Eurosurveillance

ECDC

Abstracts from the Regional Epidemiologists' meeting, Minsk 2009

 Rediger
  Published: 16.12.09 Updated: 16.12.2009 17:20:54

Epidemiological surveillance of measles in the Republic of Karelia

G. E. Bondarenko
Directorate of the Federal Service for Surveillance on Consumer Rights Protection and Human Well-being (Rospotrebnadzor) in the Republic of Karelia

Citation: Bondarenko G E. Epidemiological surveillance of measles in the Republic of Karelia.EpiNorth.2009;10(3):140-141.

Over the last 8 years, a total of 2 cases of measles were reported in 2006 and 2007 and no case of measles was registered in 2008. During the same period 27 cases were reported in the Russian Federation (0.02 per 100,000 population). It is possible to conclude that the epidemiology of measles is stable in the republic.

For the purpose of active measles surveillance in 2008, the medical and preventive treatment facilities in the republic sent samples from 18 patients with exanthematous diseases (with negative test results) for additional laboratory analysis to the Regional Centre for Surveillance of Measles of the Saint-Petersburg Pasteur Institute. Samples from 34 patients were sent in 2007 (1 with a positive IgM test result).

In order to implement the Resolution of the Chief State Sanitary Doctor of the Russian Federation ”On measures to implement the National Measles Elimination Programme in the Russian Federation by 2010”, the following measures were taken in the republic:

  • Resolutions of the Chief State Sanitary Doctor of the Republic of Karelia “On immunisation of the population of the Republic of Karelia as part of the Priority National Healthcare Project in 2008” and “On seromonitoring of the collective immunity status of the population of the Republic of Karelia in 2008” were issued.
  • A Plan of Action to implement the “National Measles Elimination Programme in the Russian Federation by 2010 in the Republic of Karelia for 2008-2010” was approved by an Order of the Directorate of the Federal Service for Surveillance on Consumer Rights Protection and Human Well-being (Rospotrebnadzor).
  • The issue of organising measles immunisation was considered at the meeting of the Infectious Disease Prevention Staff of the Ministry of Health and Social Development of the Republic of Karelia and at 15 meetings at administrations of cities and regions of the republic.

In 2005-2007, 1,136,000 roubles were allocated from the republic’s budget to purchase measles vaccines. A total of 29,151 doses of measles vaccine were purchased; 7,800 doses of measles vaccine were purchased in 4 regions for 330,800 roubles from the local budget resources.

In 2008, measles specific immunity was studied among 200 people in 2 indicator population groups (aged 15-17 years and 18-35 years). The proportion of seronegative persons among adolescents aged 15-17 years was 2% and among adults was 6%, which is indicative of a high level of protection against measles in the population.

Measles vaccination coverage among children aged 24 months as of 1 January 2009 was 98.7% and has been maintained above the standard level of 95.0% for several years. Measles vaccination coverage among adults is 99.3% across the republic.

The main areas of work for 2009 are:

  • Preparation for certification of the republic as a measles-free area.
  • Maintenance of vaccination coverage and revaccination of children within the established time-frames at a level of at least 95.0% in each medical and preventive treatment facility and paediatric practice.
  • Completion of additional measles immunisation among risk groups aged 18-35 years.
  • Timely detection, registration and laboratory confirmation of all cases of measles.

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Epidemiological and cost effectiveness of hepatitis B vaccine prophylaxis in Arkhangelsk oblast

R Buzinov, T Gordienko
Directorate of Federal Service for Surveillance on Consumer Rights Protection and Human Well-being (Rospotrebnadzor) in Arkhangelsk oblast

Citation: Buzinov R, Gordienko T. Epidemiological and cost effectiveness of hepatitis B vaccine prophylaxis in Arkhangelsk oblast.EpiNorth.2009;10(3):142-143.

An analysis of the dynamics of viral hepatitis B (HBV) incidence from 1991 to 2008 in the Russian Federation and in Arkhangelsk oblast showed that:

  1. the epidemic process of the hepatitis B incidence had a wave-like pattern, i.e. periods of decrease and increase in incidence were observed;
  2. during the investigation period, the incidence peaked in 2001 in Arkhangelsk oblast and amounted to 19.7 per 100,000 population;
  3. an increase in the hepatitis B incidence in Arkhangelsk oblast was observed in 1993-1994, 1995-1996 and in 1996-2001;
  4. the lowest incidence of hepatitis B over the investigation period in Arkhangelsk oblast was observed in 2008 and was equal to 1.9 per 100,000 population, which was 10.3 times lower than the peak incidence level.
  5. the dynamics of hepatitis B incidence in Arkhangelsk oblast was less marked than in the rest of the Russian Federation over the investigated period with an average multiyear incidence rate of 26.3 and 12.4 (2.1 times lower) per 100,000 population in the Russian Federation and Arkhangelsk oblast, respectively.

