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EUR update

This presentation covers the current state of measles and rubella in the WHO European Region, emphasizing efforts towards control and elimination goals. It includes data on epidemiological situations, top countries with cases, challenges faced, recommendations, and molecular epidemiology information. The focus is on the Regional Verification Process, European MR Labnet activities in 2015-2016, and performance evaluation. Conclusions from the European RVC meetings and the status of verification processes are highlighted.

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EUR update

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  1. EUR update Accelerating Progress towards Measles / Rubella Control and Elimination Goals, Geneva, 21-23 June 2016

  2. Acknowledgements All National and subnational Laboratories Regional Laboratories WHO/EURO & HQ • Dragan Jankovic • Mark Muscat • GI – Moscow • Sergey Shulga • Nina Tikhonova • Tamara Mamaeva • LIH – Luxembourg • Claude Muller • Judith Hübschen • RKI – Berlin • Annette Mankertz • Sabine Santibanez GSL, CDC Atlanta • Paul Rota and measles team • Joe Icenogle and rubella team • GID : funding EUR MR lab • Sergei Deshevoi • Shahin Huseynov • Robert Jensen • Malika Abdusalyamova • Catharina de Kat- Reynen • Theo Kaloumenos • Simarjit Singh • Patrick O’Connor • Robb Butler • Mick Mulders GSL, PHE London • Kevin Brown • Richard Myers 2

  3. Poliovirus Containment Procedures in European Region Slide courtesy of Eugene Gavrilin Maria Iakovenko

  4. Outline • Current epidemiological situation • Regional verification process • European MR Labnet activities in 2015-2016 • MR Labnet performance • Challenges • Recommendations Additional slides 4

  5. Current epidemiological situation • Regional verification process • European MR Labnet activities in 2015-2016 • MR Labnet performance • Challenges • Recommendations 5

  6. Measles in the WHO European Region, 1993, and 2007-2015 341982 7075 9168 Georgia 7868 Bulgaria 21664 France 14 966 Russian Federation 3264 Ukraine 12 744 Kyrgyzstan 17 779 1993 98% REDUCTION 32174 33268 30604 26786 7892 17782 30 762 2012 2014 2015 2010 2013 2011 2007 2009 2008 Data extracted 04 June 2016 6

  7. Top 10 countries with measles cases, WHO European Region, 2015 88% of cases in the Region in 4 countries (n=27 085) 11 countries reported zero cases Data extracted 04 June 2016 7

  8. Highest incidence countries for measles per million inhabitants, WHO European Region, 2015 10countries Highest incidence of >10 per million inhabitants Data extracted 04 June 2016 8

  9. Measles outbreaks occurred in several susceptible populations Roma and Sinti communities Susceptible adults Unvaccinated adolescents Traveller communities Unvaccinated children Health care workers Followers of anthroposophy Ultra-orthodox Jewish communities Orthodox protestant communities 9

  10. Rubella in the WHO European Region, 2000 and 2011-2015 621 039 Romania 4805 Romania 20773 Poland 38585 Poland 5899 Poland 2029 98% REDUCTION 39554 2368 29618 9464 6516 2000 2014 2015 2011 2012 2013 Data extracted 04 June 2016 10

  11. Countries with rubella cases, WHO European Region, 2015 86% of cases in the Region in 1 country (n=2029) 21 countries reported zero cases Data extracted 04 June 2016 11

  12. Diagnosis classification of reported rubella cases in top four countries, 2015 12

  13. Measles virus genotypes reported to MeaNS, WHO European Region, 2010-2015 Number of sequences reported to MeaNS D8 B3 Number of sequences reported to MeaNS Source : MeaNS 17.06.2016 13

  14. Measles virus genotype D8 named strains reported to MeaNS, WHO European Region, 2014-2016 D8 Number of sequences reported to MeaNS Unnamed D8 Named strains Number of sequences reported to MeaNS Source : MeaNS 17.06.2016 14

  15. Measles virus genotype B3 named strains reported to MeaNS, WHO European Region, 2014-2016 B3 Number of sequences reported to MeaNS Unnamed B3 Named strains Number of sequences reported to MeaNS Source : MeaNS 17.06.2016 15

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  20. Rubella genotypes reported to RubeNS, WHO European Region, 2010-2016 Number of sequences reported to RubeNS Source : RubeNS 14.06.2016 20

  21. Current epidemiological situation • Regional verification process • European MR Labnet activities in 2015-2016 • MR Labnet performance • Challenges • Recommendations 21

  22. Verification of Measles and Rubella elimination • Regional Verification Commission (RVC) established in 2012 • 4th RVC meeting, November 2015 • Evaluation of country Annual Status Updates and feedback to countries • Meetings with National Verification Committees • Modifications to verification process • Updating of annual reporting form • Messaging and communication • 5th RVC meeting : 24-26 October 2016 22

  23. Status of the measles and rubella elimination verification process in WHO European Region, as of end-2015 53 Member States 50 established National Verification Committees (NVCs) 50 country reports reviewed for 3-year period: 2012-2014 23

  24. Molecular epidemiology information • 47 MS submitted 2014 ASU before RVC meeting, Oct 2015 • 37 MS reported measlescases • 33 MS : genotype information • Region : - 69% chains of transmission genotyped - 80% sporadic cases genotyped • Country level - 21/32 MS (65%) :  80% chains of transmission genotyped - 23/27 MS (85%) :  80% sporadic cases genotyped • 22 MS reported rubella cases, 2 MS reported CRS • 2 MS : genotype information 24

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  28. European RVC conclusions on measles and rubella elimination status by country, 2012-2014    19 16  28

  29. Current epidemiological situation • Regional verification process • European MR Labnet activities in 2015-2016 • MR Labnet performance • Challenges • 2017 planning Additional slides (including all RRL slides) 29

