communicable disease threats report 28 sep 2013

7/28/2019 Communicable Disease Threats Report 28 Sep 2013

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EU Threats

Measles, a highly transmissible vaccine-preventable disease,is still endemic in many countries of Europedue to a decrease inthe uptake of immunisation.The 30EU/EEA countries reported 8 643 cases of measles duringAugust 2012 to July 2013.France, Germany, Italy, Romania, Spain, the Netherlands and the United Kingdom accounted for 95% of the cases in the last

12-month period.

Measles - Multistate (EU) - Monitoring European outbreaksOpening date: February 2011 Latest update: 26 September 2013

Update of the weekhe outbreaks inthe Netherlandsand in Germany are still on-going.In the neighbouring countries there are outbreaks in the

Russian federation, Turkey and Georgia.

West Nile fever (WNF) is a mosquito-borne disease which causes severe neurological symptoms in a small proportion ofinfected people. During the transmission season between June and November, ECDC monitors the situation in EU MemberStates and neighbouring countries in order to inform blood safety authorities regarding WNF-affected areas and identifysignificant changes in the epidemiology of the disease.During the 2012 season, 244 probable and confirmed caseswerereported in the EU, and 693 cases in neighbouring countries.

West Nile virus - Multistate (Europe) - Monitoring season 2013Opening date: 3 June 2013 Latest update: 26 September 2013

Update of the weekDuring the past week,20 new cases were detected in the EU:three from Greece, thirteen from Italy andfour from Romania. Inneighbouring countries, 28 new cases were reported, all from Serbia.

Rubella, caused by the rubella virus and commonly known as German measles, isusually a mild and self-limiting disease and isan infection which often passes unnoticed. The main reason for immunising against rubella is the high risk of congenitalmalformations associated with rubella infection during pregnancy. All EU Member States recommend vaccination against rubellawith at least two doses of vaccine for both boys and girls. The vaccine is given at the same intervals as themeasles vaccine aspart of the MMR vaccine.

Rubella - Multistate (EU) - Monitoring European outbreaksOpening date: 7 March 2012 Latest update: 3 July 2013

Update of the weekSince the last updateno new outbreaks were detected.

I. Executive summar

All users

Week 39, 22-28 September 2013

CDTR

REPORTCOMMUNICABLE DISEASE THREATS

This weekly bulletin provides updates on threats monitored by ECDC.

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European Centre for Disease Prevention and Control (ECDC)Postal address: ECDC 171 83 Stockholm, Sweden

Visiting address: Tomtebodavgen 11a, Solna, Swedenwww.ecdc.europa.eu

Epidemic Intelligence duty email: [email protected]


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Non EU Threats

EU/EEA countries, as well as the rest of the WHO European Region, have been polio-free since 2002. Wild polio virus type 1(WPV1) has been isolated in sewage and in the faeces of asymptomatic carriers in Israel in samples collected from 3 Februaryto 25 August 2013. Detection of WPV in environmental samples is a signal of WPV transmission and consequently of concernand highlights the potential for re-establishing transmission in Europe.

Poliovirus - Israel- Detection of WPV1 in environmental samples and healthyindividualsOpening date: 19 August 2013 Latest update: 26 September 2013

Update of the weekDuring the week leading up to26 September 2013, no new positive poliovirus samples have been detected in Israel.

Between April 2012 and26 September 2013, 133 laboratory-confirmed cases, including60 deaths, of acute respiratory diseasecaused by Middle East respiratory syndrome coronavirus (MERS-CoV), have been reported by national health authorities.MERS-CoV is genetically distinct from the coronavirus that caused the SARS outbreak. To date, all cases have either occurred inthe Middle East or have had direct links to a primary case infected in the Middle East.

Middle East respiratory syndrome- coronavirus (MERS CoV) - MultistateOpening date: 24 September 2012 Latest update: 26 September 2013

Update of the weekBetween19 and26 September,three new cases, includingtwo deaths have been reported by the national health authoritiesoftheKingdom of Saudi Arabia. WHO has confirmed a deathof a previously reported case from Qatar. Two secondary cases inItaly are now re-classified as probable cases.he WHO Emergency Committee has again concluded in a teleconference meeting held on 25 September 2013that "conditions

for a Public Health Emergency of International Concernhave not at present been met".