Over the investigation period, two groups with particularly high incidence were identified in Arkhangelsk oblast: aged 15-19 years (11-29% of all cases) and 20-29 years (42-56%). This may be explained by the fact that people in these age groups are more exposed to risk factors for acute hepatitis B infection (drug abuse, unprotected sex with many partners, etc.).

Hepatitis B vaccination was not performed in the oblast until 2000. Vaccination of children and high-risk group populations started in 2000, and mass immunisation of children started in 2001. From 2003 to 2006, together with the Norwegian Institute of Public Health we worked in collaboration with the Vishnevskaya-Rostropovich Foundation. As a result, the completed vaccination coverage increased from 11.8% to 53.7% and from 4.5% to 73.9% among children aged 1 14 years and adolescents aged 15-17 years, respectively.

The National Priority Project in Public Health aimed at additional immunisation of the population has been ongoing in the oblast since 2006. During 2006-2007, a total of 61,533 children and adolescents and 181,652 adults under 35 years of age have been vaccinated. Immunisation has resulted in a decrease of incidence by 3.9 times compared to 2005. A high vaccination coverage rate was achieved in 2008 among the following age groups: 0-14 years (98.8%), 15-17 years (99%), 18-35 years (62.2%), 36-55 years (58.0%).

During 1999-2005, 994 cases of acute HBV were reported, and the total economic loss was more than 9,808,000 roubles. In 2006-2008, 121 people were infected, and the number of possibly infected, unvaccinated people was 405. During that period alone, 284 cases of acute HBV were prevented.

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Viral Hepatitis A: Main Results of Vaccine Prophylaxis in Minsk

E Fisenko, I Glinskaya, F Germanovich, L Volosar
Minsk Municipal Centre for Hygiene and Epidemiology, Belarus

Citation: Fisenko E, Glinskaya I, Germanovich F, Volosar L. Viral Hepatitis A: Main Results of Vaccine Prophylaxis in Minsk.EpiNorth.2009;10(3):143-144.

Long-term monitoring of viral hepatitis A (HAV) during 1996 – 1999 showed that the situation in Minsk changed from highly to middle endemic. At the same time the high-risk age group also changed to include children of 7 – 14 years that, under the necessary condition, might conceivably cause a mass outbreak of HAV in educational institutions. In 2000 – 2002 the average annual incidence rate among 7 – 14 year olds was more than two times higher than in 1996 – 1999. These data suggest an unfavourable prognosis and the probable deterioration of the epidemiological situation over the next few years.

As a result of the situation and international experience of HAV vaccination, the immunisation for elementary school-age children was introduced in Minsk in 2003 as a part of the Municipal Extended Immunoprophylaxis Programme in order to prevent epidemic outbreaks in schools. This strategy was later developed to comprise immunisation from 2005 of all risk groups, including children 6 – 14 years of age living in dormitories and adults working at such enterprises as dairy plants, water supply services, and public catering services. From 2009 children and adults suffering from HBV and HCV were included in the programme. In 2004 immunisation was implemented to control outbreaks in HAV foci as soon as the first case of the disease is registered.

Since 2003 vaccine coverage among 6-year-old children has been 96 – 98% and among the high-risk categories has reached 96%. Since 2005 there have been no cases of HAV reported among 6 – 9 year old children. There has also been a considerable reduction in incidence among the 10 – 14 year olds. Due to the rapid reduction of the HAV among elementary school-age children (up to total eradication in some areas) there is no risk of person-to-person or environmental route of infection transmission in schools. There have been no outbreaks of the disease for several years in the educational institutions of the city after immunisation was completed in HAV-infection foci.

As a result of HAV immunoprophylaxis, viral hepatitis A is considered to be a low frequency infection: it has hardly any incidence with just a few cases registered among adults in Minsk. According to estimates for an alternative epidemic scenario without vaccination, 2,000 cases of HAV were prevented by immunisation in 2003-2008 yielding an economic benefit of 5 million US dollars.

