Transcript Measles in EMRO

Measles in EMR
7th Annual Meeting of Partners for Measles
Advocacy
Washington, 2007
Outline

Regional progress in measles elimination

Key constraints

Indicators to monitor measles elimination in EMR
Strategy for Measles Mortality Reduction and
Elimination in EMRO



Routine infant immunization
 > 90% coverage MCV1 in all districts
Catch-up vaccination
 susceptible cohorts
Second dose of measles vaccine either through a 2
dose schedule or follow-up SIAs
 > 90% coverage in all districts

Case-based surveillance

Optimized case management
MCV1 coverage (%)
150
100
125
80
100
60
75
40
50
25
20
0
0
2006
2005
2004
* Preliminary, 2006
2003
Year
2002
2001
2000
1999
1998
1997
1996
1995
Measles cases (1000s)
Trends in Measles Case Counts and
MCV1 Coverage in EMR, 1995-2006*
Geographic Distribution of Children not
Receiving MCV1 in EMRO, 2005 (n=2.8 million)
6%
13%
7%
5%
8%
20%
41%
Pakistan
Sudan
Afghanistan
Yemen
Somalia
Iraq
Others
Supplemental Immunization Activities
Measles Campaigns in EMRO through 2005
Palestine
Bahrain
Preschool and school age (15)
School age (5)
Ongoing (2)
Measles Campaign Coverage in South Sudan
Status by County (Jan 28, 2007)
Renk
Ruweng
Tonga
Aweil North
Aweil East
Mayom
Sobat
Rubkoana
Twic
Old Fangak
Atar
Aweil West
Raja
Guit
Gogrial
Aweil South
Latjor
Nyirol
Koch
Ayod
Waat
Leer
Tonj
Wuror
Diror
Panyijar
Wau
Akobo
North Bor
Rumbek-Cueibet
Pochalla
Pibor
Yirol
Completed
South Bor
Awerial
Tambura
103.4%
Ongoing
Yambio
Ezo
105.4%
Maridi
Mundri
87.3%
Maruko
Payam missed out
Terekeka
101.3%
Kapoeta
64.2%
Juba
Budi
Torit
74.2%
Micro plans ready
Not yet micro-planned
Yei
Kajo Keji
Magwi
91.1%
Catch-up Campaign in Somalia, 2005-06
Area of
campaign
% of
country
targeted
Target pop
No. children
vaccinated
%
coverage
2005
NW (6 districts)
5
160,563
137,581
85.7
NE (18 districts)
7
182,993
142,571
78.2
CS (5 districts)
3
102,976
80,495
78.2
71.5
2006
NWZ(14 dist)
15.4
542,104
387,787
CSZ (78 dist)
67.7
2,266,917
1,838,729
81
Measles Vaccine Doses Administered in Catch-up
Campaigns, 1999-2006 EMRO
40,000,000
35,000,000
30,000,000
25,000,000
20,000,000
15,000,000
10,000,000
5,000,000
0
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
Doses administered
45,000,000
Year
Reduction in Measles Mortality in EMR, 1999-2005
120,000
100,000
Deaths
80,000
50% mortality
reduction target
60,000
40,000
20,000
0
1999 2000 2001 2002 2003 2004 2005
Year
Planned Supplemental Measles
Immunization; 2007-08
.
Catch-up campaigns
Follow-up campaigns
High-risk/mop-up campaigns
Recommended SIAs in EMR that are not
Planned; 2007-08
.
Catch-up campaigns
Follow-up campaigns
High-risk/mop-up campaigns
Pakistan Catch-up Campaign
• Phase 1
• Mar 2007
•1 district in 4 provinces (2.6M target)
• Phase 2
• Jul 2007
• parts of NWFP, Baluchistan, Fana, AJK (8.2M)
• Phase 3
• Aug 2007
• Finish NWFP, Bal, AJK (5.3M)
•Phase 4
• Nov 2007 (13.6M)
• Sindh
• Phase 5
• 1st Qtr ’08 (34.0M)
• Punjab
Second Dose of Measles Immunization in
EMRO, 2005
• 19 countries with 2 dose schedule
 12 at 12 –24 mos
 7 at 4-6 yrs
 16 use MMR
Palestine
Bahrain
 1 countries with periodic SIAs
 2 countries with periodic SIAs and
2 dose schedule
 2 countries with no second
opportunity
Routine second dose
1 dose + SIAs
2 doses + SIAs
1 dose schedule
Measles Surveillance in EMRO
Palestine
Bahrain
Case based (17)
Case-based, needs to be improved (3)
Aggregate data (2)
Status of Measles Reporting in
EMRO, Jan-Dec, 2006*
No.
Total
countries susp
reporting cases
20 (90%)
19,950
Total
with
lab
test
7031
No. labconf
measles
No. epi- No.
Total
linked
clinical measles
measles measles
2259
935
* Provisional data, reporting not complete
9750
12,944
Feedback of Surveillance and Coverage Data

