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Sarah Earnshaw

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  1. ECDC data show that up to 80% of teenagers and young adults who contracted measles in 2017 had not been vaccinated. ECDC analysis of sub-national data indicates that even countries with high overall levels of vaccine coverage may have groups that are unvaccinated. In recent and ongoing measles outbreaks, ECDC’s recent rapid risk assessment identifies healthcare workers as among those affected. This information can prompt targeted actions in specific areas to identify unvaccinated individuals, increase coverage rates and carry out response activities. ECDC Director, Dr Andrea Ammon said: “It is essential that teenagers and young adults check their vaccination status as we are seeing a recurring pattern in measles outbreaks where they are being affected”. She continued, “Countries may need to consider catch up campaigns to close vaccination gaps in teenagers and young adults”. All countries in the EU/EEA have routine measles vaccination programmes in place targeting children and these programmes should be fully implemented. Due to an increasing number of cases among teenagers and young adults, catch-up programmes for individuals who have missed vaccination or for those who were too old to have been targeted by routine programmes exist in a number of countries and could be considered in other countries. EU Commissioner for Health and Food Safety, Dr Vytenis Andriukaitis said: “We must all sit up and pay attention to ECDC's data and analysis on the spread of measles in Europe. Measles is gaining pace in an increasing number of EU countries. This demonstrates that vaccine-preventable infectious diseases do not respect borders and one country's immunisation weakness puts the whole Union at risk. Cooperating in this area is in all our interests. The Commission will this week put forward an initiative for strengthened cooperation against vaccine preventable diseases, calling for joint action to increase vaccination coverage and ensure that everyone in the EU has access to vaccination, thus bridging inequalities and gaps in immunisation". Unvaccinated infants[1]: six times higher risk to die from measles Not only can measles cause severe complications in adults, it is infants who are the most affected, as they cannot be vaccinated and have a six-fold risk of death according to analysis of ECDC data from 2013-2017[2] of this age group. Infants can only be protected through so-called ‘herd immunity’, which is when 95% of the population in a country are vaccinated with two doses of measles vaccine. During European Immunization Week (23-27 April), ECDC publishes data and analysis on the serious and escalating measles situation in many EU countries. Between 1 January 2017 and 31 December 2017, 14 600 cases of measles were reported by EU/EEA countries which was more than triple the number reported in 2016. Within the broader European region the number of measles cases quadrupled from 2016 to 2017[3]. Most cases were reported by Romania (5 608)[4], Italy, (5 098), Greece (967) and Germany (929), accounting, respectively, for 38%, 35%, 7% and 6% of all cases reported by EU/EEA countries. Thirty-seven deaths due to measles were reported during 2017; with 26 in Romania, four in Italy, two in Greece, and one each in Bulgaria, France, Germany, Portugal and Spain. ECDC’s monthly measles surveillance report released in April 2018 provides an update on the latest situation across EU/EEA countries. [1] Infants are children under one year of age [2] The European Surveillance System (TESSY) [3] http://www.euro.who.int/en/media-centre/sections/press-releases/2018/europe-observes-a-4-fold-increase-in-measles-cases-in-2017-compared-to-previous-year [4] Count excludes an estimated 2200 cases from Romania which are not yet reported to ECDC, due to the outbreak-related workload. The most up-to-date data are available from the Romanian National Institute of Public Health (INSP). Measles-and-Rubella-Surveillance-2017.pdf
  2. Summary The Norwegian Immunisation Information System “SYSVAK” has been improved such that it can provide a list identifying children who have not been vaccinated with the second dose of Measles, Mumps and Rubella vaccination (MMR2) before the age of 16. Having an established rule for automated reminders in SYSVAK allowed for the Norwegian authorities to quickly respond and update the rule to expose MMR2 coverage levels in 16 year olds. Background Before 2015, Norwegian national coverage data for Measles, Mumps and Rubella (MMR) vaccination reported in SYSVAK did not routinely include the second dose (MMR2). Instead, SYSVAK considered an individual to be fully vaccinated if they had received one dose of MMR in the past nine years. Whereas, the Norwegian Childhood Immunisation Program recommends two doses of MMR vaccine, with MMR1 administered at 15 months and MMR2 at 11-12 years. What happened? Significant inconsistencies in data reported to the WHO’s European Regional Verification Commission and figures based on SYSVAK were identified, and Norway was considered to be at risk of measles and rubella transmission becoming re-established. The official vaccine coverage figures based on SYSVAK data, which indicated that individuals were fully vaccinated if they had received one MMR dose in the past 9 years, showed that only one of 19 counties in Norway had MMR coverage below 90% in 16 year olds. Whereas, data being reported by Norway to the European Regional Verification Commission, which included MMR 1 and MMR 2 coverage data, showed that six out of 19 counties had MMR2 coverage levels below 90% in 16 year olds. Action taken The SYSVAK method to assess coverage of MMR vaccination for 16 year olds was updated to secure the inclusion of MMR2 coverage. This included a mechanism for verifying that two doses of MMR vaccine have been given before age 16, and not just one dose in the last 9 years. To support this change in SYSVAK, the advice contained in the official recommendation from the Norwegian Childhood Immunisation Programme was strengthened to emphasise the need for two doses of MMR vaccine to secure lifetime immunisation. Communications around this advice were implemented to remind both vaccinators and the public about the need for two MMR doses. Results Based on SYSVAK data, real time surveillance of MMR vaccinations has significantly improved as children who are missing MMR2 by age 14 will appear on a list of unvaccinated 15 year olds before they leave secondary school. As a result, MMR2 coverage has increased with only 3 out of 19 counties continuing to have MMR2 coverage levels below 90% in 16 year olds according to the latest data from 2016.
