In June 2009 the World Health Organiza-tion (WHO) increased the alert level for novel influenza A (H1N1) to pandemic alert phase 6. This pandemic alert, the first in 40 years, confirmed that the H1N1 virus was maintain-ing sustained human to human infection in at least two geographic areas of the world. Since then, more than 212 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic (H1N1) 2009 influenza, including at least 15 921 deaths (as of 14 February 2010).

To ensure equity of access to pandemic influenza vaccines, which can protect people from severe morbidity and mortality associ-ated with pandemic (H1N1) 2009 influenza, governments, foundations and manufacturers have donated vaccines, ancillary products (such as syringes and safety boxes) and pro-vided operational costs to support pandemic influenza vaccine deployment in low and low-middle income countries. Globally, WHO has received pledges of approximately 200 million doses of vaccine, 74 million syringes and US$ 48 million for operations.

WHO is coordinating the distribution of donated pandemic influenza vaccine to 95 countries. In the European Region there are eight countries that are eligible to receive do-nated stockpiled vaccine.

In January 2010, Azerbaijan became the first in the European Region to receive WHO stockpile donated vaccine. Through the United Nations Country Team, the Govern-ment of Azerbaijan is being supported with the response to pandemic (H1N1) 2009 by a host of organizations, including: Academy for Educational Development (AED), Ros-tropovich-Vishnevskaya Foundation (RVF), United Nations Children’s Fund (UNICEF), the United Nations High Commissioner for Refugees (UNHCR), the United States Agency for International Development (USAID), the International Federation of Red Cross (IFRC) and Red Crescent Societies, the World Bank /Ministry of Health “Health Sector Reform

Project” and WHO. A United Nations joint programme has been established to promote the overall coordination of the deployment operation by the Ministry of Health.

Azerbaijan received its first shipment of donated pandemic (H1N1) 2009 vaccine, con-taining 172 000 doses out of a total 860 000 on 8 January 2010. Vaccination will target health care workers, staff of life support services, pregnant women in their third trimester of pregnancy (20 percent of all pregnant women), people with a history of chronic lung disease and children aged 14–17 years. The January deliveries were received and checked by staff from the Innovation and Supply Centre of the Ministry of Health. Jour-nalists and film crews were present at the air-port to see the arrival of the vaccine and me-dia coverage of the vaccine arrival and de-ployment has been prominent.

The vaccine was transferred to the na-tional cold-storage facility at the Ministry and then was re-packed for shipment to desig-nated health care centres. The vaccine was distributed to health facilities within seven days of its arrival.

The pandemic vaccination campaign is ongoing and will continue for the next couple of months, expanding into children aged 14-17 years. Azerbaijan’s achievements are the result of effective planning and team work by the Ministry of Health and its international partners. Azerbaijan has assured vaccination campaign success, to date, by comprehen-sively preparing pandemic immunization activities, including training for vaccinators, building the required injection safety capacity and developing and adapting the essential pandemic communication materials.

Contributed by Dr Vusala Allahverdiyeva, National Professional Officer, WHO Coun-try Office, Azerbaijan

Azerbaijan begins vaccination of priority groups with donated pandemic (H1N1) 2009 vaccine

A MONTHLY NEWSLETTER OF THE WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR EUROPE

Issue 13, December 2009 - January 2010

Issue 13, December 2009-January 2010 page 2

Globally, rotaviruses are the most com-mon cause of severe diarrhoeal disease in young children. WHO estimates from 2004 indicate approximately 527 000 children under 5 years of age die each year from vaccine-preventable rotavirus infections and most of these children live in low-income countries.

The update report recommends the inclu-sion of rotavirus vaccination as part of na-tional programmes where efficacy data sug-gest a significant impact in public health – principally from the Americas and Europe (1). Taking into account the new evidence, WHO now recommends infants worldwide, be vacci-nated against rotavirus. This report is a revi-sion of the 2007 position paper (2) that recom-mends implementing rotavirus vaccination programmes to support prevention of all childhood diarrhoea.

Two oral, live, attenuated rotavirus vac-cines – Rotarix® and RotaTeq® are available internationally and have been proven to be safe and effective in preventing gastrointesti-nal disease caused by rotaviruses.

WHO recommends the following actions to reduce severe rotavirus-associated diar-rhoea and child mortality:

• the introduction of the vaccine in coun-tries where diarrhoeal deaths account for

≥10% of mortality among children aged <5 years;

• the first dose of either Rotarix® or Ro-taTeq® be administered at age 6–15 weeks;

• two doses of Rotarix® be administered with the first and second doses of diphtheria–tetanus–pertussis (DTP) vaccine rather than with the second and third doses, to ensure maximum immunization coverage and reduce the potential for late administration beyond the approved age window; and

• a comprehensive strategy to control diar-rhoeal diseases should include, among other interventions, improvements in hygiene and sanitation, zinc supplementation, community-based administration of oral rehydration solu-tion and overall improvements in case man-agement.

References:

1. Weekly epidemiological record (WER) 2009, No. 51-52, 84:533–540. Rotavirus vaccines: an update. Geneva, WHO, 2009.

Available online: http: / / w w w.who.int / wer /2009 /wer8451_52 /en / index.html (accessed 27 January 2010).

