Abstract
Although most countries in the WHO European Region were verified in 2017 as having interrupted endemic measles transmission, nine countries were still endemic. Among these, Italy accounted for the second highest number of measles cases reported in Europe in 2017. The elimination of measles is verified at national level by each country’s National Verification Committee (NVC) through the production of an Annual Status Update (ASU). Since in Italy decentralization has led to an inhomogeneous implementation of immunization strategies among the 21 administrative Regions, the Italian NVC proposed that measles elimination should also be documented at the subnational level through regional ASUs and Synthetic Regional Reports (SRRs). The regional ASUs and the SRRs for 2014, 2015 and 2016 were produced and appraised by the NVC to evaluate the Regions’ performances in each individual year as well as over the whole period. A specific analysis of vaccination coverage, including official immunization data for 2017, was performed. Moreover, the measles epidemic of 2017 was examined. Firstly, in the period 2014–2016, low immunization rates were registered in most Regions. Sixty-three per cent of southern Regions reported rates below the national mean and an overall low-quality performance. The approval of Italy’s mandatory vaccination law in 2017 resulted in a marked increase in vaccination coverage; however, this increase was not homogeneous among Regions. Secondly, more than 50% of Regions did not report any supplemental immunization activity (SIA) for the period 2014–2016. Thirdly, from 2014 to 2016, fewer than one-third of Regions improved their reporting of outbreaks. Finally, over the study period, only two Regions reached the target required by the WHO for measles laboratory investigations. In countries with decentralized health policies, subnational monitoring can help identify local barriers to measles elimination. In Italy it has highlighted the need for further SIAs and a stronger surveillance system.
Highlights
Most member states in the WHO European Region were verified in 2017 as having interrupted the endemic transmission of measles, nine countries were still endemic [1, 2]
This paper aims to describe the results of the regional monitoring carried out through the regional Annual Status Update (ASU) and the Synthetic Regional Reports (SRRs) for the period 2014–2016, highlighting progress made and barriers encountered by the Regions with specific regard to measles elimination, and the extent to which further efforts are still needed in order to reach this goal
Data on population immunity are provided by the Ministry of Health (MoH), based on the data collected by the Regions from the respective administrative territories
Summary
Most member states in the WHO European Region were verified in 2017 as having interrupted the endemic transmission of measles, nine countries were still endemic [1, 2]. Romania and Italy were responsible for the majority of measles cases notified in 2017 to the European Surveillance System, accounting respectively for 38% and 35% of the 14 451 cases reported [3]. In Europe as well as in most WHO Regions the verification of measles elimination is carried out by the Regional Verification Commission (RVC) based on the evidence provided by each country’s National Verification Committee (NVC) on an annual basis. Decentralization may affect the national capacity to conduct epidemiological surveillance and outbreak investigation as well as to provide complete and timely surveillance data [4]
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