A new public health study introducing dry blood spot (DBS) and oral fluid (OF) sampling for suspected measles and rubella cases was launched in Sofia, Bulgaria, on 9 February 2026. The initiative was inaugurated by Japan’s Ambassador to Bulgaria, H.E. Mr Chikahisa Sumi; Kristina Mauer-Stender, Special Representative of the WHO Regional Director in Bulgaria; and Professor Dr Iva Hristova, Director of the National Centre of Infectious and Parasitic Diseases. The study aims to strengthen disease surveillance and support Bulgaria’s continued efforts to sustain measles and rubella elimination.
Under the study, general practitioners in selected regions will collect paired DBS and OF samples from suspected cases, mainly children presenting with fever and rash. These samples will be analysed for measles and rubella antibodies and ribonucleic acid at the National Reference Laboratory for Measles, Mumps and Rubella at the NCIPD. Compared to traditional venous blood sampling, DBS and OF methods are less invasive, more acceptable to parents and can be conducted in local clinics rather than hospitals. This approach is expected to increase the number of samples submitted for laboratory testing and improve the sensitivity and coverage of surveillance systems. The study will evaluate the diagnostic performance, feasibility and acceptability of integrating these methods into routine practice.
The initiative is being implemented in partnership with the NCIPD and the Ministry of Health of Bulgaria, with support from the Asia-Europe Foundation and the Government of Japan. According to WHO representatives, the new sampling approach is designed to make surveillance more accessible, efficient and responsive, ultimately generating reliable data to guide public health interventions.
Bulgaria achieved measles and rubella elimination status, as verified in September 2025 by the European Regional Verification Commission for Measles and Rubella Elimination of the World Health Organization European Region. However, maintaining elimination requires sustained vigilance, prompt case detection and comprehensive laboratory investigation of every suspected case. In recent years, some regions have reported lower-than-expected numbers of samples from suspected cases, based on WHO surveillance indicators. Strengthening sample collection, particularly in rural and harder-to-reach communities, has therefore become a priority to ensure continued compliance with elimination standards.
The findings of the study are expected to inform future surveillance policy, enhance outbreak preparedness and response capacity, and reinforce Bulgaria’s commitment to sustaining elimination gains. The initiative reflects a collaborative effort between national authorities and international partners to safeguard public health and contribute to broader health security across the WHO European Region.
