The National Board of Health and Welfare has drawn up and coordinated a national plan of action that aims to prevent the spread of measles and rubella in the country pursuant to the undertaking made within the framework of efforts of WHO to eliminate these diseases.
Measles and rubella are viral infections that only can affect humans. There is no specific treatment, but there are effective vaccines. The World Health Organisation (WHO) considers that there are prerequisites for elimination of the diseases the diseases through immunisation programmes, which is now part of the organisation's long term objective.
Sweden has not had a continuous domestic spread of measles or rubella since the end of the 1980s. Immunisation coverage is high and on the basis of national cross-sectional surveys immunity has been assessed to be generally good. At the same time, import-related cases of disease have led to several major outbreaks of measles in recent years. The number of cases in different age groups shows that the two diseases no longer should be considered as children's diseases, even though the majority of those who become ill are unvaccinated children. With a spread of infection among adults there is an increased risk of healthcare-associated infections. A growing risk group, which is dependent on herd immunity against measles, are persons with reduced immunity to infections, particularly patients treated with immunosuppressive drugs. A cessation of the circulation of rubella in Sweden provides protection to unvaccinated women in the country, however not if they travel to countries where the disease is circulating. In 2011, the first case in three decades was reported, where a child was born with severe injuries of rubella, after an unvaccinated woman was infected during an overseas trip during early pregnancy.
The establishment and maintenance of a high level of public confidence in the immunisation programme in general and vaccination against measles and rubella in particular is a prerequisite to reduce the spread of infection and to contribute nationally to the implementation of WHO's global objective for elimination, and it will also be one of the greatest challenges. Accordingly, an important intermediate target in the elimination of measles and rubella is to reach and maintain very high coverage (more than 95 per cent) with two doses of measles vaccine and at least one dose of vaccine against rubella. This demands improved availability and use of evidence-based information to the profession and to the general public, about the advantages and risks associated with vaccination against measles and rubella. Targeted efforts are needed to identify groups with low immunisation coverage and to put tailored measures in place, for example, targeted communication initiatives. Such initiatives are, for example, the promotion of initiatives on local and individual levels in areas with consistently low immunisation coverage through, among others, strengthening resources at vaccinating units (Child Health Centres).
Another important intermediate target is to offer vaccine against measles and rubella, including supplemental vaccination to all sections of the populations at risk of and susceptibility to measles and rubella. This applies to groups with increased risk of being exposed, such as people travelling abroad, and health care professionals as well as persons who for different reasons may have a lower degree of coverage, for example, community fostered children and newly arrived refugees. Children under 18 months who have not yet received their first vaccine dose are a special problem. The higher number pregnant women who have vaccine induced immunity, the earlier the infant's antibodies from the mother subside. This requires a documented knowledge base and a standpoint on the optimal timing for the first dose.
Strengthening monitoring systems through strict case studies and laboratory verification of suspected individual cases and outbreaks is becoming more important when approaching the elimination of measles and rubella. A basic problem is that increasingly rare diseases disappear from the clinical awareness of health care professionals, which creates an increased need for knowledge support for both health care and virological laboratories.
Bolstering procedures for outbreak management and contact tracing will also increase in importance in a phase, when individual cases are becoming rare. Clear plans are needed to manage both outbreaks and contract tracing of individual cases, including guidelines for the use of immunoglobulin as postexposure prophylaxis.