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The CDTR may contain confidential or sensitive information (i.e. EWRS) and therefore, its distribution is restricted to authorized users only.

COMMUNICABLE DISEASE THREATS REPORT Week 39 22-28 Se tember 2013


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Measles - Multistate (EU) - Monitoring European outbreaks

Opening date: 9 February 2011 Latest update: 26 September 2013

Epidemiological summary

EU Member StatesThe Netherlands update

Since May 2013 and as of25 September 2013, the National Institute for Public Health and the Environment (RIVM) reported1540 cases of measles. The actual number of cases is estimated to be much higher. So far there have been 90 cases ofpneumonia, one case of encephalitis, and 82 hospital admissions. Most measles cases are unvaccinated (96%) and are in the agegroup 4-12 years (59%). There are 11 health care workers among the cases. Of these, nine are unvaccinated and two personsare vaccinated with two doses.A recent survey found that in the Netherlands religious beliefwas, by far, the most common (93.6%) reason given for not gettingvaccinated.

Germany updateMeasles outbreaks continue in Germany. According to the Federal Ministry of Health, the number of reported measles cases thisyear have been nearly ten times as high as the whole of last year. As of 11 September 2013, there have been 1 520 reportedcases. Most cases occurred in Bavaria, followed by Berlin and North Rhine and Westphalia.

Italy - updatehemedia report that the number of reported measles cases in the Milan area has reached 350 (compared to 20 cases during the

whole of 2012). Most cases are adults, between 20 and 40 years of age.

Rest of the worldTurkey

urkey hasreported 6 547 cases during the first half of 2013, particularly in its southern provinces. This is anearly 20-foldincrease compared to last year when 349 cases were reported.

Russian federation

InAstrakhan, there is an on-going measles outbreak involving students at the State Medical Academy and their contacts. So far,as of 18 September, 37 cases have been reported. According to the Ministry of Health in the Astrakhan region, the primary casewas a student from Dagestan. There is an on-going mass vaccination of students and teachers in the institution.here is also an outbreak of measles in Kazan, the capital of the Republic ofTatarstan with 26 cases. During the first seven

months of 2013, there were 720 cases of measles in 40 regions of the Republic of Tatarstan.

The U.S.According toa recentMorbidity and Mortality Weekly Reportthere have been 159 cases of measles in 16 states during 1January24 August 2013. Eighty-two percent of the cases were unvaccinated persons. Of those who were unvaccinated, 92(79%) had philosophical objections to vaccination. Of the 159 cases, 99% were import-associated, 50% of the importations werefrom the WHO European Region.

Publications

WHO has published:

Guidelines for measles and rubella outbreak investigation and response in the WHO European Region and a

Measles and rubella elimination 2015 - package for accelerated action: 20132015

Web sources:ECDC measles and rubella monitoring | ECDC/Euronews documentary| WHO Epidemiological Briefs|MedISysMeasles page|EUVAC-netECDC|ECDC measles factsheet| RIVM

ECDC assessmenthe transmission season for measles persists in Europe. However, although therehave beenseveraloutbreaks during this season,

the number of aggregated casesis lower than in the previous year.The largest outbreaks have been in Wales and the

Netherlands. In the EU neighbourhood,large outbreaks affecting Georgia and Turkey give cause for concern.

he target year for measles elimination in Europe is 2015. The current outbreaks suggest that endemic measles transmission