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Haemophilus Influenza Type b: Main Results of Vaccine Prophylaxis in Minsk

E Fisenko, I Glinskaya, F Germanovich, L Volosar
Minsk Municipal Centre for Hygiene and Epidemiology, Belarus

Citation: Fisenko E, Glinskaya I, Germanovich F, Volosar L. Haemophilus Influenza Type b: Main Results of Vaccine Prophylaxis in Minsk.EpiNorth.2009;10(3):145.

In 2001 – 2008 invasive forms of Haemophilus influenza type b (Hib) infection had incidence rates of up to 15.3 per 100,000 children aged
0 – 5 years. The highest proportion of Hib cases was registered in the same age group. In 2001 – 2008, 96% of Hib meningitis cases among children caused complications involving the central nervous system, heart, liver and kidneys. In the early rehabilitation period after Hib meningitis, patients complained of frequent headaches, emotional lability and motor dysfunction. Children, even at the end of rehabilitation, suffered from various changes in neurological status with severe disabling complications including motor dysfunctions and acoustic disturbances (sometimes anacusis).

Hib strains from patients who suffered from invasive forms of the infection indicated the presence of multiresistance to antibiotics. As in many other countries, resistance to aminopenicillins was observed among 10% of the Hib strains. Economic losses caused by Hib meningitis incidence in Minsk were calculated by standard methods taking into account  patients’ treatment and lifelong rehabilitation, and amounted to over 700,000 US dollars per year. In 2007 children under 5 years of age belonging to risk groups (infirm children, HIV-infected children, etc.) were vaccinated against Hib.

The results of research, international experience and WHO recommendations confirmed the necessity of Hib vaccination of infants of 3 months and older which was introduced in immunisation programme in Minsk in 2008.  Simultaneously, a catch-up immunisation campaign for children from 6 to 24 months (the age of the highest risk of infection) was conducted. By the end of 2008, Hib vaccine coverage in Minsk was 62.6% among children under the age of 5. The highest vaccination coverage (97.2%) is among children under the age of 2. In the second half of 2008 and the first quarter of 2009 there were no cases of invasive Hib-infection registered among vaccinated children.

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Project progress report: Development of a hospital-based active surveillance for rotavirus to assess the burden of disease in Northwestern Russia

K Junussova (1,2), P Aavitsland (2), E Flem (2).
1 European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
2 Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway

Citation: Junussova K, Aavitsland P, Flem E. Project progress report: Development of a hospital-based active surveillance for rotavirus to assess the burden of disease in Northwestern Russia.EpiNorth.2009;10(3):146-147.

Background
Although rotavirus infection has been notifiable in Russia since 1995, the available incidence data are inadequate for decision-making regarding the introduction of rotavirus vaccine. We aimed to create a basis for estimating the disease burden of rotavirus infection in Northwestern Russia.

Methods
In a generic protocol, WHO has recommended active rotavirus surveillance to measure the proportionate morbidity of rotavirus infection among children <5 years of age hospitalized for acute diarrhea. To apply this method in Russia, we contacted the St. Petersburg Pasteur Institute and several children’s infectious disease hospitals in Northwestern Russia through the EpiNorth network. A surveillance system was piloted in the children’s infectious disease hospital No. 5 in St. Petersburg from November 2006 through October 2007. Subsequently, we visited the hospitals to evaluate suitability for the study.

Results
The WHO protocol was adapted to the study settings in collaboration with the Pasteur Institute, hospitals and the Federal public health authorities after several rounds of negotiations on contents and organisation. Five hospitals and five laboratories, located in Arkhangelsk, Kaliningrad, Murmansk, Syktyvkar and St Petersburg, were chosen for surveillance. Rotavirus test kits and training in surveillance methods will be provided. In a pilot study conducted at the St. Petersburg hospital No. 5, 576 out of 1739 (33%) of hospitalized diarrhea cases were positive for rotavirus with seasonal increase to 60% during the spring season.

Conclusions
In a collaboration between the Norwegian Institute of Public Health and the St. Petersburg Pasteur Institute, using a well-established network and a WHO generic protocol it was possible to set up a new sentinel surveillance system for rotavirus infection in Russia. The system is expected to enrol around 4600 children over two years starting from the 2009-2010 rotavirus season. Surveillance data will provide better estimates on rotavirus morbidity on which decisions regarding the introduction of vaccines in Russia may be based.