2. Weekly epidemiological record (WER) 2007, No. 32, 82: 285–296. Rotavirus vaccines: WHO position paper. Geneva, WHO, 2009. Available online: http: / /w w w . w h o.in t / w e r / 2007 / w e r 8232 / e n / i n d ex .h t mll. (accessed 27 January 2010).

WHO update on rotavirus vaccine

Rotavirus is a main cause of mortality from severe acute gastroenteritis in young children worldwide. According to the authors of this placebo-controlled trial study (1), close to 600 000 children under five years of age die every year from rotavirus infections.

This study investigates the efficacy and safety of the pentavalent human-bovine reas-sortant oral rotavirus vaccine RotaTeq®, con-ducted among infants in Europe (1). Close to 70 000 infants were enrolled in the random-ized, blinded Rotavirus Efficacy and Safety Trial (REST) from 2001–2005. The main results are from 30 523 infants enrolled in five Euro-pean countries – Belgium, Finland, Germany, Italy and Sweden. The first dose of the vaccine, or placebo, was administered to healthy in-fants at 6–12 weeks of age and two more doses

at 4–10 week intervals, up to 32 weeks of age.

In Europe, RotaTeq® vaccine was found to have excellent clinical efficacy against severe rotavirus disease and reduced the severity of rotavirus gastroenteritis (RVGE) - 98.3%. The vaccine was found to be 68% efficacious against all RVGE due to any serotype for 2 ro-tavirus seasons, post vaccination. These find-ings coincide with WHO’s current position on including rotavirus vaccine as part of national programmes.

References: 1. Vesikari T., Itzler R., Karvonen A., Korhonen T.,

Van Damme P., Behre U., Bona G., Gothefors L., Heaton PM., Dallas M., Goveia MG. RotaTeq, a pentavalent rotavi-rus vaccine: efficacy and safety among infants in Europe. Vaccine. 11 December 2009; 28(2):345-51.

Article overview Safety and efficacy of rotavirus vaccine: RotaTeq®

Issue 13, December 2009-January 2010 page 3

Update

European Immunization Week 2010

More than a decade ago, Member States adopted a regional goal of eliminating measles and ru-bella by the end of 2010. But the mo-m e n t u m on this impor tan t – and achievable – goal has stalled in recent years. Measles coverage in many western European countries has fallen below the recommended 95% and measles has made a comeback, with ongoing outbreaks in the western part of the Region. In a few months, the fifth European Immunization Week (EIW) will take place from 24 April to 1 May. WHO Regional Office for Europe, to-gether with Member States, will use EIW 2010 as an opportunity to focus on what countries in the Region need to do to achieve the mea-sles and rubella elimination goal in the near future.

This year, WHO Regional Office for Europe is leveraging innovative web-based and traditional communication methods to advocate for the 2010 elimination goal. The initiative will launch an online ‘community’ concept that WHO /Europe intends to build upon over the coming years. At the regional level, for 2010, the campaign will consist of a

web-cast video conference; launch of a Wikipedia page for EIW; a real-time online EIW diary for the week; and a host of state-ments from public health sector immunization champions. A small booth will also be estab-lished at Copenhagen Airport to contact pas-sengers both leaving from and arriving to Denmark with key messages related to immu-nization. If successful, this activity will be scaled-up in subsequent years to other Euro-pean regional air transport hubs to work alongside Member States and WHO Regional Office for Europe during EIW.

All activities will be interlinked and com-plemented by the EIW 2010 web site: (www.euro.who.int /eiw). This site will pre-sent materials and messages, myths about vac-cination, questions and answers, and links to recent reports on outbreaks of measles in the European Region. Additional WHO corporate and technical communication products and publications will support the week by spot-lighting key messages and reviewing topical articles.

The 2010 goal is a vital and attainable goal, but it will only be met if individual countries, and the Region as a whole, make a focused and concerted effort to achieve it. We urge you to contact your local EIW focal point to see how you can get involved.

The WHO European Regional Office point person in Copenhagen for EIW 2010 is Chelsea Hedquist (e-mail: eiw2010@euro.who.int).

Issue 13, December 2009-January 2010 page 4

In response to pandemic (H1N1) 2009, more than 30 vaccines have been developed and licensed. Since September 2009, more than 50 countries have implemented immunization programs targeting various populations. These populations include health-care workers, chil-dren, pregnant women and persons with spe-cific underlying medical conditions – includ-ing chronic lung disease, diabetes and heart disease – as well as persons with compromised immune systems (1, 2).

From 21 September, tens of millions of doses of the pandemic (H1N1) 2009 vaccine have been administered, thereby providing the basis for the first safety review published on 18 December 2009 by the WHO Global Advisory Committee on Vaccine Safety (GACVS) (3).

Pandemic influenza vaccines include live a t te n u a te d vaccines, inac tiva te d u n-adjuvanted vaccines (split, subunit virion, or whole virion) and inactivated adjuvanted vac-cines (split or subunit virion). An estimated 350 million vaccine doses have been distrib-uted in many countries around the world; 39% in the European Region (Fig. 1). No unex-pected safety concerns have been identified for any of the pandemic (H1N1) 2009 vaccines (3).

Of the 53 Member States in the WHO Euro-pean Region 37 (69.8%) have started immuni-zation (Fig. 2) with the highest vaccination coverage reported by Sweden (60%). In addi-tion, Finland is planning to vaccinate its entire population.