II. Detailed reports

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http://www.forbes.com/sites/emilywillingham/2013/09/10/another-measles-outbreak-in-a-religious-community/%20http://www.forbes.com/sites/emilywillingham/2013/09/10/another-measles-outbreak-in-a-religious-community/%20http://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2013/Ausgaben/36_37_13_wotab34.pdf?__blob=publicationFile%20http://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2013/Ausgaben/36_37_13_wotab34.pdf?__blob=publicationFile%20http://milano.repubblica.it/cronaca/2013/09/04/news/torna_il_morbillo_gli_adulti_nel_mirino_la_fascia_pi_colpita_dai_20_ai_40_anni-65845348/?rss%20http://www.euro.who.int/__data/assets/pdf_file/0003/214833/EpiBrief-Issue-3,-2013.pdfhttp://hhttp//www.rg.ru/2013/09/16/reg-ufo/kor-anons.html%20http://www.kzn.ru/news/40949-v-kazani-prinimayutsya-mery-protiv-obscherossijskoj-vspyshki-zabolevaemosti-koryu%20http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6236a2.htm?s_cid=mm6236a2_e%20http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6236a2.htm?s_cid=mm6236a2_e%20http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6236a2.htm?s_cid=mm6236a2_e%20http://www.euro.who.int/__data/assets/pdf_file/0003/217164/OutbreakGuidelines-updated.pdfhttp://www.euro.who.int/__data/assets/pdf_file/0020/215480/PACKAGE-FOR-ACCELERATED-ACTION-20132015.pdfhttp://www.euro.who.int/__data/assets/pdf_file/0020/215480/PACKAGE-FOR-ACCELERATED-ACTION-20132015.pdfhttp://ecdc.europa.eu/en/publications/Publications/Forms/ECDC_DispForm.aspx?ID=1124http://prod-euronews.euronews.net/2012/03/26/eliminating-measles-personal-storieshttp://prod-euronews.euronews.net/2012/03/26/eliminating-measles-personal-storieshttp://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/vaccines-and-immunization/news/news/2013/05/regional-decline-in-measles-with-large-rubella-outbreaks-in-two-countries-epidemiological-overview-for-2012https://medisys.jrc.it/medisys/dynamic?language=en&page=1&edition=alertedition&option=Measles&section=diseaseshttps://medisys.jrc.it/medisys/dynamic?language=en&page=1&edition=alertedition&option=Measles&section=diseaseshttp://ecdc.europa.eu/EN/ACTIVITIES/SURVEILLANCE/EUVAC/Pages/index.aspxhttp://ecdc.europa.eu/en/healthtopics/measles/Pages/index.aspxhttp://www.zorgatlas.nl/gezondheid-en-ziekte/ziekten-en-aandoeningen/infectieziekten/mazelen-2013/http://www.zorgatlas.nl/gezondheid-en-ziekte/ziekten-en-aandoeningen/infectieziekten/mazelen-2013/http://ecdc.europa.eu/en/healthtopics/measles/Pages/index.aspxhttp://ecdc.europa.eu/EN/ACTIVITIES/SURVEILLANCE/EUVAC/Pages/index.aspxhttp://ecdc.europa.eu/EN/ACTIVITIES/SURVEILLANCE/EUVAC/Pages/index.aspxhttp://ecdc.europa.eu/EN/ACTIVITIES/SURVEILLANCE/EUVAC/Pages/index.aspxhttps://medisys.jrc.it/medisys/dynamic?language=en&page=1&edition=alertedition&option=Measles&section=diseaseshttps://medisys.jrc.it/medisys/dynamic?language=en&page=1&edition=alertedition&option=Measles&section=diseaseshttp://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/vaccines-and-immunization/news/news/2013/05/regional-decline-in-measles-with-large-rubella-outbreaks-in-two-countries-epidemiological-overview-for-2012http://prod-euronews.euronews.net/2012/03/26/eliminating-measles-personal-storieshttp://prod-euronews.euronews.net/2012/03/26/eliminating-measles-personal-storieshttp://prod-euronews.euronews.net/2012/03/26/eliminating-measles-personal-storieshttp://ecdc.europa.eu/en/publications/Publications/Forms/ECDC_DispForm.aspx?ID=1124http://www.euro.who.int/__data/assets/pdf_file/0020/215480/PACKAGE-FOR-ACCELERATED-ACTION-20132015.pdfhttp://www.euro.who.int/__data/assets/pdf_file/0020/215480/PACKAGE-FOR-ACCELERATED-ACTION-20132015.pdfhttp://www.euro.who.int/__data/assets/pdf_file/0020/215480/PACKAGE-FOR-ACCELERATED-ACTION-20132015.pdfhttp://www.euro.who.int/__data/assets/pdf_file/0020/215480/PACKAGE-FOR-ACCELERATED-ACTION-20132015.pdfhttp://www.euro.who.int/__data/assets/pdf_file/0020/215480/PACKAGE-FOR-ACCELERATED-ACTION-20132015.pdfhttp://www.euro.who.int/__data/assets/pdf_file/0020/215480/PACKAGE-FOR-ACCELERATED-ACTION-20132015.pdfhttp://www.euro.who.int/__data/assets/pdf_file/0003/217164/OutbreakGuidelines-updated.pdfhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6236a2.htm?s_cid=mm6236a2_e%20http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6236a2.htm?s_cid=mm6236a2_e%20http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6236a2.htm?s_cid=mm6236a2_e%20http://www.kzn.ru/news/40949-v-kazani-prinimayutsya-mery-protiv-obscherossijskoj-vspyshki-zabolevaemosti-koryu%20http://hhttp//www.rg.ru/2013/09/16/reg-ufo/kor-anons.html%20http://www.euro.who.int/__data/assets/pdf_file/0003/214833/EpiBrief-Issue-3,-2013.pdfhttp://milano.repubblica.it/cronaca/2013/09/04/news/torna_il_morbillo_gli_adulti_nel_mirino_la_fascia_pi_colpita_dai_20_ai_40_anni-65845348/?rss%20http://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2013/Ausgaben/36_37_13_wotab34.pdf?__blob=publicationFile%20http://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2013/Ausgaben/36_37_13_wotab34.pdf?__blob=publicationFile%20http://www.forbes.com/sites/emilywillingham/2013/09/10/another-measles-outbreak-in-a-religious-community/%20http://www.forbes.com/sites/emilywillingham/2013/09/10/another-measles-outbreak-in-a-religious-community/%20