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Immunisation against hepatitis A virus in Vologda oblast

L Lesnikova
Directorate of Federal Service for Surveillance on Consumer Rights Protection and Human Well-being (Rospotrebnadzor) in Vologda oblast, Vologda, Russia

Citation: Lesnikova L. Immunisation against hepatitis A virus in Vologda oblast.EpiNorth.2009:10(3);148.

In Vologda Region, as throughout the Russian Federation, viral hepatitis A incidence has a cyclic pattern. A rapid increase in incidence began in 2000 in Vologda Region with an average increase rate of 17.2% which was 1.4-4.7 times above the average levels for Russia.

Water was the main driving force for the development of the viral hepatitis A epidemic. Monitoring the circulation of the causal agent in water reservoirs indicated that hepatitis A antigen was present in 0.7-10.6% of drinking water samples during 2000-2005.

The highest incidence rates were registered from September 2005 to January 2006 in the region (14.1-26.4 per 100,000 population monthly). A viral hepatitis A vaccination programme due to epidemiological indications was organized through an initiative of the Directorate of Rospotrebnadzor in Vologda oblast by the government of the oblast and heads of the local administration. During 2005-2008, 46,400 people in the oblast aged 3-17 years received two doses of vaccine. The costs were covered by funds from the regional and municipal budgets as part of vaccine prevention programmes, as well as donations from legal entities and private entrepreneurs. Following vaccination, the incidence rates in the oblast decreased by 88 times: to 0.3-0.8 per 100,000 population in November-December 2006. Only sporadic cases were reported during 2007-2008.

The immunisation against viral hepatitis A was most efficient during the mass vaccination of children attending pre-school institutions and middle schools. The vaccination of contacts was also effective. The incidence rates decreased by 28 times (from 140.5 per 100,000 population in October 2005 to 5.0 per 100,000 population in January 2006) within a short period of time as more than 75% of children were vaccinated in a number of regions.

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EU contribution to the national immunisation programmes

P L Lopalco
European Centre for Disease Prevention and Control, Stockholm, Sweden

Citation: Lopalco P L. EU contribution to the national immunisation programmes.EpiNorth.2009;10(3);149.

The European Centre for Disease Prevention and Control (ECDC) is an independent agency belonging to the EU family. Decisions regarding immunisation policy are the responsibility of the Member States. However, the ECDC is involved in strengthening Europe's defences against infectious diseases and should therefore support the improvement of national immunisation programmes among the Member States.

During recent years the ECDC has conducted many activities in the field of vaccination providing a service for the Member States. Surveillance, scientific advice, outbreak investigation, epidemic intelligence, training and communication have been noteworthy activities in the field of vaccine-preventable diseases. In addition, EU-wide networks aimed at exchanging data, information and good practices between Member States have been established.

The VENICE (Vaccine European New Integrated Collaboration Effort) project, founded by the ECDC in December 2008, is a network of experts throughout the EU. The aim of this project is to collect and share information on the national vaccination programmes in order to improve the overall performance of the immunisation systems. VAESCO (Vaccine Adverse Event Surveillance and Communication), a consortium of institutions expert in the field of vaccine safety monitoring, is another example of a large network created to support the EU immunisation programmes. Both the VENICE and VAESCO networks have been very useful when the need for monitoring the pandemic flu vaccination programmes arose.

In conclusion, even though any final decision on vaccination policy is the responsibility of national authorities, support from the ECDC can be advantageous. Breaking national barriers, maintaining national identities will be a big challenge for vaccination strategies in Europe.

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Epidemiological Surveillance of Haemophilus Influenzae Type b Infection: Experience with the Introduction of the Hiberix Vaccine in Murmansk Oblast

E. A. Matsievskaya
Directorate of the Federal Service for Surveillance on Consumer Rights Protection and Human Well-being (Rospotrebnadzor) in Murmansk oblast

Citation: Matsievskaya E. A. Epidemiological surveillance of haemophilus influenzae type b infection: experience with the introduction of the hiberix vaccine in Murmansk oblast.EpiNorth.2009;10(3):150.

