Measles and rubella elimination: verification process continues amid COVID-19 pandemic

Public health systems and independent national verification committees in countries of the WHO European Region have shown continued commitment to measles and rubella elimination even with the COVID-19 pandemic creating an extraordinary burden on health systems.

As part of an annual verification process, a majority of countries have submitted their annual status updates on measles and rubella transmission for 2019 for review by the independent European Regional Verification Commission for Measles and Rubella Elimination (RVC).

Exceptional verification process in an exceptional year

The RVC is an independent group of experts that meets each year in June to review surveillance and immunization data submitted by the national verification committees, with the aim of assessing the status of measles and rubella elimination in each country and the Region. This year the RVC meets virtually in a series of sessions, the first of which was held on 29 June 2020 when the Commission reviewed 11 of the submitted annual status update reports. These were from:

• Armenia
• Azerbaijan
• Denmark
• Estonia
• Finland
• Latvia
• Netherlands
• Norway
• Sweden
• Tajikistan
• Turkmenistan.

The RVC verified that all countries had maintained their measles elimination status; and all countries that had previously achieved rubella elimination maintained this status. The Commission determined that all 11 countries demonstrated the absence of endemic transmission of both diseases in 2019 and commended these countries for the achievement and for documenting their activities.

The Commission based its conclusions on:

• routine and supplemental immunization performance;
• measles and rubella surveillance with laboratorial and molecular epidemiology segments;
• outbreak response;
• activities focused on advocacy, communication and health literacy of the population and health-care workers;
• commitment of stakeholders to the elimination goal.

Denmark: elimination of rubella confirmed

This first session provided the opportunity for the RVC to reassess the status of rubella transmission in Denmark, using the latest global guidance and data provided in the annual status updates for 2019 and previous years. Basing its assessment on the review of previous and newly submitted data, the Commission determined that for the first time, Denmark was verified as having eliminated rubella.

Final recommendations and reporting

WHO/Europe will work with countries to support completion of the reporting process where needed. The Commission is expected to review all remaining annual status reports in a series of virtual meetings in the coming months. Once the reports from all 53 countries have been reviewed, the full 9th RVC meeting report with conclusions on elimination status in the Region and country-specific recommendations will be published.

Status of measles and rubella elimination in the European Region in 2018

At its 8th meeting in 2019, the RVC concluded that as of the end of 2018, endemic transmission of measles was interrupted in 37 of 53 countries and endemic rubella transmission was interrupted in 42 countries. Twelve countries were considered measles endemic, 11 were rubella endemic, and nine were endemic for both diseases.

Measles outbreaks

The surge in measles cases that began in 2017 peaked in 2019, with over 100 000 cases reported. Monthly case reports in the initial months of 2020 show a significant decrease in transmission compared to 2018 and 2019, with 12 028 reported for January–June 2020. However, this is still higher than for the same period in 2016 and 2017, and may be an underestimation due to disruptions in laboratory surveillance for measles during the peak of COVID-19 outbreaks in the Region.

Under these circumstances, it is commendable that national health systems have recognized the necessity of continuing efforts to fight against devastating vaccine-preventable diseases, by ensuring prioritization of immunization programmes as a vital part of essential health services, continuation of disease surveillance and detection of and response to outbreaks.