According to the European Medicines Agency (EMA), as of 25 January 2010 at least 130 million doses of pandemic (H1N1) 2009 vaccines were distributed and approximately 38.6 million people, including 296 000 preg-

nant women were vaccinated in the European Economic Area (EEA) (4). Some vaccinated individuals received two doses but the per-centage varies across countries.

Immediate hypersensitivity reactions have been reported after the use of all types of pan-demic (H1N1) 2009 vaccines. These events in-clude urticaria, angioedema and anaphylaxis, with reactions ranging from mild to serious. Anaphylaxis is a known, potentially life-threatening adverse effect of all vaccines but is a very rare event. The overall reporting rates for anaphylaxis ranges from 0.1 to 1.0 per 100 000 distributed doses. The total reporting rate for suspected adverse events following immu-nization (AEFI) is 34.2 reports per 100 000 doses administered.

In the ongoing immunization campaigns, deaths temporally associated with vaccination have been reported in many countries. Given the large number of persons who have been vaccinated, it is expected that some deaths not related to vaccination would be considered temporally associated (5).

Concerns have been raised about the use of adjuvanted pandemic vaccines in patients with immune disorders, such as immunodeficiency, autoimmune disorders and solid organ trans-plants. To date, post-marketing surveillance has not found any evidence for causality of safety issues in such patients. Viral infections such as influenza, can lead to severe complica-tions in immunocompromised patients. Thus, the benefit of pandemic (H1N1) 2009 vaccines – adjuvanted or unadjuvanted – far outweighs the potential risks in these patients.

Some errors have also been reported, in-cluding erroneously administering other

Pandemic (H1N1) 2009 vaccines: safety data are reassuring

Fig. 1. Estimated number of H1N1 vaccine doses distributed in the World (January 2010)

141,500,00039%

224,620,00061%

EURO The other regions

Issue 13, December 2009-January 2010 page 5

drugs instead of vaccine, or mixing of the adju-vant and antigen components, that is required for some of the vaccines. Immunization pro-grammes should take appropriate measures to prevent such errors.

In conclusion, the review by GACVS ac-knowledges the safety of pandemic (H1N1) 2009 vaccines that are currently in use and, to date, the safety data is reassuring. The vast ma-jority of adverse reactions that have been re-ported as of 24 January 2010 are considered to be non-serious and unexpected safety concerns have not been identified. The benefit-risk bal-ance of the vaccines currently being used for pandemic (H1N1) 2009 continues to be positive. Under the coordination of WHO, there should be an unprecedented, ongoing exchange of safety information among regulatory and pub-lic health authorities around the world. Moni-toring vaccine safety (pharmacovigilance) is critical and should include regular information sharing with WHO by national regulatory and health authorities.

References: 1. WHO, 2009. Strategic Advisory Group of Experts on

Immunization report of the extraordinary meeting on the influ-enza A (H1N1) 2009 pandemic. Weekly Epidemiological Re-port, 2009, Vol. 84(30):301-308 (available at http: / /www.who.int / w er /2009 / wer8430 /en / index.html).

2. WHO, 2009. Pandemic influenza A (H1N1) 2009 virus

vaccine-conclusions and recommendations from the October 2009 meeting of the immunization Strategic Advisory Group of Ex-perts. Weekly Epidemiological Report, 2009, Vol. 84(49):505-516 (available at http: / / www.who.int / w er /2009 /wer8449 /en / index.html).

3. WHO, 2009. Statement from WHO Global Advisory

Committee on vaccine safety about the safety profile of pandemic influenza A (H1N1) 2009 vaccines (available at http: / /w w w. w ho.in t / csr / r eso u rces / p u blications / s wi neflu /gacvs_statement_20091218 /).

4. European Medicines Agency (EMA), 2010. Eighth

pandemic pharmacovigilance weekly update (available at http: / / w w w.ema.europa.eu / influenza / u pdates.html).

5. Black S., Eskola J., Siegrist CA et al., 2009. Importance

of background rates of disease in assessment of vaccine safety during mass immunization with pandemic H1N1 influenza vac-cines. Lancet, doi:10.1016 /S0140-6736(09)61877-8.

H1N1 vaccination in WHO/EURO regionNo vaccinationVaccination started

The boundaries and name shown and the designa-tion used on this map do not imply the expression of any opinion whatsoever on the part of the World

Fig. 2.

Immunize Now

Issue 13, December 2009-January 2010 page 6

This 2007 cross-sectional study reports on the low coverage of hepatitis B virus (HBV) vaccination among health care workers (HCWs) in the Republic of Georgia (1). WHO has classified Georgia as a high prevalence country of HBV, 3.4% of blood donors are tested positive for hepatitis B surface antigen (HBsAg). Globally HCWs are at high occupa-tional risk for infection but vaccination cover-age among them is low.

A safe and effective vaccine has existed since 2000 and this study reports on the utiliza-tion of the vaccine, vaccine status, willingness to recommend vaccination to other HCWs and barriers to vaccination in Georgia. The survey was conducted in Batumi and Kaspi among 124 physicians and 173 nurses from two large hospitals. Over half (58%) of HCWs were at risk of infection while only 12% of workers reported being fully vaccinated. It was re-ported that health care workers under 40 years of age were more likely to be vaccinated than those aged 40 years or older.

