Is EU/EEA population protected from polio?

The WHO European Region has been declared polio-free since 2002. By 2010, inactivated polio vaccine (IPV) was the only polio vaccine in use in the EU/EEA for the primary vaccination of children. A systematic review of the literature on polio seroprevalence studies, complemented by the analysis of available vaccine coverage data, has been carried out with the aim of assessing the level of protection against polio in the European population. A total of 52 studies, with data from 14 out of the 31 EU/EEA countries, were included in the analysis. This systematic review shows that, overall, seroprevalence for PV1 and PV3 is high in most countries, although seroimmunity gaps have been detected in several birth cohorts. In particular, relatively low immunity status was found in some countries for individuals born in the 60's and 70's. Discrepancies between reported vaccination coverage and immunity levels have been also highlighted. Countries should make sure that their population is being vaccinated for polio to reduce the risk of local poliovirus transmission in case of importation. Moreover, assessing immunity status should be priority for those traveling to areas where wild polioviruses are still circulating.

Characteristics and practices of National Immunisation Technical Advisory Groups in Europe and potential for collaboration, April 2014.

In many countries, national vaccination recommendations are developed by independent expert committees, so-called national immunisation technical advisory groups (NITAG). Since the evaluation of vaccines is complex and resource-demanding, collaboration between NITAGs that evaluate the same vaccines could be beneficial. We conducted a cross-sectional survey among 30 European countries in February 2014, to explore basic characteristics and current practices of European NITAGs and identify potential modes and barriers for collaboration. Of 28 responding countries, 26 reported to have a NITAG or an equivalent expert group. Of these, 20 apply a systematic approach in the vaccine decision-making process, e.g. by considering criteria such as country-specific disease epidemiology, vaccine efficacy/effectiveness/safety, health economics, programme implementation/logistics or country-specific values/preferences. However, applied frameworks and extent of evidence review differ widely. The use of systematic reviews is required for 15 of 26 NITAGs, while results from transmission modelling and health economic evaluations are routinely considered by 18 and 20 of 26 NITAGs, respectively. Twenty-five countries saw potential for NITAG-collaboration, but most often named structural concerns, e.g. different NITAG structures or countries' healthcare systems. Our survey gathered information that can serve as an inventory on European NITAGs, allowing further exploration of options and structures for NITAG collaboration.

Varicella vaccination: a laboured take-off.

Varicella vaccines are highly immunogenic, efficacious and safe in preventing varicella disease. The USA has been the first country recommending universal vaccination. In the European Union/European Economic Area countries, the use of varicella vaccine is heterogeneous, with some countries recommending universal vaccination in children at national or regional level, others only in high-risk groups and others having no recommendation at all. Uncertainties on the potential impact of varicella vaccination on the epidemiology of varicella and herpes zoster still exist. These uncertainties are the main reason behind the diverse vaccine recommendations. Surveillance systems and mathematical models could be useful to address these uncertainties. However, the lack of surveillance of varicella and herpes zoster in some countries, as well as the high variability of surveillance systems in the countries that have one, makes it difficult to assess the effect of the vaccine. On the other hand, mathematical models are based on assumptions and should be interpreted carefully. Continuous surveillance of varicella and herpes zoster is needed to identify any changes in the epidemiological presentation of the diseases. In any case, continuous surveillance will be needed to fully describe the impact of the programmes currently running and clarify some of the actual uncertainties in the near future. Additionally, increasing our understanding of the risk factors for development of herpes zoster is required.

Impact of measles national vaccination coverage on burden of measles across 29 Member States of the European Union and European Economic Area, 2006-2011.

