In the WHO European Region, 42 of 53 countries have interrupted endemic transmission of measles, and 37 countries have interrupted endemic transmission of rubella as of the end of 2016. This was determined by the European Regional Verification Commission for Measles and Rubella Elimination (RVC) at its 6th meeting in June 2017.

Image/TheAndrasBarta via pixabay
Image/TheAndrasBarta via pixabay

“I congratulate each country for fulfilling the commitment to protect its people from measles and rubella and collectively moving the European Region closer to its elimination goal,” said Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “However, we cannot become complacent now. Outbreaks continue to cause unnecessary suffering and loss of life, and routine immunization coverage is decreasing. It is unacceptable that 1 in every 15 children still does not receive the first vaccination dose against measles and rubella on time. We will eliminate these diseases from our Region, but need to be ready to walk the hardest last mile.”

Latest progress in the Region

The number of countries in the Region that have demonstrated interruption of endemic measles and/or rubella transmission continues to increase. Based on 2016 reporting, the RVC concluded that:

  • Austria, Germany, Kyrgyzstan, Poland, the Russian Federation, Switzerland and Turkey have interrupted endemic measles transmission for at least 12 months, bringing the total of countries to 42 for the Region;
  • Bulgaria and Kyrgyzstan have interrupted endemic rubella transmission for at least 12 months, bringing the total of countries to 37 for the Region.

Elimination of measles or rubella can be verified once a country has sustained interruption of endemic transmission for at least 36 months. The RVC verified that the following countries achieved elimination status as of 2016 for one or both diseases *:

  • Denmark, Spain and the United Kingdom eliminated measles;
  • the Republic of Moldova, Sweden and the former Yugoslav Republic of Macedonia eliminated rubella;
  • Croatia, Greece, Iceland, Lithuania, Montenegro and Uzbekistan eliminated both measles and rubella.

This brings to 33 the total of countries that have eliminated measles and also to 33 the total of countries that have eliminated rubella. The Region can be verified as having eliminated measles and/or rubella when all 53 Member States have achieved elimination for both diseases.

Remaining challenges

The measles virus can spread wherever immunity gaps exist. Despite progress towards elimination in many countries and a record low in measles cases for the Region in 2016 (5200), over 11 000 measles cases have been reported so far this year. The largest outbreaks have taken place in the remaining endemic countries, but cases have also been reported following importation of the virus into countries that no longer have endemic transmission.

Regional coverage with the first dose of measles-containing vaccine is estimated to have gradually decreased over the last 5 years from 95% in 2012 to 93% in 2016 *.  At least 95% vaccination coverage is considered necessary to protect an entire population from this highly contagious disease. In 2016, 25 Member States reported national coverage below this threshold **.

The barriers to achieving and sustaining high immunization coverage include vaccine shortages, inequitable or inconvenient access to immunization services, vaccine hesitancy among parents and/or insufficiently informed health workers. Overcoming these barriers requires an all-government effort. By protecting everyone in the Region from vaccine-preventable diseases, countries contribute directly to their populations’ health and well-being, but also to a range of other global targets enshrined in the Sustainable Development Goals.

“This Region has eradicated polio, eliminated malaria and drastically reduced the transmission of measles and rubella. With continued commitment and hard work we will be the generation that also eliminates measles and rubella from the remaining endemic corners of this Region,” says Dr Nedret Emiroglu, Director for Health Emergencies and Communicable Diseases of WHO/Europe. “This is not only our contribution but also our obligation to the generations that follow us.”