title: Toward rubella elimination in Europe: an epidemiological assessment.
abstract: BACKGROUND
  The elimination of rubella and prevention of congenital rubella syndrome (CRS) by 2015 are established goals for Europe. Our aim was to review the epidemiology of rubella in relation to this goal.
  
  
  METHODS
  National surveillance institutions from 32 European countries provided information on rubella and CRS surveillance systems and data for 2000-08. We reported the number of notified rubella cases by year for countries with a national mandatory notification system for rubella covering total country population consistently throughout 2000-08 and analysed rubella surveillance data for 2008.
  
  
  RESULTS
  Throughout 2000-08, 24 countries conducted passive routine surveillance based on mandatory reporting rubella covering total country population. Altogether these countries reported 526,751 rubella cases. The median incidence per million inhabitants declined from 7.2 in 2000 to 0.3 in 2008. By 2008, the number of countries with mandatory notification systems for rubella increased to 28. These countries reported 21,475 rubella cases of which 1.5% (n=317) were laboratory-confirmed. Most cases (n=21,075; 98%) were reported from Poland, Italy and Romania. Ten countries reported zero rubella cases and five others reported an incidence of <1 per million inhabitants. In 2008, 20 CRS cases were reported from five countries.
  
  
  CONCLUSIONS
  The overall decline in rubella incidence and increase in the number of countries conducting rubella surveillance through a mandatory notification system are notable achievements toward the goal of rubella elimination in Europe. However, in a few countries with high rubella incidence the risk for CRS still exists. Achievement and maintenance of the required high vaccination coverage and high-quality surveillance of rubella and CRS including laboratory testing of all suspected cases are fundamental to eliminate rubella and prevent CRS in Europe.
authors.affiliation: EUVAC.NET hub, Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark. markmuscat1@gmail.com
authors.forename: Mark
authors.initials: M
authors.lastname: Muscat
authors.forename: Laura
authors.initials: L
authors.lastname: Zimmerman
authors.forename: Sabrina
authors.initials: S
authors.lastname: Bacci
authors.forename: Henrik
authors.initials: H
authors.lastname: Bang
authors.forename: Steffen
authors.initials: S
authors.lastname: Glismann
authors.forename: Kåre
authors.initials: K
authors.lastname: Mølbak
authors.forename: Susan
authors.initials: S
authors.lastname: Reef
mesh_terms: D060740:Disease Eradication / Q000639:trends*; D018563:Disease Notification; D005060:Europe / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D012409:Rubella / Q000453:epidemiology / Q000517:prevention & control*