BACKGROUND: Challenges in reaching good vaccination coverage against measles emerged in several European Union/European Economic Area Member States (EU/EEA MS) leading to progressive accumulation of susceptible individuals and outbreaks. The Burden of Communicable Diseases in Europe (BCoDE) project developed a methodology for measuring the burden of communicable diseases expressed in Disability-Adjusted Life Years (DALYs) in the EU/EEA MS. The aim of this study was to compare national vaccination coverage and burden of measles across EU/EEA MS. METHODS: Country-specific data on measles national vaccination coverage 2006-2011 from 29 EU/EEA MS (MCV1) were retrieved from Centralized Information System for Infectious Diseases (CISID). DALYs were calculated for each country separately using a disease progression model with a single input parameter (annual measles incidence, adjusted for under-estimation). A software application was used to compute estimated DALYs according to country-specific and year-specific population age-distributions (data retrieved from Eurostat). Log-linear mixed-effect regression modeling approach was used to investigate a linear relation between natural logarithm-transformed DALYs and coverage. RESULTS: The reported annual vaccination coverage ranged from 72.6% to 100%. The estimated national annual burden ranged from 0 to 30.6 DALYs/100,000. Adjusting for year, there was a significant negative relationship between coverage and burden. For a given country there was a decrease in log-transformed DALYs/100,000 of 0.025 (95% confidence interval: -0.047 to -0.003) for every percentage increase in vaccination coverage. The largest effect of calendar time on estimated burden of measles was observed for the year 2011, the smallest was for the year 2007. CONCLUSIONS: This study shows that the degree of success of national measles vaccination programs, when measured by the coverage obtained, is significantly associated with overall impact of measles across EU/EEA MS. In EU/EEA MS each percentage point increase in national vaccination coverage seems to lead to early significant reduction of overall burden of measles.

Actual immunization coverage throughout Europe: are existing data sufficient?

Assessing vaccine coverage is an essential component of vaccine programme monitoring and evaluation. Vaccine coverage data are available in EU/EEA countries at both national and subnational levels and are used for programmatic purposes at any level. European-wide data collection is performed by WHO through the Centralized Information System for Infectious Diseases, as part of the global data collection jointly conducted with UNICEF. Data quality and comparability are still challenging at an international level. According to available information, vaccination registries are available in 11 countries in the EU/EEA, but only in five countries do they have national coverage. In 2012 ECDC, through the VENICE II network, started the European Vaccination Coverage Collection System (EVACO project), with the final aim of improving the quality of vaccine coverage data at EU level, by defining and implementing standards.

Measles still spreads in Europe: who is responsible for the failure to vaccinate?

All countries in the European Region of the World Health Organization (WHO) have renewed their commitment to eliminate measles transmission by 2015. Measles elimination is a feasible target but requires vaccination coverage above 95% with two doses of a measles-mumps-rubella vaccine (MMR) in all population groups and in all geographical areas. Measles has re-emerged in the EU recently, due to suboptimal immunization levels that led to accumulation of susceptible populations over the last years. In fact, while an overall decreasing trend had been observed until 2009, the number of cases increased by a factor of four between 2010 and 2011. According to vaccination coverage data reported to the WHO, between 2000 and 2010, almost 5 million individuals in the EU in the age group 2-12 had not had MMR vaccination. Catch-up vaccination activities for susceptible populations are paramount in order to reach the elimination goal, but only feasible if a multi-component approach is put in place quickly and efficiently. Advocacy and communication are key strategic areas.

Healthcare workers role in keeping MMR vaccination uptake high in Europe: a review of evidence.

Measles is a highly contagious and potentially fatal disease. Europe is far from the 95% coverage rates necessary for elimination of the disease, although a safe and cost-effective vaccine is available. We reviewed the literature on studies carried out in European countries from January 1991 to September 2011 on knowledge, attitudes and practices of health professionals towards measles vaccination and on how health professionals have an impact on parental vaccination choices. Both quantitative and qualitative studies were considered: a total of 28 eligible articles were retrieved. Healthcare workers are considered by parents as a primary and trustworthy source of information on childhood vaccination. Gaps in knowledge and poor communication from healthcare workers are detrimental to high immunisation rates. Correct and transparent information for parents plays a key role in parental decisions on whether to have their children vaccinated. Healthcare workers' knowledge of and positive attitudes towards measles-mumps-rubella (MMR) vaccination are crucial to meeting the measles elimination goal. An effort should be made to overcome potential communication barriers and to strengthen vaccine education among healthcare professionals.

2009 pandemic influenza A(H1N1) outbreak in a complex of schools in Paris, France, June 2009.

An outbreak of 2009 pandemic influenza A(H1N1), involving 81 cases with symptoms of influenza-like illness, was confirmed in June 2009 in a complex of schools in Paris, France. At that time, there was no community transmission in France. The index case, a 10-year-old girl, had travelled to the United Kingdom with her school class. Of the 81 symptomatic cases, 35 were confirmed and 46 were probable; 48 of the cases were female. Three were adults and 78 were children (median age of the children was 7.9 years, range: 6 months to 12 years). Control measures were implemented as soon as a new case was confirmed in a school, which included active case finding among the pupils in the same class as the index case, setting up a dedicated influenza outpatient clinic that families were recommended to consult if necessary, prophylactic treatment of contacts and school closure. A retrospective study was conducted on all confirmed cases and all symptomatic cases who had consulted the dedicated outpatient clinic from 17 to 27 June 2009. Further work is needed to better define conditions under which the pandemic virus can be transmitted in schools and in households.

