Campaign poster from the Ministry of Health, Equalities, Care and Ageing, North Rhine-Westphalia, Germany

In September 2010, Member States in the WHO European Region set themselves a new target date for eliminating measles and rubella – 2015 – in a resolution adopted by WHO/Europe’s governing body. Measles remains an important health issue in the Region. Political and public complacency about the value of immunization threatens many national programmes, and measles transmission has continued in western and central European countries. The resurgence of cases corresponds to lower immunization rates among selected population groups and geographic clustering.

At a WHO/Europe consultation on 2–3 December 2010, national immunization experts agreed on the steps that will be taken to document and verify the elimination of measles and rubella, and the prevention of congenital rubella syndrome (due to infection early in pregnancy) from the Region. The participants approved a framework for the verification process that takes account of countries’ experiences.

The consultation also gave countries a chance to discuss their measles and rubella programmes, and the challenges to elimination.

Experts’ description of progress and challenges in national programmes

Russian Federation

The measles and rubella programmes in the Russian Federation are at different stages. While an internal process to verify measles elimination is close to completion, surveillance of rubella is not standardized in the country and no national plan has been established.

“We must work hard to ensure that we catch up on rubella elimination by 2015, building on the measles experience,” commented Dr Olga Tsvirkun, Senior Researcher at the Gabrichevskiy Scientific Research Institute for Epidemiology and Microbiology, Moscow. “These WHO meetings are very important to share country experiences and it is interesting to learn we have common challenges – such as addressing immunization in migrant groups and how rubella is becoming an increasing problem in older groups, particularly older men.”

Turkey

Turkey has had a national immunization programme for measles since the 1980s, and introduced the combined measles, mumps and rubella (MMR) vaccine in 2006. The country’s health system is in transition, and the high turnover of health care workers creates not only challenges but also opportunities for training and behaviour change.
“Turkey is in a good position in terms of measles elimination, thanks to the surveillance system in the country. The measles response has a long history, and huge work has already been done. We must do the same for rubella,” said Dr Aslihan Coskun, Public Health Specialist at the Ministry of Health.

Germany

Germany has experienced both endemic and imported cases of measles in recent years. The main challenge is neglect among those to be immunized, compounded by missed opportunities by doctors to encourage vaccination and a vocal anti-immunization lobby, according to Dr Sabine Reiter, Deputy Head of the Preventive Immunization Division at the Robert Koch Institute in Berlin: “We need a concerted effort at both the local and federal levels with strong political commitment to strengthen immunization. It is encouraging that measles elimination is still a high priority in countries in the Region.”

Framework for the verification process in Europe

Documenting and verifying the elimination of measles and rubella and prevention of congenital rubella syndrome in the WHO European Region require several standard, interrelated components, including:

  • detailed information on measles and rubella epidemiology;
  • virologic surveillance, supported by molecular epidemiology;
  • an analysis of the vaccinated population;
  • high-quality surveillance; and
  • a sustainable national immunization programme.

National committees for verification of measles and rubella elimination will be established to compile and submit this information annually to a regional commission. The national committees will continue to provide data for at least three years after the regional commission has reported the interruption of endemic measles and rubella transmission. Only then can regional elimination be declared.

Reported measles cases by month and year, 2004-2010, WHO European Region

Recent resurgence of measles in western and central Europe. Click on image to view full graph.