New framework for verifiying elimination of measles and rubella in the European Region

A framework document released today as part of European Immunization Week describes the steps to be taken to report, document and verify that elimination of measles and rubella has been achieved in the WHO European Region. It presents the criteria for declaring the Region measles and rubella free,  as well as indicators that will be used in subsequent years to assess whether the Region has maintained its elimination status.

The verification process was developed through consultation with Member States and the Regional Verification Commission (RVC) for Measles and Rubella Elimination, in light of successful mechanisms put in place earlier for certification of smallpox and poliomyelitis eradication.

Required evidence

Interruption of endemic transmission of these diseases in a particular country will be determined based on:

  • detailed information about measles and rubella epidemiology;
  • virologic surveillance supported by molecular epidemiology;
  • analyses of vaccinated population cohorts;
  • quality surveillance; and
  • sustainability of the national immunization programme.

National verification committees in all Member States are responsible for compiling and annually submitting these data to the RVC. Review and evaluation of annual national reports will continue in each Member State for at least 3 years after the RVC confirms that endemic measles and rubella transmission has been interrupted in all 53 Member States of the Region.

Rationale for establishing an elimination target

In 2010, the WHO Strategic Advisory Group of Experts on Immunization (SAGE) conducted a comprehensive review of the evidence to determine the biological and technical feasibility of measles eradication, and concluded that measles can and should be eradicated. Given that most Member States have already incorporated combined measles-rubella-containing vaccines into their vaccination schedules, and that rubella is less contagious than measles, rubella elimination is considered feasible within the frameworks of the regional measles elimination strategies.

Several factors support these conclusions:

  • There is no animal or environmental reservoir and humans are thus critical to maintaining transmission.
  • Accurate diagnostic tests are available.
  • Vaccines and existing vaccination strategies for both diseases are effective and safe.
  • Transmission has already been interrupted in large geographic areas.

Need for accelerated action

Outbreaks of measles and rubella reported in the WHO European Region in the past two years seriously threaten the Region’s elimination goal for these diseases. To be successful, greater political commitment and accelerated action is needed by Member States, WHO and other partners.

The Regional Office has consequently implemented a “Package for accelerated action for measles and rubella elimination”. In numerous priority areas, the Office is increasing technical support to Member States as they seek to eliminate measles and rubella by the 2015 target date.

The Package lays out stepped-up activities in:

  • vaccination and immunization system strengthening
  • surveillance
  • outbreak prevention and response
  • communications, information and advocacy
  • resource mobilization and partnerships
  • verification of measles and rubella elimination.
A timeline for expected outputs in each category has also been adopted to monitor progress toward the elimination goal.