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continues in many EU Member States and the prospect of achieving the 2015 objectiveis diminishing. During the periodAugust2012-July 2013,11 of the 30 EU/EEA countries met the elimination target of less than one case of measles per million population.

ActionsECDC monitors measles transmission and outbreaks in the EU and neighbouring countries in Europe on a monthly basis throughenhanced surveillance and epidemic intelligence activities. Elimination of measles requires consistent vaccination coverage above95% with two doses of measles vaccine in all population groups, strong surveillance and effective outbreak control measures.

West Nile virus - Multistate (Europe) - Monitoring season 2013Opening date: 3 June 2013 Latest update: 26 September 2013


As of 27 September 2013, 187 human cases of West Nile fever have been reported in the EU and 464 cases in neighbouringcountries since the beginning of the 2013 transmission season.

EU Member StatesCroatiaCroatia has recorded 11 cases of WNV so far this year.Ten new probable caseswere reportedlast week, one casefromMedimurska county and nine casesfrom the Zagrebacka county, an area withone previous case report. In addition, the firstprobable case reported in Zagrebacka Countyon 23 August 2013 is now a confirmed case. Forthe remainingcases, finallaboratory confirmation resultsare still pending. The city of Zagreb has been identified as the possible place of infection of threealready reported cases.

GreeceEighty-one cases ofWest Nile virus (WNV) have been reported in Greece. The regions affected are Attiki (35), Imathia (2), Kavala(10), Thessaloniki (6), Xanthi (16), Kerkyra (1), Serres (5) Ileia (1), Pella (4) andone case was reportedin thepreviousweekwhere the place of infection is not availableat the moment.

ItalyItaly has reported59 cases of WNV. The provinces affectedare Modena (15),Rovigo (9), Verona (6),Reggio Emilia (5), Mantova(5),Bologna (2),Padova (1), Ferrara (5),Parma (3), Cremona (2) and newly affected areasTreviso (4) and Venezia (2).