Even with low vaccination coverage, 54% of respondents indicated they would recom-mend vaccination to other HCWs. Barriers to high coverage among HCWs included atti-tudes towards vaccine safety and fear of ad-verse events.

The results of this study suggest that risk

communication in vaccination campaigns is necessary to counter concerns about vaccine

safety. Although HCWs are more knowledge-able than the general public about vaccine-preventable diseases, their perception on vac-cine safety and side-effects will affect their de-cision to get vaccinated from HBV, despite their high risk of infection.

Several strategies are recommended for increasing vaccine acceptance among health care workers in Georgia:

• a vaccine safety message should be ar-ticulated that is appropriate for all HCWs, es-pecially older health care workers who are less likely to accept vaccination;

• program coordinators should schedule vaccinations and follow-up with visits to com-plete the vaccination series;

• vaccination should be provided free or at low cost; and

• a screening protocol should be adopted and used to provide HCWs with confidential-ity.

References: 1. Topuridze M., Butsashvili M., Kamkamidze G.,

Kajaia M., Morse D., McNutt LA. Barriers to Hepatitis B Vaccine Coverage among Health care Workers in the Re-public of Georgia: An International Perspective. Infection Control and Hospital Epidemiology, 28 December 2009.

Underutilization of HBV vaccine among health care workers in Georgia

Issue 13, December 2009-January 2010 page 7

1 2 3

S M T W Th F Sa S M T W Th F Sa S M T W Th F Sa

W53 1 2 W5 1 2 3 4 5 6 W9 1 2 3 4 5 6

W1 3 4 5 6 7 8 9 W6 7 8 9 10 11 12 13 W10 7 8 9 10 11 12 13

W2 10 11 12 13 14 15 16 W7 14 15 16 17 18 19 20 W11 14 15 16 17 18 19 20

W3 17 18 19 20 21 22 23 W8 21 22 23 24 25 26 27 W12 21 22 23 24 25 26 27

W4 24 25 26 27 28 29 30 W9 28 W13 28 29 30 31

W5 31

4 5 6

S M T W Th F Sa S M T W Th F Sa S M T W Th F Sa

W13 1 2 3 W17 1 W22 1 2 3 4 5

W14 4 5 6 7 8 9 10 W18 2 3 4 5 6 7 8 W23 6 7 8 9 10 11 12

W15 11 12 13 14 15 16 17 W19 9 10 11 12 13 14 15 W24 13 14 15 16 17 18 19

W16 18 19 20 21 22 23 24 W20 16 17 18 19 20 21 22 W25 20 21 22 23 24 25 26

W17 25 26 27 28 29 30 W21 23 24 25 26 27 28 29 W26 27 28 29 30

W22 30 31

7 8 9

S M T W Th F Sa S M T W Th F Sa S M T W Th F Sa

W26 1 2 3 W31 1 2 3 4 5 6 7 W35 1 2 3 4

W27 4 5 6 7 8 9 10 W32 8 9 10 11 12 13 14 W36 5 6 7 8 9 10 11

W28 11 12 13 14 15 16 17 W33 15 16 17 18 19 20 21 W37 12 13 14 15 16 17 18

W29 18 19 20 21 22 23 24 W34 22 23 24 25 26 27 28 W38 19 20 21 22 23 24 25

W30 25 26 27 28 29 30 31 W35 29 30 31 W39 26 27 28 29 30

10 11 12

S M T W Th F Sa S M T W Th F Sa S M T W Th F Sa

W39 1 2 W44 1 2 3 4 5 6 W48 1 2 3 4

W40 3 4 5 6 7 8 9 W45 7 8 9 10 11 12 13 W49 5 6 7 8 9 10 11

W41 10 11 12 13 14 15 16 W46 14 15 16 17 18 19 20 W50 12 13 14 15 16 17 18

W42 17 18 19 20 21 22 23 W47 21 22 23 24 25 26 27 W51 19 20 21 22 23 24 25

W43 24 25 26 27 28 29 30 W48 28 29 30 W52 26 27 28 29 30 31

W44 31

Monthly Deadlines: Measles/Rubella/Diphtheria Case based and aggregate data and measles lab data (for previous month)

Surveillance and Monitoring Team, WHO EUROEnter Diphtheria data in CISID or submit to diphtheria@euro.who.int

Enter AFP/Polio Lab data in CISID or submit to polio@euro.who.int

Enter Measles Rubella / MR Lab data in CISID or Submit to measles@euro.who.int

Weekly Deadlines: Weekly AFP and Lab Data for the previous week (current EPI week is mentioned in first column )

September 2010

January 2010 February 2010 March 2010

December 2010November 2010October 2010

VPD Data Reporting Calendar, 2010January 2010 - December 2010

June 2010May 2010April 2010

July 2010 August 2010

WHO European Regional office collects and consolidates vaccine preventable diseases surveillance data, analyses and present it to the Member States, policy makers, partners and donors and the general public. The purpose of this VPD Data Reporting Calendar is to provide a time sequence that will ensure timely in-formation and the opportunity for the individual institutions in Member States to report VPD data to WHO European Region in an accurate and timely manner.