Monthly Bulletin
 Case counts by country and
case classification

Key indicators

Mapping through EPIINFO
• Website
MeaslesImmunisation Status of Age Groups in Sud 2005
100%
• Monitoring of susceptibility
profiles
80%
60%
40%
20%
0%
23
22
21
20
19
18
17
16
Protected by 1st Dose
Protected in Campaigns
15
14
13
12
11
10
9
8
7
6
5
4
Age in 2005
Protected by 2nd Dose
Never Protected
3
2
1
Outline

Regional progress in measles elimination

Key constraints

Indicators to monitor measles elimination in EMR
Key Constraints in Regional Elimination

Lack of national support for elimination

Competing priorities


Insecurity
Resource mobilization for non-GAVI countries
 Egypt, Morocco, Syria

Failure of keep-up strategies

Limited use of surveillance data
Measles Case Counts and Vaccination
Coverage, 1988-2005, Saudi Arabia
Catch-up campaigns
12-18 yrs 6-13 yrs
15000
100
90
70
10000
60
50
40
5000
30
20
10
0
0
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
Year
Coverage
Measles cases
80
Age Distribution of Measles Cases in
Saudi Arabia, Jan-Dec 2006
15%
19%
< 1 yr
7%
1 to 4 yrs
5 to 9 yrs
14%
10 to 14 yrs
33%
15-20 yrs
12%
n=697
5% vaccinated
> 20 yrs
Age Distribution and Vaccination Status of Measles
Cases in Selected EMR Countries, Jan-Dec 2006
5%
15%
2%
8%
22%
11%
5%
20%
19%
25%
< 1 yr
31%
37%
Egypt n=998
Syria (n=462)
96% vaccinated
48% vaccinated
14%
15%
18%
4%
1 to 4 yrs
5 to 9 yrs
10%
10 to 14 yrs
5%
5%
15-20 yrs
17%
42%
26%
23%
21%
Qatar (n=108)
Lebanon (n=843)
54% vaccinated
20% vaccinated
> 20 yrs
Geographic Distribution of Measles Cases, Jan-Dec ‘06
Outline

