13th meeting of the European Regional Verification Commission for Measles and Rubella Elimination (RVC)

Event highlights

23 April 2025

At its 13th meeting, based on reports submitted for 2023 and previous years, the European Regional Verification Commission for Measles and Rubella Elimination (RVC) concluded that: 

• 33 (62%) Member States provided evidence to demonstrate the elimination of endemic measles (interruption for at least 36 months) and 50 (94%) – of the elimination of endemic rubella; 33 (62%) Member States provided evidence of the elimination of both measles and rubella; 
• 8 (15%) Member States interrupted measles transmission, of which 7 (13%) interrupted it for 24 months and 1 (2%) – for 12 months;  
• 9 (17%) Member States were considered endemic for measles; 
• 3 (6%) Member States were considered to have re-established measles transmission; and
• 3 (6%) Member States are pending a retrospective review of rubella status. 

The RVC noted that countries in the Region have reported increasing numbers of measles cases since 2021, largely due to the impact of the COVID-19 pandemic on health systems and easing of the social restrictions adopted in response. However, in the majority of countries, there was no recognized continuous chain of transmission of either measles or rubella for a period of 12 months or longer by the end of 2023. 

The RVC defined the following priorities for WHO to support elimination of measles and rubella and its verification:   

• support the remaining endemic countries to take the necessary steps to raise their vaccination coverage and surveillance sensitivity and quality to levels consistent with achieving elimination, and support countries with re-established endemic transmission to regain their previous status as soon as possible;  
• follow up with countries that have achieved elimination to help them to sustain their status; and
• support national measles and rubella elimination verification committees (NVCs) and their secretariats to improve the quality of annual status updates (ASUs) and provide all available additional information, documents or retrospective analyses of already existing data, when feasible.   

The RVC is concerned about the high number of documented and undocumented relocated people, migrants, refugees, asylum seekers and other groups in the European Region who need medical support and services (including immunization and disease case management), but may not have access to these services, may not be recognized by national health systems or may have services provided differently to them than to the general population. Information about them may not be adequately included in the ASUs. The RVC encourages NVCs to work with their secretariats to find ways to reliably collect information about such populations, assess their role and relevance for measles and rubella epidemiology and disease elimination, address any barriers they face to accessing the health system and to report and present this information in the ASUs.

Recommendations 

Presented below are recommendations for Member States.  

• The RVC requests that NVCs (and their secretariats) make every effort to provide comprehensive ASUs in advance of the deadlines for submission to the RVC Secretariat.  
• The RVC calls upon all NVCs and their secretariats to strongly promote and facilitate national authorities and main stakeholders’ prioritization of measles and rubella elimination. This may include raising decision-makers’ awareness of outbreaks, immunization gaps and the presence of unimmunized children among the general public as well as among high-risk populations, and of core challenges for the immunization programme and for the surveillance of measles and rubella.  
• All countries with ongoing measles outbreaks should take all actions needed as soon as possible to stop outbreaks, investigate the reasons for the outbreaks and implement all measures to prevent outbreaks in the future. All countries should develop, update and test their outbreak preparedness and response guidelines and regulations.  
• Countries with decreasing vaccination coverage should prioritize increasing coverage to WHO-recommended levels to prevent outbreaks caused by importations. Countries are encouraged to take steps to ensure that their subnational laboratories are providing high-quality data, with the support and oversight of national reference laboratories.
• In line with surveillance indicators, Member States should conduct laboratory investigation of at least 80% of suspected measles and rubella cases. All Member States should also genotype at least 80% of chains of transmission.  
• To support surveillance activities, the RVC urges Member States that do not already do so to test all measles immunoglobulin M (IgM)-negative sera from suspected measles cases for rubella IgM, and vice versa.  
• The RVC reminds Member States that the achievement of measles or rubella elimination status implies the elimination of endemic measles or rubella transmission, but not measles or rubella infection per se. Health-care staff should be reminded to continue to investigate suspected measles and rubella cases and discard these as measles or rubella infection only through timely epidemiological investigation and laboratory testing. 

Presented below are recommendations for the RVC Secretariat (WHO/Europe):  

• The Secretariat, as per its mandate, should continue to support the verification activities of NVCs and national technical counterparts, especially in endemic countries, countries with re-established endemic transmission, ongoing outbreaks and countries undergoing retrospective rubella reviews (Bosnia and Herzegovina, Poland and Ukraine). The RVC is expecting to see the countries’ reviews once feasible, to enable potential finalization of the verification process for rubella elimination in the Region. The RVC stresses its readiness to support countries together with the Secretariat by participating in country missions, online meetings, in-person bilateral meetings with NVCs and/or in-person meetings during the annual RVC meeting. 
• The Secretariat should consider supporting NVCs and their secretariats in further capacity-building related to verification requirements and surveillance performance. Most countries in the Region have eliminated endemic rubella. The Secretariat is encouraged to explore avenues to use rubella as a success story to emphasize the importance of further efforts to eliminate measles. 

The 13th RVC meeting report, including the full text of conclusions and recommendations, is pending publication.

RVC conclusions on measles and rubella elimination status per Member State for 2023

Event notice

The European Regional Verification Commission for Measles and Rubella Elimination (RVC) will conduct its annual meeting to review the 2023 annual status updates on measles and rubella elimination from Member States of the WHO European Region. In addition to assessing the elimination status of each Member State, the RVC will provide recommendations related to immunization coverage and disease surveillance.