[Age of smoking initiation as predictor in smoking cessation]. / Edad de inicio en el consumo del tabaco como predictor de la deshabituación tabáquica.

OBJECTIVE: To determinate the relationship between the age of smoking initiation and the success of the smoking cessation program. DESIGN: Prospective cohort. SETTING: Smoking Cessation Unit, in the University Hospital of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. PARTICIPANTS: 2801 smokers of 10 or more cigarette per day, who started a smoking cessation program between January 1993 to December 2002. METHODS: Kaplan-Meier method was used to obtain the probability of relapse. The log-rank test was used to determine relapse differences in time between groups of age at smoking initiation. Hazard ratios (HR) of quitting were estimated with a Cox model. RESULTS: The mean age at smoking onset was 15.5+/-4.1 years for men and 17.7+/-5.4 years for women. The age of onset smoking was significant for relapse during smoking cessation in men with a HR=1.42 (95% CI, 1.09-1.86), and for women who started to smoke before 14 years old compared with the reference group a HR=1.25 (95% CI, 0.76-1.49). CONCLUSIONS: This study shows that age of smoking onset predicts higher rates of relapse in a smoking cessation program in men. The low motivation for cessation was in both sex a significative factor for relapse and the low and high nicotine dependence were in women.

Edad de inicio en el consumo del tabaco como predictor de la deshabituación tabáquica / Age of smoking initiation as predictor in smoking cessation

Objetivo. Determinar la relación entre la edad de inicio del consumo del tabaco y el éxito de un programa de deshabituación tabáquica. Diseño. Estudio de cohortes prospectivo. Emplazamiento. Unidad de Deshabituación Tabáquica del Hospital Universitario de Bellvitge, en L'Hospitalet de Llobregat (Barcelona). Participantes. Participaron en el estudio 2.801 fumadores de 10 o más cigarrillos al día, que iniciaron un programa de deshabituación tabáquica entre enero de 1993 y diciembre de 2002. Mediciones principales. Se utilizó un análisis de Kaplan-Meier para obtener la probabilidad de recaída, y la prueba de rangos logarítmicos, para determinar diferencias de recaída en el tiempo entre los grupos de edad de inicio. El riesgo relativo (RR) de recaída se estimó mediante un modelo de Cox. Resultados. La edad media ± desviación estándar de inicio de los varones fue de 15,5 ± 4,1 años, y la de las mujeres, de 17,7 ± 5,4 años. La edad de inicio al consumo mostró ser un factor de riesgo significativo para la recaída durante la deshabituación tabáquica, con un RR de 1,42 (intervalo de confianza del 95%, 1,09-1,86) para los varones que iniciaron el consumo a una edad inferior a los 14 años y con un RR de 1,25 (intervalo de confianza del 95%, 0,76-1,49) para las mujeres que también lo iniciaron a dicha edad. Conclusiones. El inicio del consumo del tabaco en edades tempranas es un factor predictor de recaída en los programas de cesación tabáquica entre los varones. En cambio, la escasa motivación en ambos sexos y la dependencia alta a la nicotina en las mujeres son factores que favorecen la recaída

Objective. To determinate the relationship between the age of smoking initiation and the success of the smoking cessation program. Design. Prospective cohort. Setting. Smoking Cessation Unit, in the University Hospital of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. Participants. 2801 smokers of 10 or more cigarette per day, who started a smoking cessation program between January 1993 to December 2002. Methods. Kaplan-Meier method was used to obtain the probability of relapse. The log-rank test was used to determine relapse differences in time between groups of age at smoking initiation. Hazard ratios (HR) of quitting were estimated with a Cox model. Results. The mean age at smoking onset was 15.5±4.1 years for men and 17.7±5.4 years for women. The age of onset smoking was significant for relapse during smoking cessation in men with a HR=1.42 (95% CI, 1.09-1.86), and for women who started to smoke before 14 years old compared with the reference group a HR=1.25 (95% CI, 0.76-1.49). Conclusions. This study shows that age of smoking onset predicts higher rates of relapse in a smoking cessation program in men. The low motivation for cessation was in both sex a significative factor for relapse and the low and high nicotine dependence were in women