Regional progress in measles elimination

Key constraints

Indicators to monitor measles elimination
Indicators for Measles Elimination
Recommendations from EMR-TAG, 2006
Completeness of reporting
Indicator: > 80% of districts reporting on a monthly
basis
Sensitivity of reporting system
Indicator: At least 2 suspect cases (excluding lab and
epi-confirmed measles and rubella) per 100,000
population at the national level.
Adequacy of laboratory testing
Indicator: > 80% of suspect measles cases are tested
for measles IgM antibody, excluding cases
epidemiologically linked to a laboratory confirmed
case from the denominator
Indicators for Measles Elimination
Recommendations from EMR-TAG, 2006
Adequacy of epidemiologic investigation*
Indicator: > 80% of suspect measles cases have an
adequate epidemiologic investigation*.
Adequacy of laboratory testing
Indicator: > 80% of measles virus outbreaks and chains
of transmission chains (outbreaks) have sufficient*
samples for viral isolation
*An adequate investigation includes at a minimum the suspect cases
with all of the following data elements; date of rash onset,
specimen collection, date of specimen collection, vaccination
status, date of last vaccination, age, and district)
Completeness of Reporting to Regional Office,
Countries Reporting on a Monthly Basis, 2006
Palestine
Bahrain
Reporting on a timely basis (n=16)
Delayed reporting (n=4)
Inconsistent/not reporting (2 countries)
20
15
10
Proposed regional target 2/100,000
+ Suspect cases – lab and epi confirmed cases
* Adjusted for annualized rate
Pak
Kuw
Tun
Syr
Lib
Sud
UAE
Irn
Ira
KSA
Leb
Dji
Mor
Pal
Egy
Jor
Som
Afg
Qat
Bah
0
Oma
5
Yem
Measles cases per 100,000
Suspect Cases+ per 100,000 in EMR,
Jan-Dec-2006*
25
Serologic Testing of Suspect Cases (Jan-Dec ’06, EMR)
Indicator: > 80% of suspect cases with testing
Palestine
Bahrain
> 80% of suspect cases (10 countries)
50-80% (3 countries)
< 50% (7 countries)
Not reporting (2 countries)
Adequacy of Epidemiologic Investigation, Jan-Dec ’06 EMR
Indicator: >80% of measles case reports with complete investigation
Palestine
Bahrain
> 80% (6 countries)
50-80% (5 countries)
< 50% (6 countries)
Not reporting (5 countries)
Recommended Criteria for Measles Elimination
EMR-TAG, 2006
 Measles incidence of < 1 confirmed case per million
per year, excluding cases confirmed as imported.
 All districts with > 90% vaccination coverage for the
first dose of measles vaccine and 95% coverage
national coverage for the second dose.
 90% of outbreaks are < 10 cases in size
 Epidemiologic and laboratory data indicate that
measles viruses are imported.
* provisional
m
r
l
Tu
n
Jo r
Ir n
Pa
Lib
Ir q
Eg
y
UA
E
Om
a
Su
d
Ba
h
Sy
KS
A
Mo
r
Dji
So
m
Afg
Qa
t
L eb
Ye
Measles cases per 1,000,000
Measles Cases per Million in EMR,
Jan-Dec-2006*
250
200
150
100
50
0
MCV1 Coverage*
Indicator: > 90% coverage in all districts
Palestine
Bahrain
MCV1 > 90% in all districts (7 countries)
MCV1 > 80% in all districts (2 countries)
MCV1 > 50% in all districts (4 countries)
MCV1 < 50% in some districts (8 countries)
* Based on 2005 JRF, data is unavailable for Lebanon
Summary
•
Considerable progress in mortality reduction
• Pak campaign will reduce further
•
Few countries are close to elimination
•
Several countries with large outbreaks
• Failure of “keep-up” strategies
•
SIAs are playing an important role to achieve
elimination
Summary
•
Surveillance is improving
• Impact on program activities
•
Countries have accepted agreed upon
indicators
•
RTAG will address issue of “certification”
Priority Activities
•
Advocacy
• Raising awareness of national health authorities
• Development of country-level TAGs
• Certification process?
•
Surveillance
• Revisit regional reporting format
• Outbreak surveillance
• Source of infection
• Genotyping
•
Achieving high population-based immunity
• Better monitoring of routine EPI data
• Achieving and monitoring high MCV2 coverage
• Monitoring susceptibility profiles at sub-national levels
EMR MCV Coverage and Percent of
Games Won-Chicago Cubs, 1995-2006
Percent
100
75
Cubs
EMRO
50
25
0
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
Year