Table 1. Classification of reported suspected measles and rubella cases, January–December 2009 (data as of 31 Jan 2010)

Issue 13, December 2009 – January 2010 page 8

Lab

conf

irm

ed

Epi-

Link

Cli

nica

l2

Dis

card

ed % Complet

e-ness

% Timeli-ness

Lab

conf

irm

ed

Epi-

Link

Cli

nica

l2

Dis

card

ed % Complete-

ness

% Timeli-ness

Albania 3 207 639 0.0 0 0 0 0 7 0 100% 91% 1 1 (100%) 0 0 1 3 100% 91%

Andorra 74 725 0.0 0 0 0 0 0 0 100% 50% 0 0 0 0 0 0 100% 50%Armenia 2 995 890 0.0 0 0 0 0 0 0 91% 58% 4 4 (100%) 3 0 1 0 91% 58%Austria 8 391 254 5.0 42 (100.0) 10 0 32 0 1 41% 8% - - - - - - 0% 0%Azerbaijan 8 533 620 0.1 1 (6.0) 0 0 1 15 0 66% 16% 6 0 (0%) 0 0 0 6 33% 8%Belarus 9 635 397 0.0 0 0 0 0 0 0 66% 66% 1 1 (100%) 1 0 0 0 66% 66%Belgium 10 480 390 3.1 33 (94.0) 24 2 7 2 4 100% 75% - - - - - - 0% 0%Bosnia and Herzegovina 3 940 397 2.0 8 (100.0) 0 0 8 0 0 16% 8% 225 225 (100%) 10 0 215 0 50% 25%Bulgaria 7 583 684 296.6 2249 (100.0) 696 1226 327 1 1 100% 66% - - - - - - 0% 0%Croatia 4 550 273 0.4 2 (100.0) 1 0 1 0 2 75% 41% - - - - - - 0% 0%Cyprus 863 624 0.0 0 0 0 0 0 0 100% 83% 0 0 0 0 0 0 25% 25%Czech Republic 10 183 437 0.5 5 (83.0) 5 0 0 1 1 100% 100% - - - - - - 0% 0%Denmark 5 453 204 1.5 8 (100.0) 8 0 0 0 1 100% 91% 0 0 0 0 0 0 8% 8%Estonia 1 330 510 0.0 0 0 0 0 0 0 100% 100% 0 0 1 0 0 0 100% 100%

Finland 5 292 617 0.6 3 (100.0) 3 0 0 0 3 100% 100% - - - - - - 0% 0%France 61 945 596 23.9 1481 (97.0) 783 92 606 51 32 66% 41% - - - - - - 0% 0%Georgia 4 360 801 5.3 23 (100.0) 2 0 21 0 0 100% 25% 67 67 (100%) 1 0 66 0 100% 25%Germany 82 534 214 6.9 568 (98.0) 386 144 38 10 25 100% 100% - - - - - - 0% 0%Greece 11 171 744 0.2 2 (100.0) 1 0 1 0 0 91% 50% - - - - - - 0% 0%Hungary 10 000 165 0.1 1 (100.0) 1 0 0 0 1 91% 58% - - - - - - 0% 0%Iceland 303 495 0.0 0 0 0 0 0 0 91% 58% - - - - - - 0% 0%Ireland 4 380 073 37.9 166 (97.0) 76 20 70 6 3 100% 91% 23 23 (100%) 1 0 22 0 100% 100%

Israel 7 044 501 0.7 5 (100.0) 0 0 5 0 0 91% 8% - - - - - - 0% 0%Italy 58 945 700 2.4 143 (100.0) 0 0 143 0 0 50% 8% - - - - - - 0% 0%Kazakhstan 15 531 645 0.0 0 0 0 0 0 0 41% 33% 306 306 (100%) 69 99 138 0 33% 25%Kyrgyzstan 5 376 432 0.0 0 0 0 0 0 0 91% 75% - - - - - - 0% 0%Latvia 2 265 485 0.0 0 0 0 0 0 0 91% 41% - - - - - - 0% 0%Lithuania 3 371 128 0.0 0 0 0 0 0 0 100% 91% 0 0 0 0 0 0 100% 100%

