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Surveillance Guidelines for Measles, Rubella and Congenital Rubella Syndrome in the WHO European Region. Geneva: World Health Organization; 2012 Dec.

Cover of Surveillance Guidelines for Measles, Rubella and Congenital Rubella Syndrome in the WHO European Region

Surveillance Guidelines for Measles, Rubella and Congenital Rubella Syndrome in the WHO European Region.

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5Monitoring and evaluation

Monitoring and evaluation of surveillance systems over time is necessary to identify areas that need strengthening and to verify the relevance and quality of the information obtained. These objectives are particularly important in the context of eliminating measles and rubella.

To help with the routine monitoring of surveillance systems, WHO has defined a set of core indicators for measles and rubella (see Chapter 5.1 “Surveillance performance indicators” below). Together with surveillance indicators, indicators for monitoring progress towards elimination are helpful in determining the current status and activities needed for elimination (see Chapter 5.2 “Indicators for monitoring progress towards elimination” below).

Surveillance performance should be analysed at each administrative level in order to monitor and document local and national progress towards achieving and sustaining elimination. Indicators for monitoring progress must be interpreted with regard to the quality of disease surveillance and also with regard to the immunity profile of specific subgroups (age group, geographical area, etc.) when available.

In addition to routine monitoring, detailed periodic reviews of system performance should be conducted with reasonable frequency (between annually and every five years) to assess system quality and implement modifications based on the review findings.

5.1. Surveillance performance indicators

The following indicators (Table 3) measure the performance of measles and rubella surveillance.

Table 3. Measles and rubella surveillance performance indicators.

Table 3

Measles and rubella surveillance performance indicators.

5.2. Indicators for monitoring progress towards elimination

Vaccination coverage and disease incidence are useful indicators for providing general guidance regarding progress towards elimination. However, they are not sufficient to document elimination by themselves. Rather, an assessment of several lines of evidence (e.g. population immunity, quality of surveillance, molecular epidemiology data, etc.) will be necessary for reliable conclusions to be drawn. In countries with small populations, these indicators should be interpreted with caution.

1. Vaccination coverage

Countries should monitor vaccination coverage continuously to enable population immunity to be assessed. Although high coverage with one dose of the rubella-containing vaccine provides sufficient protection against rubella and is likely to interrupt transmission, all Member States of the European Region have currently implemented a routine immunization programme offering two doses of combined measles and rubella-containing vaccines (MR, MMR, measles/ mumps/ rubella/ varicella – MMRV).


Vaccination coverage of the first and second routine doses of measles/rubella-containing vaccine.


Achieving and maintaining of at least 95% coverage with both first and second routine doses of measles/rubella-containing vaccine in all districts or their administrative equivalents and at the national level.

2. Incidence

Incidence of measles or rubella is a basic measure of progress in disease elimination, used to describe the overall level of disease control and enable meaningful comparisons across countries and regions. Monitoring incidence is reliable only when the surveillance system meets essential performance indicators.


Incidence of ALL measles or rubella (laboratory confirmed, epidemiologically linked and clinically compatible) cases per million total population. The numerator should exclude imported cases.


Achievement of a measles/rubella incidence of <1 case per 1 million total population.

Meeting individual indicators for monitoring progress towards elimination does not define measles elimination nor confirm that it has been achieved. Conclusions regarding verification of measles and rubella elimination should be based on examination of several lines of evidence.

Copyright © World Health Organization 2009, update 2012.

All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Address requests about publications of the WHO Regional Office for Europe to: Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK–2100 Copenhagen Ø, Denmark. Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the WHO European Regional Office web site at

Bookshelf ID: NBK143251


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