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Background: All Member States of the World Health Organization (WHO) European Region have endorsed rubella elimination and congenital rubella syndrome (CRS) prevention. However, Poland has continued high levels of reported rubella., Methods: We reviewed rubella incidence in Poland since 1966 and analyzed national aggregated surveillance data from the period 2003-2008 and case-based data from 4 provinces from the period 2006-2008. We described CRS cases since 1997 and assessed maternal receipt of vaccine. We reviewed national vaccination coverage from 1992 through 2008., Results: Since 1966, rubella outbreaks have occurred every 4-6 years in Poland. Aggregate and case-based data from the period 2003-2008 indicate that rubella virus transmission has occurred across wide age ranges (from <1 year to 60 years), with disproportionately higher percentage of cases among adolescent boys. Of 18 children with reported CRS cases from 1997 through 2008, 15 (83%) of their mothers had not been vaccinated. Measles-mumps-rubella dose 1 vaccination coverage ranged from 97% to 99%., Conclusions: Poland had the highest incidence of rubella in the WHO European Region in 2007 and 2008. Rubella occurs predominantly in age and sex cohorts historically not included in vaccination recommendations. The risk for CRS continues. To achieve rubella elimination, supplemental immunization activities among adolescent boys are needed, as is integration with measles elimination efforts., (Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2011.)

To achieve measles elimination, an efficient surveillance system for rash illnesses is necessary. The aim of the present study was to ascertain which viruses, other than measles, are causing measles-like illnesses (MLIs) in Poland. Serum samples (n=278) collected from MLI cases and submitted to the National Reference Laboratory during 2006-2007 were investigated for anti-measles (MeV), rubella (RUBV), parvovirus B19 (B19V), Epstein-Barr (EBV) and herpesvirus type-6 (HHV-6) IgM presence. Age was strongly associated with MLIs etiology. In the youngest age group, 0-4 years, MeV and HHV-6 infection were prevailing, while in group of 5-9 years--RUBV and B 19V. Measles was confirmed more often in patients with high fever (p < 0.001) and with rash lasting longer than 5 days (p < 0.001). The type of rash was not significantly associated with MeV infection. Our results strongly suggest that according to WHO EURO strategic plan, Poland is close to elimination phase. High number of MLIs were caused by pathogens other than measles. Addition of anti-B 19V IgM testing to routine MLIs screening protocol may improve system performance in the more advanced stages of measles elimination.

During a mass immunisation campaign following an outbreak of measles in a Roma community settled in the town of Pulawy, Poland, we performed an estimation of the size of this Roma population and an assessment of its vaccination uptake. We obtained a list of Roma residing in Pulawy from the local municipality and estimated using a simple capture-recapture formula that Pulawy had 377 Roma residents (43% under 20 years old), which was 27% more than the 295 registered at the municipality. During the vaccination campaign, demographic information was recorded that could be linked to information from the municipality list as well as to prior immunisation status. Among the people whose data were recorded during the vaccination campaign, 14% were not registered at the primary healthcare centres, and were therefore deprived of access to healthcare. Among 102 screened subjects under the age of 20 years, 51% were vaccinated according to schedule. Vaccine uptake for the first dose of measles-containing vaccine was 56% (54/96) and for the second dose 37% (18/49). The present study indicates the need to get a better demographic overview of Roma communities living in Poland and to understand the barriers limiting their access to healthcare and social services. Organisation of catch-up immunisations of this vulnerable population is necessary.

We describe a local indigenous outbreak of measles in a susceptible Roma community, which occurred in Pulawy, a town of 50,000 citizens in the Lubelskie province (eastern Poland) during summer 2009. From 22 June to 30 August 2009, 32 measles cases were reported, and additionally nine possible cases were actively identified. A mass immunisation campaign was organised to stop measles transmission in the Roma community. Active surveillance of rash-febrile illnesses allowed documentation of the impact of mass immunisation in preventing further measles spread in the Roma community, and the surrounding population of Pulawy.

The objective of this study was to describe transmission chains of measles observed in Poland during 2008-2009. A decade ago, the incidence of measles in Poland declined and approached one case per million inhabitants one of the World Health Organization's criteria for measles elimination. Following a period of very few reported measles cases (2003 to 2005), an increase in incidence was observed in 2006. Since then, the incidence has constantly exceeded one case per million inhabitants. Of 214 measles cases reported in 2008 and 2009 in Poland, 164 (77%) were linked to 19 distinct outbreaks, with 79% of cases belonging to the Roma ethnic group. Outbreaks in the non-Roma Polish population had different dynamics compared to those in the Roma population. On average, measles outbreaks in Roma communities involved 10 individuals, seven of whom were unvaccinated, while outbreaks in the non-Roma Polish population involved five individuals, half of whom were incompletely vaccinated. The majority of outbreaks in Roma communities were related to importation of virus from the United Kingdom. In six outbreaks, the epidemiologic investigation was confirmed by identification of genotype D4 closely related to measles viruses detected in the United Kingdom and Germany. Our data indicate that Poland is approaching measles elimination, but measles virus circulation is still sustained in a vulnerable population. More efforts are needed to integrate the Roma ethnic group into the Polish healthcare system and innovative measures to reach vulnerable groups should be explored.