HungaryHungary has reported 18 cases so far this year. The counties affected are: Fejer (2), Pest (3), Komaron (1), Bks (2), Budapest(3), Csongrd (2), Hajd-Bihar (2), Jsz-Nagykun-Szolnok (1), Heves (1) and Bcs-Kiskun (1).

RomaniaRomania hasreported18 cases of WNV. The countiesaffected areBraila(4), Ialomita (3), Iasi (2), Galati (2),Constanta (2),ulcea (1), Bucuresti (2) and the newly affected counties Ilof (1) and Mures (1).

Spain

On 19 September 2013, theAndalusia Ministry of Agriculture in Spain detected two horses with West Nile encephalitis in thenewly affected province of Huelva.

Neighbouring countriesBosnia and HerzegovinaOne case of WNFhasbeenreported inTuzlansko-podrinjski canton.

IsraelFifty-six cases of WNV have been reported in Israel. The affecteddistricts areCentral (27), Haifa (17), Tel Aviv (11)and thenewly affected Southern district (1)

MontenegroMontenegro hasreported two cases so far this year.One casein Podgorica region, an area suspected to be affected last year.he second case was recorded this week in the newly affected Cetinjeregion.

Serbia

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http://www.juntadeandalucia.es/agriculturaypesca/portal/export/sites/default/comun/galerias/galeriaDescargas/cap/agricultura-ganaderia/Ganaderia/Sanidad-Animal/Focos_WN_2013.xls_18_09_13.pdfhttp://www.juntadeandalucia.es/agriculturaypesca/portal/export/sites/default/comun/galerias/galeriaDescargas/cap/agricultura-ganaderia/Ganaderia/Sanidad-Animal/Focos_WN_2013.xls_18_09_13.pdf


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Serbia has reported 238 cases of WNF from eight districts: Grad Beograd (144), Podunavski (13), Sremski (9), Juzno-backi (4),Juzno-banatski (40), Kolubarski (10), Macvanski (3) Branicevski district (2), Jablancki (1), Srednje-banatski (4), Severno-banacki(3) Moravicki (2), Severno-banatski (1), Zapadno-backi (1), and one case in the newly affected Zlatiborski district.

the former Yugoslav Republic of Macedonia

One case has been reported in Kocani (Eastern Macedonia).

RussiaRussia has reported 165 cases of WNF from ten oblasts and one republic in Russia: Adygeya oblast (1), Astrakhanskaya oblast(61), Lipetskaya oblast (2), Rostovskaya oblast (8), Samarskaya oblast (9), Saratovskaya oblast (28), Volgogradskaya oblast (48),Voronezhskaya oblast (3), Belgorodskaya oblast (2) Kaluzhskaya oblast (1), Omskaya oblast (1) and the newly affectedOrenburgskaya oblast (1).

Ukrainehefirst casefor thisyear was reported in Zhytomyrska oblast.

Websources:ECDC West Nile fever risk maps |ECDCWest Nile fever risk assessment tool|Volgograd oblast |SerbiaMoH|Macedonian PH Institute|Croatia PHI |Israel MoH |

ECDC assessmenthe 2013 season is progressingin comparable fashion to previous yearsin theEU and neighbouring countries. West Nile fever in

humans is a notifiable disease in the EU. The implementation of control measures are considered important for ensuring bloodsafety by the national health authorities when human cases of West Nile fever occur. According to the EU blood directive, effortsshould be made to defer blood donations from affected areas with ongoing virus transmission to humans.

ActionsECDC produces weeklyWest Nile fever risk maps during the transmission season to inform blood safety authorities regardingaffected areas.

ECDC published a West Nile feverrisk assessment tool on 3 July 2013.