  3. Results of ECDC Survey Report on Immunisation Information Systems Introduction Strong information systems to digitally record information about vaccination, Immunisation Information Systems (IIS), are an integral part of a well-functioning vaccine programmes. This is recognised by the World Health Organisation’s European Vaccines Action Plan (EVAP) and further endorsed by the 2014 EU Council Conclusions on vaccination as an effective tool in public health. As part of its activities in support of the establishment of IIS in the EU/EEA Member States, ECDC has developed 2 surveys on IIS status and functionalities: (1) a comprehensive survey for countries with an established IIS; and (2) a shorter survey for countries in the early stages of implementation. The ECDC Survey Report on IIS presents the results providing information on the status of IIS in the EU/EEA countries and describes their functionalities. This information is particularly important for countries that have no system, are in the beginning stages of implementation or are updating their systems. 27 of the 30 EU/EEA countries responded the ECDC surveys, including 16 responses received to the comprehensive survey. 21 countries have an IIS or a pilot IIS in place, of which 14 countries have a national system or pilot in place and 7 countries have a sub-national system or pilot in place. Headline results (relating to the 16 countries that responded to the comprehensive survey) Where possible, we have linked the headline results from the ECDC Survey Report to the key messages of the European Immunisation Week: · Automated reminders For programme monitoring purposes, IIS can be used to determine which vaccinations are due or overdue, generate reminder or recall for providers and vaccine recipients, and determine immunisation coverage levels. 5 countries can send vaccine recipients automated reminders through their IIS. · Requirement to record public and private vaccination data Vaccines may be administered by different providers including private as well as public sector. For example, there are variations in vaccines administered as part of an EU/EEA country’s routine national immunization schedules or in the case of travel vaccinations to protect against diseases that are not common in the country of residence. 8 countries are required by law to record public and private vaccination data in the IIS, while 4 countries are required to record public vaccination data. · Whole-of-life vaccination data Vaccines are not just for kids and can offer protection at all ages. Many adults may neither have had access to currently available vaccines as a child, nor developed immunity to the diseases through natural infection. For some, boosters are needed to maintain protection. Adults over the age of 50 may be eligible for several vaccines that prevent diseases of particular concern for older populations. 10 countries include whole-of-life vaccination data in their IIS, whereas 6 record vaccination up to 18 years of age only. · Individual access to information For vaccine recipients, the possibility to access vaccination records easily and print an immunisation history or certificate is an important tool for individuals to stay up to date on immunisation. Many adults may not have received immunisation as part of their country’s current routine immunization schedule and may be unsure of their vaccination status. 5 countries provide individual vaccine recipients or their guardians with access to their individual information in the IIS. IIS_Survey_report_2016_Final-250417_KOCB2.pdf e. Simple graphics, ECDC survey on IIS.pptx
  4. The ECDC catalogue of interventions to address vaccine hesitancy offers a collection of 40 interventions developed in various countries around the world in order to measure and address vaccine hesitancy. It showcases examples of practices that can serve as a bank of ideas and be adapted according to national and local needs and strategies. The catalogue is divided into two parts. First, it lists relevant interventions that focus on developing tools to measure the scope and scale of vaccine hesitancy in various populations. These diagnostic tools can then be used by public health professionals to inform the development of targeted interventions to address vaccine hesitancy. Second, it focuses on interventions designed to address or respond to vaccine hesitancy. This part is subdivided into three categories: individual-level interventions focusing on parents; individual-level interventions focusing on improving healthcare workers’ confidence and communication skills to respond to hesitant patients; and interventions focusing on responding to hesitancy at a community level. Examples of interventions measuring the scope and scale of hesitancy Global vaccine confidence index The aim of the Global Vaccine Confidence Index is to measure vaccine hesitancy and provide information about hesitant populations and the nature of their concerns. Information is gathered through a survey administered globally through a joint collaboration between Gallup International and the London School of Hygiene and Tropical Medicine Vaccine Confidence Project. It gives a comparable indication about populations’ trust in vaccines and what their concerns are. Questionnaire measuring vaccine hesitancy among general practitioners The aim of the questionnaire is to measure, and to some extent quantify, vaccine hesitancy among general practitioners (GPs). The questionnaire assesses perceptions about vaccines (risk, utility), recommended behaviours towards patients, personal vaccination behaviours, and confidence in various sources of information about the benefits and risks of vaccines. It was administered by telephone interviews. Examples of interventions addressing or responding to vaccine hesitancy Web-based MMR decision aid The aim of the web based decision aid is to empower parents to make informed decisions about vaccination against measles, mumps and rubella. It