Purulent bacterial meningitis (PBM) remains one of the major causes of mortality and invalidism in Murmansk. Being the most severe and overt illness caused by haemophilus influenzae type b infection (Hib), PBM primarily affects children under the age of 5. While effective medicines have been used for prevention, the incidence rate of hemophilic PMB has not previously been investigated. This prevented the adequate evaluation of perspectives regarding the introduction of conjugated Hib vaccines that are used worldwide and approved for use in Russia. In 2002 microbiological monitoring of Hib meningitis was started among children 0 – 5 years of age with PBM diagnosed and treated at the Murmansk Children’s Infection Hospital. Cerebrospinal fluid samples from PBM patients were analysed for causal agents including H. influenzae type b, N. meningitidis serogroups А, В, С and S. рneumoniae.

From 2002 to 2006, 13 cases of meningitis caused by Hib were registered in the oblast. Eight cases were detected among children under 5 of which 6 cases were among children 0 – 2 years of age. In 2006, when the official registration of Hib infection was introduced in Russia, the Hib incidence rate among children 0 – 1 years of age was 12.6 per 100,000 population.
During 2007 – 2008, Hib vaccination with the Hiberix vaccine was introduced in Murmansk oblast for all children under the age of 2. In 2007 and 2008, 99% and 93% of children from 6 weeks to 2 years were immunized, respectively. In 2007 – 2009 there were no cases of Hib registered among the vaccinated children. Laboratory investigations of all hospital patients with diagnosed PBM in Murmansk continue with the same intensity.

Epidemiological surveillance of hemophilic PBM should be based on routine laboratory diagnostics performed throughout the oblast. Experience with the introduction of the Hib vaccine can contribute to the development of immunisation approach in other regions of the Russian Federation.

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Measles and rubella in Europe

M Muscat, H Bang, S Glismann, K Mølbak
EUVAC.NET hub, Statens Serum Institut, Copenhagen, Denmark

Citation: Muscat M, Bang H, Glismann S, Mølbak K. Measles and rubella in Europe.EpiNorth.2009;10(3):151.

Background
Measles and rubella persist in Europe even though measles and rubella vaccines were included into routine childhood vaccination programmes in most countries more than 20 years ago. Our aim was therefore to review the epidemiology of these diseases in relation to the proposed elimination by 2010.

Methods
National surveillance institutions from 32 European countries submitted measles data for 2008 and rubella data from 2000-2007. Measles data consisted of case-reports by age, diagnosis confirmation, vaccination, hospital treatment, importation of disease, the presence of acute encephalitis as a complication of disease and death. Rubella data consisted of the number of cases in specified age-groups categorised by number of rubella vaccines received and diagnosis confirmation.
For both diseases, we analysed clinical, laboratory-confirmed, and epidemiologically-linked cases that met the requirements for national surveillance obtained through national mandatory notification systems. Cases were separated by age: younger than 1 year, 1–4 years, 5–9 years, 10–14 years, 15–19 years, and older than 20 years.

Findings
For 2008, a total of 7,818 cases of measles from 32 countries was recorded. Most cases (n=7,031; 90%) were from six countries: Switzerland, Italy, UK, Germany, France and Austria. The majority of cases were unvaccinated or incompletely vaccinated children, and one in four was aged 20 years or older. One measles-related death was recorded. The high measles incidence in some European countries revealed suboptimal vaccination coverage. Of the 218 cases that were reported as being imported, 165 (76%) came from another country within Europe and 30 (14%) from Asia. A total of 504,990 rubella cases was reported from 23 countries for the period 2000-2007 with most cases from Poland (n=238,068; 47%) and Romania (n=200,926; 40%).

Interpretation
The suboptimal vaccination coverage raises serious doubts that the goal of measles and rubella elimination by 2010 can be attained. Achievement and maintenance of optimal vaccination coverage and improved surveillance are cornerstones of the measles and rubella elimination plan for Europe.

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Community-wide outbreak of hepatitis A in Latvia during 2008-2009

J Perevoscikovs, I Lucenko, S Magone
State Agency “Public Health Agency”, Riga, Latvia

Citation: Perevoscikovs J, Lucenko I, Magone S. Community-wide outbreak of hepatitis A in Latvia during 2008-2009.EpiNorth.2009;10(3):152-153.