Luxembourg 472 066 0.0 0 0 0 0 0 0 100% 33% - - - - - - 0% 0%Malta 408 212 2.4 1 (100.0) 1 0 0 0 0 91% 83% - - - - - - 0% 0%Monaco 32 819 0.0 - - - - - - 0% 0% - - - - - - 0% 0%Montenegro 597 851 0.0 0 0 0 0 0 0 83% 41% 0 0 0 0 0 0 83% 50%Netherlands 16 450 022 0.5 9 (100.0) 8 0 1 0 1 25% 8% - - - - - - 0% 0%Norway 4 727 260 0.4 2 (100.0) 2 0 0 0 2 91% 66% - - - - - - 0% 0%Poland 38 022 140 4.2 160 (76.0) 85 61 14 51 0 91% 16% - - - - - - 0% 0%Portugal 10 661 632 0.3 3 (60.0) 3 0 0 2 1 66% 8% - - - - - - 0% 0%Republic of Moldova 3 759 599 0.0 0 0 0 0 0 0 75% 58% - - - - - - 0% 0%Romania 21 344 129 0.3 7 (3.0) 7 0 0 212 2 91% 8% - - - - - - 0% 0%Russian Federation 141 780 033 0.7 101 (100.0) 101 0 0 0 0 100% 100% - - - - - - 0% 0%San Marino 31 126 0.0 - - - - - - 0% 0% - - - - - - 0% 0%Serbia 9 879 595 0.1 1 (100.0) 1 0 0 0 0 91% 83% - - - - - - 8% 0%Slovakia 5 392 350 0.0 0 0 0 0 0 0 100% 91% 0 0 0 0 0 0 83% 58%Slovenia 2 001 578 0.0 0 0 0 0 0 0 100% 75% - - - - - - 0% 0%Spain 44 592 771 0.9 42 (100.0) 31 3 8 0 6 100% 91% - - - - - - 0% 0%Sweden 9 159 978 0.3 3 (100.0) 3 0 0 0 3 100% 66% - - - - - - 0% 0%Switzerland 7 512 120 133.3 1001 (86.0) 414 86 501 157 13 100% 83% - - - - - - 0% 0%Tajikistan 6 838 716 0.0 0 0 0 0 0 0 75% 58% 131 131 (100%) 0 0 131 0 75% 58%The former Yugoslav Republic of Macedonia 2 039 960 1.5 3 (100.0) 0 0 3 0 0 83% 41% 5 5 (100%) 0 0 5 0 58% 33%

Turkey 71 517 100 0.1 4 (100.0) 4 0 0 0 0 83% 16% 87 87 (100%) 21 0 66 0 91% 0%Turkmenistan 5 030 972 0.0 0 0 0 0 0 0 100% 41% - - - - - - 0% 0%Ukraine 45 858 834 0.5 24 (100.0) 9 0 15 0 0 75% 66% - - - - - - 0% 0%United Kingdom 61 018 648 19.3 1176 (85.0) 1158 2 16 204 8 91% 50% - - - - - - 0% 0%Uzbekistan 27 768 983 0.0 0 0 0 0 0 0 33% 8% 5 5 (100%) 5 0 0 0 33% 8%Total/Averages 886 646 134 8.21 7277 (91.0) 3823 1636 1818 719 110 81% 53% 861 856 (99.0) 112 99 645 9 25% 16%Data source : Monthly aggregate and case-based data reported by Member States to WHO/Europe and/or EUVAC.NET.1 Source: "World Population Prospects: The 2006 Revision", New York, United Nations and updates provided by Member States.

3 Imported or import related measles cases included in total measles. Indicators not meeting target and countries not reporitng monthly measles data are highligted in red.

Rubella Measles

Total Population1

Total suspected

ClassificationClassificationTotal conf. measles (% of

suspected measles cases)

Total Rubella (%)

Impo

rtat

ion3

Country

Monthly Reporting

2 Cases with missing classification are classified as "Clinical".

Monthly ReportingAnnualized

Incidence Rate per 1 million population

Table 2. Measles and rubella laboratory test results, January–December 2009 (data as of 31 January 2010)

Issue 13, December 2009 – January 2010 page 9

Tested for

measles

Positive for measles (%)

Measles Equivocal

Negative for

measles

Tested for

rubella

Positive for rubella

(%)