In Poland 40 measles cases were registered in 2007 (0.1 per 100,000 population). The most affected age group were infants (incidence 1.32 per 100,000 population) and 6-year olds (0.81). 18 measles cases (45%) were hospitalized, no deaths were recorded. Poland participates in the WHO Measles Elimination Strategy. Presently, the most important is the maintenance of a sensitive and timely surveillance of measles and measles-compatible cases, with serologic testing of one suspect case per 100,000 population. The performance of the surveillance system was insufficient with only 152 measles-compatible cases reported in 2007 (38% of expected reports). Serologic confirmation of cases was also insufficient, with 29 cases (73%) confirmed by IgM ELISA test. These results indicate the need to maintain the high immunisation coverage and improve measles surveillance system.

In Poland 120 measles cases were registered in 2006 (0.31 per 100,000 population). It was a substantial increase, compared to the years 2002-2005, when the number of locally-acquired cases was inferior to 1 case per 1 000 000 inhabitants. Three cases were linked to a large Ukrainian outbreak, including the 2006 index case on the Polish territory. Out of 106 cases with vaccination history available, 62 (58%) were not vaccinated, 26 (25%) were fully vaccinated (including 16 laboratory confirmed), and 18 (17%)--incompletely vaccinated. The most affected age groups were children under 2 years of age (incidence 2.62 per 100,000 population), 5-year olds (1.08), and adults aged 25-29 years (1.09). In 20 cases complications were seen, including pneumonia (n = 10) and otitis media (n = 6). 75 measles cases (63%) were hospitalized, no deaths were recorded. The 2006 outbreak lead to a substantial improvement of measles surveillance performance. Two hundred eighty-nine suspect cases were reported, of which 252 (89%) were tested serologically for measles. Additionally, molecular testing of suspect cases was introduced in 2006. The first isolated virus strains belong to the D4 and D5 genotypes, not related to the Ukrainian outbreak. In order to properly document measles elimination during following year, high sensitivity of rash-like illness surveillance should be maintained, and isolation of viral strains from each chain of infection should be attempted.

In Poland 13 measles cases were registered in 2005 (0.03 per 100,000 population). Three cases occurred in unvaccinated persons, 7 in persons vaccinated with one dose and 3 in vaccinated with two doses of measles vaccine (administered at the age of 13-15 months and 7 years). The most affected age groups were 1- and 2-year old children (incidence in both age groups 0.57 per 100,000 population) and 6-year olds (0.52). There were no hospitalizations or deaths associated with measles. Poland participates in the WHO Measles Elimination Strategy. Presently, the most important is the maintenance of a sensitive and timely surveillance of measles and measles-compatible cases, with serologic testing of one suspect case per 100,000 population. The performance of the surveillance system was insufficient with only 67 measles-compatible cases reported in 2005 (18% of expected reports). Serologic confirmation of cases was also insufficient, with no cases confirmed in WHO accredited laboratory, 1 case confirmed at a non accredited laboratory and 12 cases diagnosed based on clinical symptoms. These results indicate the need to improve measles surveillance system performance in Poland.

In Poland 48 measles cases were registered in 2003 (0.13 per 100,000 population)--of which 65% were cases imported from Chechnya and Afghanistan. Measles outbreaks occurred in 3 centers for immigrants. In total, 31 cases were reported, of which 96.8% were unvaccinated, and 93.5% were under 15 years of age. Of 17 local cases, 5 (29.4%) cases occurred in unvaccinated persons, 3 (17.6%) in persons vaccinated with one dose and 7 (41.2%) in those vaccinated with two doses of measles vaccine (administered at the age of 13-15 months and 7 years). Among 12 vaccinated cases only one 2-year old child was recently vaccinated. The remaining cases were in the 3-7 and 10-24 age ranges. The most affected were infants (incidence 0.57 per 100,000), 1-year old (0.28) and 2-year old children (incidence 0.27). Cases among adolescents and adults over 15 years of age increased from 23.5% in 2002 to 47.1% in 2003. The increasing age of locally-acquired cases, together with constantly high immunization coverage indicates high effectiveness of vaccinations in Poland. Out of all reported cases 13 (38%) were hospitalized. There were no deaths due to measles in Poland in 2003. Poland participates in the WHO Measles Elimination Strategy. Presently, the most important is the maintenance of a sensitive and timely surveillance of measles and measles-compatible cases, with serologic confirmation of one rash-like illness per 100 000 population. The performance of the surveillance system is insufficient with only 55 measles-compatible cases reported in 2003 (15% of expected reports). Serologic confirmation of cases was also insufficient, with 22 cases (40.0%) confirmed by IgM ELISA test. These results indicate the need to maintain the high immunisation coverage and improve measles surveillance system.