An outbreak of hepatitis A in Latvia with 4,500 confirmed cases including 22 deaths was reported between 20 November 2007 and 31 May 2009. The increase in the number of cases at the beginning of 2008 was related to the initial spread of infection among drug users, persons with low income levels living in substandard hygienic conditions and several outbreaks (a school in Riga, a restaurant in Riga). During the second part of the year, virus circulation among a highly susceptible population led to a community-wide increase in the number of cases similar to the typical seasonal activity of hepatitis A characteristic of previous endemic years. The maximum number of cases of hepatitis A (n=666) was registered in October 2008 (Figure 1).

Fig. 1. Number of reported cases of hepatitis A by month of onset, Latvia, November 2007-May 2009 (n=4,500)

Fig. 1. Number of reported cases of hepatitis A by month of onset, Latvia, November 2007-May 2009 (n=4,500)

 

 

 

 

 

 

 

 

 

 

 

 

A significant proportion of cases among adults could be explained by the low level of hepatitis A infection in Latvia during recent years and the resulting absence of naturally acquired immunity during childhood. The last significant outbreak of hepatitis A occurred in 1988-1990 with almost 20,000 cases registered during three years. The number of cases has steadily declined since 1990 and has been very low during the last 10 years with an average of 100 cases per year. The lowest number of cases of hepatitis A (n=22) was registered in 2007, the year before the current epidemic.

The modes of transmission varied including person-to-person transmission, contaminated food and, possibly, swimming in bathing waters during the summer. Following the initial spread of infection among risk groups, a community-wide increase in the number of cases was reported. The following measures were implemented to control the epidemic:

  • All cases of hepatitis A were investigated by epidemiologists at the relevant local branches of the Public Health Agency
  • Family doctors were informed about contacts
  • Control measures, such as medical observation of contacts, improved hygiene and restriction of contacts between children from different groups, were implemented at places at risk including children establishments, food enterprises, workplaces and households where two or more hepatitis A cases were registered

Monitoring of hepatitis A cases was reported on a weekly and, if necessary, daily basis at the national and local levels. Data are published on Public Health Agency website.

Detailed recommendations for different target groups (staff of food enterprises, children establishments, general public) have been developed and distributed to different institutions at national and local levels. Recommendations are available on the Public Health Agency website. Survey data indicated that in October, PHA recommendations were available in 98% of schools. Lectures for different targets groups (health professionals, school nurses, family doctors, etc.) have been provided. An intensive collaboration with mass media has been established.

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Organisation of work at the subregional laboratory of the WHO Regional Office for Europe for rotavirus infection

E.O. Samoilovich, M. A. Ermolovich, G. V. Semeyko, L. P. Titov
The Republican Research and Practical Centre for Epidemiology and Microbiology, Minsk, Republic of Belarus

Citation: Samoilovich E.O, Ermolovich M. A, Semeyko G. V, Titov L. P. Organisation of work at the subregional laboratory of the WHO Regional Office for Europe for rotavirus infection.EpiNorth.2009;10(3):154.

Rotavirus gastroenteritis is a disease for which effective prophylactic vaccines became available recently. However, no rotavirus infection surveillance was conducted until recent years in some countries of the European Region.

The World Health Organization Regional Office for Europe (WHO EURO) provides support in arranging and implementing a sentinel system of epidemiological surveillance for hospitalised cases of gastroenteritis among children aged < 5 years in six countries of the region: Azerbaijan, Armenia, Georgia, Moldova, Tajikistan and Ukraine. Rotavirus infection diagnostics is conducted with the most frequently used enzyme immunoassay IDEIA™ Rotavirus [Oxoid Ltd (Ely), Cambridge, United Kingdom]. Laboratories in the counties are combined into a subregional laboratory network for which the laboratory of the Research Institute of Epidemiology and Microbiology, Minsk (Belarus), was approved as a reference laboratory in 2009.

One of the primary objectives of the reference laboratory is to perform retesting (control testing) of samples that were investigated in local laboratories of the countries in order to provide external evaluation of quality and to type circulating rotaviruses by the main antigenically significant capsid proteins VP7 and VP4 (G- and P-genotyping). Retesting of more than 700 stool samples demonstrated that there was over 90% correlation (sensitivity and specificity) between results obtained in the countries using the enzyme immunoassay and the reference laboratory. Issues detected in individual laboratories are being addressed.

