Transcript Southeast Asia Region Update - Measles & Rubella Initiative

Measles Control in SEAR
Current Progress and Way Forward
American Red Cross Measles Meeting
Washington DC
13th Sept 2011
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Presentation Structure
Regional goals
Regional progress
Opportunities for measles elimination
Challenges
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Current regional goal and regional consultative
processes for measles elimination
Regional consultation on measles, SEARO, August 2009
Consensus on technical and biological feasibility of measles elimination
Programmatic feasibility for elimination varied between countries
62nd Regional Committee in 2009
In 2009, the Regional Committee passed a resolution urging Member
States to move towards eliminating measles
63rd Regional Committee in Sept 2010
Interim goals approved by the 63rd World Health Assembly (May 2010)
should be adopted
By 2015
– -MCV1 coverage >90% nationally and >80% in all districts
– -Incidence <5/million
– -Reduce mortality by 95% compared to 2000
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Recent Development
High-Level Ministerial Meeting (HLMM) of SEAR countries
on Increasing and Sustaining Immunization Coverage in
South East Asia convened in New Delhi, India: 2 August
2011.
2012 to be declared the Year of Intensification of Routine
Immunization in countries of South-East Asia Region
Endorsed by the 64th Session of the WHO Regional
Committee
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Status of measles control activities in SEAR 2011
Implementing elimination strategies (9)
Bangladesh, Bhutan, DPR Korea, Indonesia, Maldives,
Myanmar, Nepal, Sri Lanka and Thailand
Advanced stage of mortality reduction (1)
Timor-Leste
Accelerated implementation of mortality reduction
strategies (1)
India
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Estimated measles mortality (2000-08), MCV1 coverage and SIA
achievements SEAR, 2000 to 2010
2000-2010: Over
153 million
childrenvaccinated
immunized through
through MEASLES
SIA
120 million
SIA
6.3
1.5
5.2
10
10.4
42.4
40.7
3.6
2.0
30.7
250000
100
42 % reduction of mortality, 2000 - 2007
95
46%
Reduction
200000
90
150000
80
75
100000
70
MCV1 Coverage (%)
Estimated deaths
85
65
50000
60
55
0
50
2000
2001
2002
2003
Estimated Measles Deaths
2004
2005
2006
2007
2008
WHO/UNICEF estimated MCV 1 coverage
2009
2010
SIA achievement in millions
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Coverage (%) of 1st dose of Measles Containing Vaccine in
infants: 2005-2010
100
90
80
70
60
50
Source: WHO/UNICEF 2010 estimates
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2005
BAN
BHU
2006
DPK
2007
IND
INO
2008
MAL
MMR
2009
NEP
SRL
2010
THA
TLS
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Second dose of measles (MCV2) by strategy
( as on 2010)
Second Dose for Measles Immunization, SEAR, 2010
Through Routine Immunization
Through SIA
2000-2010: 153 million
children immunized
through MEASLES SIA
Catch-up & Follow-up campaigns completed
Provide MR/MMR vaccine
Catch-up completed / Follow-up ongoing
Provide Measles Vaccine
On-going Catch-up campaign
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2nd opportunity/2nd dose of Measles vaccine:
State specific Delivery strategies
MCV1 coverage national average : 69%
2010-2012: SIA
target 134 million
children (9 mo<10 years)
SIA: 14 states MCV1 <80%:
RI: 21 states (MCV1 > 80%)
MCV1: Coverage of Measles containing vaccine per DLHS-3; CES-06 for Nagaland
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Summary of measles surveillance SEAR 2010*
Case based in
11 states
11 states
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*Based on monthly data sent
Measles Surveillance Indicators SEAR 2009 and
2010
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India: Scale-up of laboratory enhanced
measles outbreak surveillance
2006
2007
2009
2010
2011
WHO NPSP West Region Review Meeting
August 17-18, 2011
Challenges for the Region … 1/3
Target population
5 countries (IND, INO, MMR, NEP, TLS) with nearly
83% of the population will need to increase MCV1
coverage by 12-25% to reach 95% level
By 2020, one billion children to be vaccinated above
the current immunization trends through SIA and
MCV2
Building strong political commitment and full country
ownership when there are competing health priorities.
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Challenges for the region … 2/3
Adequate resources (equipment, staff, training
and supervision) commitment to ensure
Safe injection practices and waste disposal.
System for monitoring and responding to Adverse
Events Following Immunization (AEFI)
Establishing a high quality surveillance system
that meets surveillance performance indicators
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Challenges: Funding support for SIA and
surveillance in 2011 -12 (3/3)
Funding for SIAs (Myanmar and Nepal)
WHO regional office for surveillance and technical support
Technical support for India.
Surveillance Costs (Bangladesh, India, Indonesia,
Myanmar and Nepal)
Support for Indonesia towards operational costs for
campaigns and technical support.
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Enabling factors … 1/2
Regional consultation on measles, 2009: Technical
experts agreed that
Eight countries (Bangladesh, Bhutan, Indonesia, Nepal, Thailand,
Myanmar, Maldives and Sri Lanka) could achieve measles elimination by
2015
For India and Timor-Leste elimination would be feasible by 2020
Regional consultation on measles, 2011: Technical experts
agreed that immunization is a highly cost-effective public health intervention
to improving child survival and presents immense opportunities to make
sustainable gains in health, bringing the member states of the Region closer
to achieving the MDG-4 for child mortality reduction
Political commitment present.
National Governments funding measles in RI and catch-up
campaign
Major contributions from Govts. Of Bangladesh, Bhutan, DPR
Korea, Maldives, Myanmar and Sri Lanka
India: All costs for MCV2 and SIA borne by National Govt.
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Enabling factors … 2/2
Vaccine supply and security
At least two countries in the Region have measles vaccine production
capacities
Can be scaled up to match additional demand
Excellent community acceptance and safety profile of catchup campaigns
Support from Polio eradication infrastructure in five priority
countries
Bangladesh, India, Indonesia, Myanmar and Nepal
Laboratory support to measles surveillance adequate and can
be scaled up
Built on Polio laboratories infrastructure plus
Inclusion of new labs for laboratory supported surveillance for measles
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SIA plan 2011-12
Country
Time
Target area
Age
group
Target
Myanmar
Q4
National
(follow-up)
9-59 M
6,500,000
Indonesia
October
11 Provinces
(Follow-up)
9 M-5Y
12,000,000
Q4
9 M-10Y
41,000,000
India
2012
9 M-10 Y
To be identified
Nepal
2012
9M-15 Y
To be identified
Remarks
YEAR 2011
India
National funds
YEAR 2012
National
MR
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* Subject to government confirmation
Summary
Most of the member countries have successfully
implemented strategies for measles mortality
reduction and moving towards elimination
Year 2012 declared the Year of Intensification of
Routine Immunization in countries of SEAR
India has planned to provide second dose ( campaign
and RI)
Collaboration of all stakeholder is necessary to
overcome challenges
Immunizing large numbers
Reach and maintain surveillance standards
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Thank you
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