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http://www.ecdc.europa.eu/en/healthtopics/west_nile_fever/west-nile-fever-maps/pages/index.aspxhttp://ecdc.europa.eu/en/publications/Publications/west-nile-virus-risk-assessment-tool.pdfhttp://34.rospotrebnadzor.ru/epidemiologic_situation/98040/http://www.batut.org.rs/index.php?content=543http://www.batut.org.rs/index.php?content=543http://www.iph.mk/index.php?option=com_content&view=article&id=207%253A-west-nile-2013-&lang=mkhttp://www.hzjz.hr/epidemiologija/zap_nil.htmhttp://www.health.gov.il/Subjects/disease/WNF/Pages/StatusReport2013.aspxhttp://www.ecdc.europa.eu/en/healthtopics/west_nile_fever/west-nile-fever-maps/pages/index.aspxhttp://ecdc.europa.eu/en/publications/Publications/west-nile-virus-risk-assessment-tool.pdfhttp://ecdc.europa.eu/en/publications/Publications/west-nile-virus-risk-assessment-tool.pdfhttp://www.ecdc.europa.eu/en/healthtopics/west_nile_fever/west-nile-fever-maps/pages/index.aspxhttp://www.health.gov.il/Subjects/disease/WNF/Pages/StatusReport2013.aspxhttp://www.hzjz.hr/epidemiologija/zap_nil.htmhttp://www.iph.mk/index.php?option=com_content&view=article&id=207%253A-west-nile-2013-&lang=mkhttp://www.batut.org.rs/index.php?content=543http://www.batut.org.rs/index.php?content=543http://34.rospotrebnadzor.ru/epidemiologic_situation/98040/http://ecdc.europa.eu/en/publications/Publications/west-nile-virus-risk-assessment-tool.pdfhttp://www.ecdc.europa.eu/en/healthtopics/west_nile_fever/west-nile-fever-maps/pages/index.aspx


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ECDC

Rubella - Multistate (EU) - Monitoring European outbreaksOpening date: 7 March 2012 Latest update: 3 July 2013


he 27 EU/EEA countries contributing to enhanced rubella surveillance reported 37 856 cases during the last 12-month periodbetween August 2012 and July 2013. Of the 27 contributing countries, 25 reported data for the entire period. Poland accountedfor 99% of all reported rubella cases in the 12-month period.

Web sources:ECDC measles and rubella monitoring | ECDC rubella factsheet | WHO epidemiological brief summary tables | WHOepidemiological briefs

ECDC assessmentAs rubella is typically amild and self-limiting disease with few complications, the rationale for eliminating rubella would be weak ifit were not for the virusteratogenic effect. When a woman is infected with the rubella virus within the first 20 weeks of

pregnancy, the foetus has a 90% risk of being born with congenital rubella syndrome (CRS), which entails a range of seriousincurable illnesses.Theincrease in the number of rubella cases reportedin 2012 and 2013 mainly due to the large outbreaks inRomania and Poland and thepotential for anincrease in thenumber of babies born with CRS arecause for concern.

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http://ecdc.europa.eu/en/publications/Publications/Forms/ECDC_DispForm.aspx?ID=1124http://ecdc.europa.eu/EN/HEALTHTOPICS/RUBELLA/Pages/index.aspxhttp://www.euro.who.int/__data/assets/pdf_file/0003/187356/Epi_Brief-Reported-measles-cases-for-last-12-months,-March-2012-February-2013-data-as-of-12-April-2013-final.pdfhttp://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/vaccines-and-immunization/news/news/2013/05/regional-decline-in-measles-with-large-rubella-outbreaks-in-two-countries-epidemiological-overview-for-2012http://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/vaccines-and-immunization/news/news/2013/05/regional-decline-in-measles-with-large-rubella-outbreaks-in-two-countries-epidemiological-overview-for-2012http://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/vaccines-and-immunization/news/news/2013/05/regional-decline-in-measles-with-large-rubella-outbreaks-in-two-countries-epidemiological-overview-for-2012http://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/vaccines-and-immunization/news/news/2013/05/regional-decline-in-measles-with-large-rubella-outbreaks-in-two-countries-epidemiological-overview-for-2012http://www.euro.who.int/__data/assets/pdf_file/0003/187356/Epi_Brief-Reported-measles-cases-for-last-12-months,-March-2012-February-2013-data-as-of-12-April-2013-final.pdfhttp://ecdc.europa.eu/EN/HEALTHTOPICS/RUBELLA/Pages/index.aspxhttp://ecdc.europa.eu/en/publications/Publications/Forms/ECDC_DispForm.aspx?ID=1124


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ActionsECDC closely monitors rubella transmission in Europe by analysing the cases reported to the European Surveillance Systemand

through its epidemic intelligenceactivities on a monthly basis. Twenty-four EU and two EEA countries contribute to the enhancedrubella surveillance. The purpose of the enhanced rubella monitoring is to provide regular and timely updates on the rubellasituation in Europe in support of effective disease control, increased public awareness andthe achievement of the 2015 rubellaand congenital rubella elimination target.