The first results of rotavirus genotyping from the subregional laboratory indicate that each of the countries has its own spectrum of circulating viruses. Overall, a circulation of widely spread rotavirus genotypes G1, G2, G3, G4, G9 (with prevalence of G4, G1) and Р4, P6, P8 (with prevalence of P8) was specific for the subregion in 2008. Approximately 10% of samples contained virus of less frequently found genotypes or unusual combinations of G-P genotypes. Currently, these genotypes are being examined to establish the origin of various fragments of genome.

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Introduction of new vaccines in the childhood vaccination programme in Norway

S. Sandbu
Norwegian Institute of Public Health, Oslo

Citation: Sandbu S. Introduction of new vaccines in the childhood vaccination programme in Norway.EpiNorth.2009;10(3):155.

Introduction of a new vaccine in immunisation programmes is preceded by careful estimates of the disease burden and death rate, cost effectiveness and expected vaccine coverage.

Haemophilus influenzae type b (Hib) was the most frequent cause of serious bacterial infections among young children in Norway until 1992 when the conjugated Hib vaccine was introduced in the immunisation programme for all children below three years of age. After a few months of intensive vaccination of all children below three years of age, the disease incidence decreased by more than 90 % among young children.

The next major change in the Norwegian child vaccination programme took place in 1998 when acellular pertussis vaccine (aP) replaced the whole cell vaccine (wP). The wP was very effective and only few cases of pertussis occured in vaccinated children below the age of two years. However, the vaccine is reactogenic and public resistance against wP was not uncommon. Reactogenicity is a small problem with aP. This vaccine is also a suitable vaccine for adolescents and adults, and is now included in the school vaccination programme.

A conjugated pneumococcal vaccine for infants at age 3, 5 and 12 months was introduced in 2006 as the incidence of invasive pneumococcal infections has increased over several years in Norway. The vaccine is expected to prevent 70 % of invasive pneumococcal infections in children under 5 years of age.

Two major changes in the vaccination programme have occurred this year. BCG vaccination of low risk groups at age 14 years has been discontinued (while risk group vaccination continues), and Human Papilloma Virus vaccine against cervical cancer has been introduced for girls at age 12 years.

All changes in the vaccination programme are followed by routine surveillance of vaccination coverage, vaccine adverse events and disease incidence.

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Epidemiologic surveillance of vaccine-preventable infections and perspectives for immunoprophylaxis in the Republic of Belarus

V Shymanovich
Republican Centre for Hygiene, Epidemiology and Public Health, Minsk, Belarus

Citation: Shymanovich V. Epidemiologic surveillance of vaccine-preventable infections and perspectives for immunoprophylaxis in the Republic of Belarus.EpiNorth.2009;10(3):156.

Immunisation in the Republic of Belarus is performed in accordance with the National vaccination programme against 9 infections (diphtheria, tetanus, measles, mumps, rubella, pertussis, tuberculosis, hepatitis В, poliomyelitis) and against 19 infections based on epidemic indications. The vaccines that are included in the National vaccination programme and required by epidemic indications are provided at healthcare institutions free of charge (from the state budget resources). Additionally, immunisation against hepatitis A virus and Haemophilus influenzae type b (HIB) infection was introduced as part of the National Demographic Safety Programme implementation in the Republic of Belarus for 2007-2010 and the State Programme on Sanitary and Epidemiological Wellbeing of the population of the Republic of Belarus for 2007-2010.

The high vaccination coverage (at least 95% among adults and at least 97% among children) maintained over the last decades provides collective protection from vaccine-preventable infections. In addition, a programme for monitoring vaccination timeliness and the frequency of medical contraindications is well-established in the republic.

The Republic of Belarus supports the WHO global strategies addressing the elimination of infectious diseases. In 2002, the republic was certified as a poliomyelitis-free territory. The system of measures aimed at preventing the import and spread of poliomyelitis in the Republic of Belarus continues to function efficiently during the post-certification period. The system is based on the detection by clinical and virological examination of children < 15 years of age with acute flaccid paralysis (AFP) syndrome.

The dynamics of measles and rubella epidemiology in the Republic of Belarus indicates that there is favourable background for elimination of both infections by 2010. From the latter half of 2006, sporadic cases of both measles and rubella have been reported in the country, enabling an integrated system of surveillance for both infections.

An improved surveillance system in the Republic of Belarus that will include new infections in the register and the availability of new highly effective, quality vaccines will enable an extension of the National vaccination programme and recommend immunisation against pneumococcal and rotavirus infections, varicella and human papillomavirus infections.


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