Rubella Equivocal

Negative for rubella

% Complete-

ness

% Timeli-

ness

Albania 7 0 (0.0) 0 7 1 0 (0.0) 0 1 100.0 75.0Andorra No LabArmenia 48 0 (0.0) 0 48 48 4 (8.0) 3 41 75.0 42.0Austria 1455 24 (2.0) 0 1431 5350 203 (4.0) 0 5147 100.0 100.0Azerbaijan 23 0 (0.0) 0 23 19 0 (0.0) 1 18 92.0 50.0Belarus 277 0 (0.0) 0 277 277 3 (1.0) 0 274 92.0 83.0Belgium 76 30 (39.0) 2 44 41 11 (27.0) 11 19 100.0 100.0Bosnia and Herzegovina No reportBulgaria 913 696 (76.0) 0 46 353 1 (0.0) 0 352 100.0 58.0Croatia 12 0 (0.0) 0 12 5 0 (0.0) 0 5 100.0 83.0Cyprus 0 0 0 0 0 0 0 0 100.0 100.0Czech Republic 27 9 (33.0) 2 16 57 7 (12.0) 2 48 100.0 92.0Denmark No reportEstonia 105 0 (0.0) 0 105 401 2 (0.0) 1 398 100.0 100.0Finland 174 4 (2.0) 0 170 570 0 (0.0) 0 570 92.0 75.0France No reportGeorgia 13 1 (8.0) 1 11 13 0 (0.0) 1 12 33.0 8.0Germany 436 172 (39.0) 3 261 66 10 (15.0) 0 56 100.0 42.0Greece 118 2 (2.0) 0 116 305 53 (17.0) 0 252 100.0 58.0Hungary 80 2 (3.0) 0 78 264 6 (2.0) 0 258 92.0 92.0Iceland No reportIreland 540 76 (14.0) 5 459 980 3 (0.0) 3 974 100.0 42.0Israel 71 12 (17.0) 0 59 588 126 (21.0) 0 453 100.0 92.0Italy No reportKazakhstan 33 0 (0.0) 0 33 114 87 (76.0) 2 25 92.0 83.0Kyrgyzstan 271 1 (0.0) 4 266 277 25 (9.0) 7 245 100.0 67.0Latvia 203 1 (0.0) 0 202 240 1 (0.0) 0 239 100.0 92.0Lithuania 7 0 (0.0) 0 7 7 0 (0.0) 1 6 100.0 83.0Luxembourg 149 1 (1.0) 3 145 77 3 (4.0) 4 70 100.0 92.0Malta 15 1 (7.0) 0 14 1231 14 (1.0) 6 1211 100.0 17.0Monaco No LabMontenegro No LabNetherlands 114 11 (10.0) 0 103 109 2 (2.0) 0 107 75.0 25.0Norway 48 4 (8.0) 0 44 34 5 (15.0) 0 29 100.0 92.0Poland 104 54 (52.0) 9 41 93 4 (4.0) 1 88 100.0 92.0Portugal 14 3 (21.0) 0 9 11 3 (27.0) 0 8 100.0 100.0Republic of Moldova 57 0 (0.0) 0 57 57 1 (2.0) 0 56 100.0 100.0Romania 278 13 (5.0) 3 262 414 9 (2.0) 5 400 83.0 83.0Russian Federation 3394 180 (5.0) 3 3210 1585 70 (4.0) 4 1509 100.0 92.0San Marino No LabSerbia 77 6 (8.0) 0 71 219 1 (0.0) 0 218 92.0 8.0Slovakia 2 0 (0.0) 0 2 19 7 (37.0) 0 11 83.0 67.0Slovenia 31 0 (0.0) 0 31 33 0 (0.0) 0 33 100.0 100.0Spain 198 54 (27.0) 2 83 71 1 (1.0) 0 41 100.0 100.0Sweden No reportSwitzerland 522 454 (87.0) 21 47 32 32 (100.0) 0 0 100.0 0.0Tajikistan 50 0 (0.0) 2 48 51 8 (16.0) 2 41 100.0 17.0The former Yugoslav Republic of Macedonia No report

Turkey 923 4 (0.0) 0 919 923 41 (4.0) 13 869 92.0 8.0Turkmenistan 7 0 (0.0) 0 7 7 0 (0.0) 0 5 100.0 100.0Ukraine 599 11 (2.0) 2 586 691 302 (44.0) 5 384 100.0 92.0United Kingdom 6544 1472 (22.0) 67 5005 1531 46 (3.0) 64 1421 100.0 67.0Uzbekistan 26 0 (0.0) 0 26 31 2 (6.0) 0 29 100.0 75.0Total / Average 18041 3298 (18%) 129 14381 17195 1093 (6%) 136 15923 75.0 53.0

Data source : Aggregated monthly lab data provided by laboratories of the regional measles and rubella lab network.

Country

Specimen* (Serum, Oral Fluid, Swab, Urine and other) Reporting

*Specimen based data are not population based, and should not be interpreted as indicators for epidemiological surveillance. Laboratories may have received more than 1 clinical sample or may have conducted more than 1 test for a given case reported in Table 1.

Table 3. Classification of AFP cases and key AFP surveillance indicators, 2008–2009

Issue 13, December 2009 – January 2010 page 10

Non-Polio

AFP RateTarg et ≥ 1.00

% With 2

Stool

Specimens2

Targ et ≥ 80.0%

Surveillance

Index3Targ et ≥ 0.8

Total Hot4

Cases

Total

>90

Days5

Annualized

Non-Polio

AFP Rate1

Targ et ≥ 1.00

% With 2

Stool

Specimens2

Targ et ≥ 80.0%

Surveillance

Index

Targ et ≥ 0.8

Albania 4 0 0 0.51 100.0 0.51 12 0 3 0 0 1.55 100.0 1.55 86.0 63.0

Andorra 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0.00 0.0 0.00 100.0 40.0