An ECDC report is available online:Survey on rubella, rubella in pregnancy and congenital rubella surveillance systems in EU/EEAcountries

Poliovirus - Israel- Detection of WPV1 in environmental samples and healthyindividualsOpening date: 19 August 2013 Latest update: 26 September 2013


Wild poliovirus type 1 (WPV1) was first isolated from sewage samples collected between 7 and 13 April 2013 in Beer Sheva andRahat in southern Israel. WPV1-specific analysis of samples indicated WPV1 introduction into that area in early February 2013.WPV1 has been detected in 96 sewage samples from 27 sampling sitesall across Israel since then, indicating widespreadtransmission throughout the country.The strain is related to strains circulating in Pakistan and also to the strain detected insewage from Cairo in December 2012. It is unrelated to the polioviruses circulating in the Horn of Africa.

In addition, as part of subsequent on-going stool sample survey activities, WPV1 has also been isolated in stool samples from 42asymptomatic carriers.Israel has been free of indigenous WPV transmission since 1988. In the past, WPV has been detected inenvironmental samples collected in this region between 1991 and 2002 without occurrence of cases of paralytic polio in the area.

hree positive samples have also been collected from the West Bank and Gaza (the most recent on 20 August). Previous and

subsequent specimens collected through environmental surveillance since 2002 in both Gaza and the West Bank have consistentlytested negative for the presence of WPV.

No case of paralytic polio has been reported in either Israel or the West Bank and Gaza.

Web sources: MoH Israel | WHO DON

ECDC assessmenthe World Health Organization (WHO) estimates the risk of further international spread ofWPV1 from Israel to remain moderate

to high.

ECDC, as stated in arecently publishedrisk assessment,considers that there is a risk of importation and re-establishment of WPVinto the EU via a recently infected person shedding the virus, if we consider the significant population flow from and to countries

where WPV is still circulating, as well as the sub-optimal potential for early detection of the virus in both the environment and thepopulation. The overall threatcan be considered to be very low in OPV vaccinees for both poliovirus infection and disease;moderate in IPV-only cohorts for poliovirus infection and low for disease; and high in low or unvaccinated groups for poliovirusinfection and moderate for disease.

he highest level of risk is posed by the proximity of clustered un- or under-immunised population groups to large populationsvaccinated using IPV-only schemes. Sub-optimal hygiene and crowded living conditions may also play a role in facilitating thespread of infection.

Web sources: ECDC Risk Assessment|

ActionsNationwide measures to prevent cases of poliomyelitis and stop the environmental spread of the virus have been adopted inIsrael, including a supplementary immunisation activity with bivalent oral polio vaccine (OPV1 and 3) with the aimof boosting

