Closing MR Immunity Gaps

Experiences from the Regions

ROMANIA

10 - 11 May, 2016

Siena, Italy

- The measles vaccine was introduced into Romanian National Immunization Programme for children 9-11 months of age in 1979.

- In 1994, the second measles vaccine dose was introduced for children 6-7 years of age (first school grade).

- The combined measles, mumps and rubella vaccine (MMR) replaced the first measles-only vaccine in 2004 and was recommended as a first dose for children at 12-15 months of age.

- The second MMR dose was recommended from October 2005 onwards for children at 6-7 years of age.

Caracteristici focar C Background of the NIP (1)

Caracteristici focar C Background of the NIP (2)Year Vaccine (recommended age)

1979-2002 (April) Monovalent measles dose 1 (9-11 months)

1994 Monovalent measles dose 2 (6-7 years)

1998 1) Monovalent measles nationwide campaign (all children 7-14, boys 15-18 [without proof of 2 doses]);

2) Measles-rubella (MR) 15-18 females only [all])

2002 (April) - (2004) Monovalent measles dose 1 (12-15 months) (in preparation for national MMR introduction)

2002 RVC (14-18 years years old Bucharest, girls only)

2003 RVC (14 years old nationwide, girls only + 10% of girls aged 13 in Bucharest)

2003-2008 Monovalent rubella (13-14 years, girls only – school campaigns)

2004-present Measles-mumps-rubella (MMR) dose 1 (12-15 months)

2005-present MMR dose 2 (6-7 years)

Epidemiology of MR (1)

• Romania committed to the WHO global measles elimination goal

• 2009 - 2012 vaccination coverage (VC) reported for MMR1* was < 95%

• In 2011 and 2012, Romania experienced large concurrent outbreaks of rubella and measles

• The most affected age group by measles was under 1 year

• The most affected age group by rubella was 15-19 years

*MMR1 = first dose of measles mumps rubella vaccine

Epidemiology of MR (2)

Epidemiology of MR (3)

Epidemiology of MR (4)

During measles outbreak 2011 – 2012 were notified 12 234 cases and out of these 3 were deaths. (laboratory confirmed – 5913 cases; epi-linked = 6147 cases; only clinical = 174 cases)

The large proportion of cases observed in infants who are not eligible to MMR vaccination and this suggests an intensely circulating measles virus.

A supplementary MMR vaccination campaign started in the defined containment area targeting all children aged 7 months to 7 years of age, irrespective of their measles vaccination status. Over 4500 children have been vaccinated.

Epidemiology of MR (5)

We observed that more parents, even among highly educated persons, lost their confidence in vaccination benefits for their children and this became an important problem that needs to be addressed.

Measles outbreak in Romania and in other European countries reveal the need for increases awareness on the declining confidencethe people have in vaccination benefits for their children and for public health intervention focused in hard to reach communities but also in the general population.

Epidemiology of MR (6)

Epidemiology of MR (7)

Rubella incidence rate by: date of onset, age groups and gender Romania, September 2011 – December 2012

Ag

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No. of cases per 100000male female

Epidemiology of MR (8)N

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Year of birth Eligible for vaccination – only females

Eligible for vaccination

Distribution of rubella cases by births cohorts eligible for vaccination and by gender, 2011 - 2012, Romania

n=24627

During rubella outbreak in Romania, 2011 –2012 were notified 24 627cases. (laboratory confirmed = 6182 cases; epi-linked = 18 442 cases; only clinical = 3 cases) .

None rubella death was reported.

The most affected age group was 15-19 years, males (506,4/100000) and females, also (386,4/100000).

These cases belong to 1995 – 1997 birth cohorts who were not eligible for vaccination (rubella vaccine was introduced into the national schedule in 2004).

Epidemiology of MR (9)

Rubella was notified within pregnant women = 119 cases (0,48%). Out of these, 110 were laboratory confirmed.

In 2012 were notified 22 congenital rubella syndrome cases.

Out of total rubella cases only 551 (2,2%) were vaccinated.

A supplementary MMR vaccination campaign targeting 15 – 19 years age group (high school and university) has been conducted. Only 2000 persons were vaccinated due to refusals.

Epidemiology of MR (10)

The risk for measles and rubella remains due to continue decreasing of vaccination coverage.

These can be used for advocacy purposes to public health authorities, medical professional societies and the public to support necessary activities to reach elimination.

Challenges (1)

Challenges (2)

Improving vaccination coverage can help to minimize the outbreak impact to both general population and government.

Identifying the “pockets” of unvaccinated and conducting vaccination activities in such populations must be continued.

Efforts should be made to sensitize parents to improve their confidence in vaccination benefits for their children and also to increase their MMR vaccine uptakes.

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Challenges (3)

Also is needed for reinforcing of surveillance activities through reporting of any suspected cases (including “zero” reporting) followed by identifying and conducting investigation.

The Romanian health authorities should provide the necessary finances and resources to support the elimination activities and mainly continued vaccines supply should be ensured.

Development and implementation of a communication plan to increase demand for vaccination and reduce potential vaccine refusals is also needed.

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CONCLUSIONS

Risk of outbreak is still high as long as MMR vaccination coverage decrease continuously.

Thank you!