Armenia 20 0 0 3.57 85.0 0.90 9 0 2 1 0 1.65 88.9 1.65 67.0 61.0

Austria 4 0 0 0.32 0.0 0.00 4 0 0 0 0 0.32 25.0 0.32 100.0 73.0

Azerbaijan 30 0 0 1.56 96.7 0.97 46 0 18 0 15 2.45 95.7 2.45 90.0 88.0

Belarus 45 0 0 3.18 82.2 0.87 51 0 9 0 5 3.66 98.0 3.66 28.0 28.0

Belgium 3 0 0 0.17 0.0 0.06 6 0 0 0 0 0.35 0.0 0.35 96.0 80.0

Bosnia and Herzegovina 1 0 0 0.15 0.0 0.00 5 0 2 0 2 0.78 60.0 0.78 94.0 73.0

Bulgaria 15 0 0 1.48 80.0 1.00 15 0 16 1 13 1.50 100.0 1.50 84.0 65.0

Croatia 3 0 0 0.44 66.7 0.30 2 0 2 0 2 0.30 50.0 0.30 100.0 26.0

Cyprus 5 0 0 3.13 100.0 1.00 1 0 0 0 0 0.63 100.0 0.63 98.0 92.0

Czech Republic 8 0 0 0.56 75.0 0.56 11 0 0 0 0 0.79 100.0 0.79 82.0 75.0

Estonia 0 0 0 0.00 0.0 0.00 1 0 0 0 0 0.51 100.0 0.51 92.0 88.0

Georgia 6 0 0 0.79 100.0 0.79 12 0 0 0 0 1.64 100.0 1.64 80.0 73.0

Germany 72 0 0 0.63 38.9 0.29 55 0 3 1 0 0.49 34.5 0.49 96.0 92.0

Greece 16 0 0 1.02 87.5 0.88 16 0 4 1 3 1.02 62.5 1.02 86.0 23.0

Hungary 15 0 0 1.00 66.7 0.80 6 0 0 0 0 0.41 33.3 0.41 88.0 50.0

Ireland 4 0 0 0.44 0.0 0.11 0 0 0 0 0 0.00 0.0 0.00 100.0 65.0

Israel 15 0 0 0.77 13.3 0.36 20 0 0 0 0 1.01 15.0 1.01 78.0 75.0

Italy 68 0 0 0.83 66.2 0.64 42 0 6 0 5 0.51 69.0 0.51 19.0 19.0

Kazakhstan 65 0 0 1.78 96.9 0.98 98 0 18 0 8 2.66 100.0 2.66 78.0 63.0

Kyrgyzstan 33 0 0 2.09 97.0 1.00 21 0 0 0 0 1.34 100.0 1.34 3.0 1.0

Latvia 1 0 0 0.33 100.0 0.33 4 0 0 0 0 1.32 100.0 1.32 100.0 44.0

Lithuania 9 0 0 1.75 66.7 1.00 9 0 0 0 0 1.80 100.0 1.80 78.0 76.0

Malta 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0.00 0.0 0.00 88.0 9.0

Montenegro 0 0 0 0.00 0.0 0.00 2 0 0 0 0 1.72 100.0 1.72 88.0 80.0

Norway 13 0 0 1.45 23.1 0.69 5 0 4 2 3 0.56 0.0 0.56 96.0 67.0

Poland 29 0 0 0.50 82.8 0.47 37 0 7 0 4 0.66 56.8 0.66 63.0 13.0

Portugal 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0.00 0.0 0.00 0.0 0.0

Republic of Moldova 10 0 0 1.45 100.0 1.00 7 0 0 0 0 1.04 85.7 1.04 100.0 96.0

Romania 17 0 0 0.52 94.1 0.52 11 0 2 0 0 0.34 100.0 0.34 86.0 84.0

Russian Federation 360 0 0 1.72 93.9 0.95 355 0 25 1 12 1.70 93.8 1.70 94.0 88.0

Serbia 15 0 0 0.83 86.7 0.72 17 0 3 0 2 0.94 94.1 0.94 90.0 86.0

Slovakia 1 0 0 0.12 0.0 0.12 3 0 1 0 1 0.36 66.7 0.36 84.0 67.0

Slovenia 0 0 0 0.00 0.0 0.00 0 0 0 0 0 0.00 0.0 0.00 90.0 67.0

Spain 35 0 0 0.54 31.4 0.31 21 0 4 0 3 0.32 28.6 0.32 96.0 71.0

Switzerland 10 0 0 0.84 0.0 0.00 7 0 0 0 0 0.60 28.6 0.60 88.0 23.0

Tajikistan 37 0 0 1.45 91.9 0.92 35 0 12 0 11 1.37 85.7 1.37 61.0 50.0The former Yugoslav Republic of Macedonia

5 0 0 1.34 100.0 1.00 8 0 1 0 0 2.20 100.0 2.20 75.0 63.0

Turkey 166 0 0 0.81 75.3 0.64 176 0 71 2 50 0.86 77.3 0.86 92.0 88.0

Turkmenistan 15 0 0 1.02 100.0 1.00 28 0 12 0 10 1.92 92.9 1.92 78.0 76.0

Ukraine 104 0 0 1.64 97.1 0.98 101 0 12 0 3 1.62 95.0 1.62 88.0 84.0

Uzbekistan 102 0 0 1.19 99.0 1.00 102 0 23 0 9 1.20 98.0 1.20 32.0 32.0Average/Total 1361 0 0 1.05 82.0 0.87 1361 0 260 9 161 1.06 84.0 0.89 77.0 58.0

4 Hot cases = AFP case reported with a priority code (e.g. less than three doses of polio vaccine/Clinically polio/Recent travel to endemic country/high risk group).

5 Total number of AFP cases pending final classification 90 days after date of onset.

3 Surveillance Index = non-polio AFP rate up to 1.0 x (% AFP cases with atleast 1 adequate specimens within 14 days of onset).

Surveillance Rates / Index

2 Two stool specimens collected at least 24 hrs. apart within 14 days of onset of paralysis and adequately shipped to the laboratory.

Polio

Compatible

Surveillance Rates / Index %

complete

ness of

weekly

reporting

%

Timeliness

of weekly

reporting

1 Non-polio AFP cases per 100 000 children under the age of 15 years (annualized for year 2009). Number of non-polio (discarded) AFP cases X 100000 / total population under 15 years.

2009 (Weeks 1-53)

Countries doing AFP surveillance in WHO

European Region

Pending Classification

Polio

Compatible

Pendig

Classi-

fication

Total

AFP

Cases

2008 (Weeks 1 - 52)

AFP Cases

Issue 2 Page 9

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