consists of a step-by-step guide including frequently asked questions and answers, numerical and graphic data comparing the potential risks of the MMR vaccine with the potential risks of contracting disease and clarifies options available. It also includes a clarifying values exercise where the user reviews the importance they place on advantages and disadvantages of vaccination. Framework for communicating with vaccine hesitant parents This communication framework aims to improve communication between clinicians and vaccine hesitant parents. It helps clinicians to tailor their conversations with patients and avoid confrontational arguments. It uses the principles of motivational interviewing, thereby guiding patients rather than directing them and focusing on developing an empathic relationship. This respectful, non-judgemental approach aims to build trust between vaccine-providers and their patients. The intervention has two different communication approaches for different types of vaccine hesitant parents. Catalogue-interventions-vaccine-hesitancy.pdf
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    ECDC's Lucia Pastore Celentano, Head of the Vaccine Preventable Disease program will present on "Recent epidemiology and outbreaks of measles in Europe" at the ECCMID conference in Vienna. LuciaPC_ECCMID_240417_measles_final.pptx
  6. Measles does not only affect children: trends for 2016 and outbreaks in Europe during 2017 During the first 2 months of 2017 we have seen 1524 cases of measles reported from 14 EU/EEA countries. Measles does not only affect children but also older age groups. In 2014 over half of the cases were in adults over 20 years old, in 2015 and 2016 this age group accounted for approximately one third of all cases. Closing immunisation gaps in adolescents and adults who have not received vaccination in the past as well as strengthening routine childhood immunisation programmes will be vital to prevent future outbreaks and reach the elimination goal. The only way to prevent illness, disability and death from vaccine preventable diseases is through timely and complete vaccination according to each country’s national immunization schedule. ECDC joins the European Immunization Week initiative to increase awareness of the importance of immunisation throughout life and thereby help build and sustain immunity in all communities throughout the European Region. ECDC Acting Director Dr Andrea Ammon said “It is worrying to see accumulation of unvaccinated individuals and as a consequence outbreaks of measles in several European countries in recent months.” Ammon continues “A further challenge in reaching the elimination goal in Europe is the high proportion of cases observed in older age groups. In 2016 28% of measles cases were above 20 years old. ” Many adults do not realize that they are susceptible to vaccine preventable diseases. They may not have had access to currently available vaccines as a child, nor developed immunity to the diseases through natural infection. The age group accounting for the largest proportion of measles cases in both 2014 and 2015 was the over 20 year olds (53% in 2014, 38% in 2015). This highlights the importance of closing immunisation gaps in adolescents and adults who have not received vaccination in the past. "It is inacceptable to hear that children and adults are dying from disease where safe and cost-effective vaccines are available. Though vaccine coverage remains relatively high in the EU, we need to continue our efforts to raise awareness and acceptance of vaccination", says Vytenis Andriukaitis, European Commissioner for Health and Food Safety. "The Commission is committed to stepping up EU support for national immunisation strategies. Improving access to vaccines, addressing vaccine shortages, countering vaccine hesitancy, facilitating comprehensive vaccination programmes and strengthening research and development are among our priorities." In the last twelve months, between 1 March 2016 and 28 February 2017, 5 881 cases of measles were reported by 30 EU/EEA countries; Romania accounted for 46% of all cases reported in this period. Other countries with a high proportion of cases were Italy (24 %), the United Kingdom (9%). A measles outbreak is ongoing in Romania and cases continue to be reported despite response measures that have been implemented at national level through reinforced vaccination activities. Since 1 January 2016 and as of 7 April 2017 a total of 4 090 cases were reported. In 2016, a number of other EU/EEA countries reported measles outbreaks, and an increase in the number of cases continues to be observed in 2017. In 10 countries (Austria, Belgium, Croatia, France, Germany, Italy, Poland, Romania, Spain and Sweden) the number of cases reported in January-February 2017 was more than double compared to the same period in 2016. Despite the progress towards measles elimination reported by The Regional Verification Commission for Measles and Rubella Elimination the vaccination coverage is still sub-optimal in many EU/EEA countries. Interrupting transmission requires at least 95% vaccination coverage with two doses in every district and community. The latest available data (2015) shows that the vaccination coverage for the second dose of measles was below 95% in 15 of 23 EU/EEA countries reporting on the second dose. The vaccination coverage for the first dose of measles was below 95% in 12 of 27 EU/EEA countries reporting on the first dose. If the elimination goal is to be reached, the vaccination coverage rates for children targeted by routine vaccination programmes will have to be increased in a number of countries. Also, immunisation gaps need to be closed in adolescents and adults who have missed opportunities for vaccination in the past. b. Graphics Trends for ECDC measles and rubella monitoring, 2013-2016.pptx Biannual measles rubella monitoring.pdf Measles_infographic.pdf
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