Strengthening national surveillance systems towards measles and rubella elimination in the WHO European Region

Since the introduction of vaccines against measles and rubella in national immunizations programmes the incidence of these diseases in the European Region of the World Health Organization (WHO European Region) has declined sharply and substantial progress has been made towards the goal of eliminating measles and rubella. However, there are still a number of challenges in surveillance and immunization that can threaten the achievement of the 2015 elimination goal.

In 2010 and 2011 more countries are reporting a higher measles incidence compared to previous years, sometimes with nationwide outbreaks. Surveillance confirms that this is attributed to the presence of pools of unimmunized individuals, mostly among adolescents and adults. A similar challenge exists with rubella and the risk of congenital rubella syndrome (CRS) is present in countries where women of childbearing age are unimmunized. These unvaccinated and under-vaccinated cohorts, together with population groups that are questioning rationale for immunization, need tailored approaches to improve vaccination coverage.

Case-based surveillance of measles, rubella and CRS, including laboratory testing of all suspected cases in elimination stage, is critical for timely detection of cases and implementation of control measures. It is also critical for defining of susceptible persons and population, and developing adequate immunization policies and strategies. Moreover, high quality surveillance is essential for documenting the interruption of endemic measles and rubella.