  30. Key activities in 2015-2016 Accreditation visits and Regional meetings Joint Epi-Lab-RVC mission Joint HQ-EURO accred. visit EURO accred, visit With RRL representative Scheduled Immunization Programme Managers Meeting European Technical Advisory Group of Experts Regional Verification Commission National Verification Committees Regional Reference Laboratories West and Central European Countries Russian Federation & Newly Independent States 30

  31. Key activities in 2015-2016 • New molecular EQA rolled out for 34 NRLs (RRL Berlin, Instand) • Annual accreditation review for the entire network • Data management : MRLDMS 2 • Capacity building – strengthening technical capacity • Individual : SPA, KAZ, MDA, SRB • Meetings & molecular workshops organized by RRL Moscow, Russian grant 2014-2015 • MeaNS training (RUS-NIS, 2015); • EQA, IQC, Verification, MRLDMS (entire network, June 2016) • Planned : BIH srj, BIH bl, SRB in Lux • Action plan for RUS – NIS (RF grant 2014-2015) • Equipment, reagents and supplies • Meetings, workshops, trainings • ELISA control panels development • EUR MR Labnet consultation on serosurveys : technical inputs to ETAGE • Procurement 31

  32. Current epidemiological situation • Regional verification process • European MR Labnet activities in 2015-2016 • MR Labnet performance • Challenges • Recommendations 32

  33. Serology : workload and results Measles Rubella Positive Equivocal Negative Source : Labnet reporting 33

  34. WHO Euro Regional Reference Laboratory for Measles/Rubella, G.N.Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia RRL MoscowSummary, proficiency tests and confirmatory testing, 2014-2015 * - real time diagnostic PCR only 34

  35. Summary, RRL Berlin Measles outbreak in Berlin 2014/2015 Activities 35

  36. Summary, RRL Luxembourg 36

  37. MR Labnet performance : 2016 accreditation • 67/68 laboratories participated, all accredited , 1 provisional. • Excellent EQA performance • Challenges : internal quality control procedures, reporting performance to WHO databases, including MeaNS and RubeNS, reporting IgM results to epi in 4 days. 37

  38. MR Labnet performance : 2017 accreditation, ongoing Accreditation criteria % of participating labs meeting the criteria 38

  39. Reporting to MeaNS, 2015 53 Member States reported measles cases + sequences to MeaNS on time No reports 3 ARM BLR BEL EST FRA IRE ROM SWE UNK 9 No measles cases 11 reported measles cases, NO sequences to MeaNS 21 9 CRO GRE MTA MNE POL SVK TJK FYM UKR reported measles cases + sequences to MeaNS, but late 39

  40. Current epidemiological situation • Regional verification process • European MR Labnet activities in 2015-2016 • MR Labnet performance • Challenges • Recommendations 40

  41. 1. High vaccination coverage 2. Closing Immunity gaps Commitment 3. High-quality surveillance 4. Knowledge and training 41

  42. Challenges for EUR MR Labnet • Accreditation : • Full implementation of internal quality control procedures • Reporting timeliness and completeness to WHO databases including MeaNS and RubeNS • Reporting IgM results within 4 days • mPT : sequence quality, rubella GT • Workload (outbreaks) • samples and panels shipment • Verification • Target : 80% chains of transmission genotyped • Rubella laboratory confirmation and genotyping • Proficiency of non-WHO labs providing MR data : role of NRLs • Sensitivity of non IgM lab confirmation strategy • Collaboration with NVCs • Sustaining lab capacity and high quality surveillance • Funding • Human resources, staff turn-over • Training • Collaboration epi-lab 42

  43. Current epidemiological situation • Regional verification process • European MR Labnet activities in 2015-2016 • MR Labnet performance • Challenges • Recommendations 43

  44. Recommendations for EUR MR Labnet • Accreditation • Harmonization of molecular EQA • Serology and molecular EQA : educational perspective : inform training needs • Follow-up for timely reporting to WHO databases, use of MRLDMS 2, IQC • Strengthen rubella laboratory investigation • Increase laboratory investigation of rubella-suspected cases (specimens) • Use CDC protocols to enhance molecular detection • Address gaps in rubella molecular detection and genotyping • Verification • Better engage national reference laboratories in the process with NVCs • Strengthen epi-lab collaboration • Formalize the role of NRLs  proficiency of other labs • Trainings / capacity building • More tailored approach based on identified needs • Optimize the use of existing resources • Think of a MR Labnet “ training package / programme” ? More detailed and updated recommendations / planning after lab regional breakout session and regional meetings 44

  45. Additional slides 45

  46. WHO Region of Europe • 53 member statesas of 2006 (+21 since WHA44) • 15 time zones(capital cities -2 to +5 hr from Copenhagen) • 4 official languages • Population 900 MillionInfants 11 Million< 5yr 55 Million<15yr 157 Million • DPT3+Pol3 94%, MCV 94% 46

  47. Essential criteria for documenting verification To demonstrate interruption of endemic measles and rubella transmission, countries are requested to provide evidence in a standardized format that: • endemic measles and rubella cases have not occurred for 3 consecutive years, • the disease surveillance system is sufficiently sensitive, specific, timely and complete to detect cases if they occurred, and • the absence of endemic cases is supported by genotyping evidence.

  48. Components of national verification

  49. Source of laboratory information, ASU 2014 % lab confirmed cases from WHO-accredited & proficient labs 3 1 13 6 30 ALB, BIH, MON, SMR, SRB, UKR : no report as of Oct 2015 49

  50. Laboratory confirmation strategy, ASU 2014 6 11 32 4 ALB, BIH, MON, SMR, SRB, UKR : no report as of Oct 2015 50

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