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http://ecdc.europa.eu/en/publications/Publications/survey-rubella-pregnancy-congenital-surveillance-systems-may-2013.pdfhttp://ecdc.europa.eu/en/publications/Publications/survey-rubella-pregnancy-congenital-surveillance-systems-may-2013.pdfhttp://ecdc.europa.eu/en/publications/Publications/survey-rubella-pregnancy-congenital-surveillance-systems-may-2013.pdfhttp://www.health.gov.il/english/Pages/HomePage.aspxhttp://www.who.int/csr/don/en/index.htmlhttp://ecdc.europa.eu/en/publications/Publications/polio-risk-assessment-transmission-in-Israel.pdfhttp://ecdc.europa.eu/en/publications/Publications/polio-risk-assessment-transmission-in-Israel.pdfhttp://ecdc.europa.eu/en/publications/Publications/polio-risk-assessment-transmission-in-Israel.pdfhttp://ecdc.europa.eu/en/publications/Publications/polio-risk-assessment-transmission-in-Israel.pdfhttp://www.who.int/csr/don/en/index.htmlhttp://www.health.gov.il/english/Pages/HomePage.aspxhttp://ecdc.europa.eu/en/publications/Publications/survey-rubella-pregnancy-congenital-surveillance-systems-may-2013.pdfhttp://ecdc.europa.eu/en/publications/Publications/survey-rubella-pregnancy-congenital-surveillance-systems-may-2013.pdfhttp://ecdc.europa.eu/en/publications/Publications/survey-rubella-pregnancy-congenital-surveillance-systems-may-2013.pdfhttp://ecdc.europa.eu/en/publications/Publications/survey-rubella-pregnancy-congenital-surveillance-systems-may-2013.pdf


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mucosal immunity levels in cohorts of children nave to OPVin order torapidly interrupt virus circulation.

ECDC supports WHO recommendations that all countries, in particular those with frequent travel and contacts with polio-infectedcountries, strengthen surveillance for cases of acute flaccid paralysis (AFP), in order to rapidly detectnew poliovirus importationsand facilitate a rapid response. Countries should also analyse routine immunisation coverage data to identify subnational gaps in

population immunity to guide catch-up immunisation activities and thereby minimise the consequences of new virus introduction.Priority should be given to areas at high risk of importations and where OPV3/DPT3 coverage is


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Actionshe latest ECDCrapid risk assessmentwas published on26 September2013.

he results of an ECDC coordinatedsurveyon laboratory capacity for testingthe MERS-CoV in Europe were publishedinEuroSurveillance.

ECDC published aPublic Health Developmenton27 August 2013regarding the isolation of MERS-CoV from a bat sample.

he first 133 cases are described inEuroSurveillance published on 26 September 2013.

ECDC is closely monitoring the situation in collaboration with WHO and the EU Member States.

Distribution of confirmed cases of MERS-CoV by month* and place of probable infection,March 2012 - 26 September 2013 (N=133)

ECDC SRS

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http://www.ecdc.europa.eu/en/publications/Publications/RRA_MERS-CoV_7th_update.pdfhttp://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20335http://www.ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20Reviews/ECDC_DispForm.aspx?List=512ff74f-77d4-4ad8-b6d6-bf0f23083f30&ID=1319&RootFolder=%252Fen%252Factivities%252Fsciadvice%252FLists%252FECDC%20Reviewshttp://www.ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20Reviews/ECDC_DispForm.aspx?List=512ff74f-77d4-4ad8-b6d6-bf0f23083f30&ID=1319&RootFolder=%252Fen%252Factivities%252Fsciadvice%252FLists%252FECDC%20Reviewshttp://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20596http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20596http://www.ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20Reviews/ECDC_DispForm.aspx?List=512ff74f-77d4-4ad8-b6d6-bf0f23083f30&ID=1319&RootFolder=%252Fen%252Factivities%252Fsciadvice%252FLists%252FECDC%20Reviewshttp://www.ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20Reviews/ECDC_DispForm.aspx?List=512ff74f-77d4-4ad8-b6d6-bf0f23083f30&ID=1319&RootFolder=%252Fen%252Factivities%252Fsciadvice%252FLists%252FECDC%20Reviewshttp://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20335http://www.ecdc.europa.eu/en/publications/Publications/RRA_MERS-CoV_7th_update.pdf


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Distribution of confirmed cases of MERS-CoV by age and gender, March 2012 - 26September 2013 (n=128*)

ECDC SRS

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Distribution of MERS-CoV cases by place of reporting as of 26 September 2013ECDC SRS

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The Communicable Disease Threat Report may include unconfirmed information which may later prove to be unsubstantiated.

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Visiting address: Tomtebodavgen 11a, Solna, SwedenEpidemic Intelligence duty email: [email protected]



communicable disease threats report 28 sep 2013

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