Transcript Slide 1

Progress towards Sustainable Measles
Mortality Reduction
South-East Asia Region
Jayantha Liyanage
Medical Officer- EPI
Immunization and Vaccine Development
WHO/SEARO
IVD
IVD
IMMUNIZATIONIMMUNIZATION
AND VACCAND
INEVACC
DEVELOPMENT
INE DEVELOPMENT
Presentation structure
• Progress towards the regional
goal
• Summary of achievements and
main challenges
• Plans for 2007-08
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
South-East Asia Region
• 11 diverse countries
• 1.6 billion; 25% of world’s population
• Massive immunization burden
>500 million children aged <15 years
35 % (11 million infants) un-immunized with 1st
dose of measles vaccine
• Polio endemic
However there is reasonable human resources for
EPI in most countries at most levels
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
Regional Strategic Plan 2006-2009
Goal
By 2009 reduce the number of estimated
measles deaths by 90% in comparison to
2000
Specific objectives
• 1st dose measles coverage >90%, nationally
and in >80% of districts by 2009
• Fully investigate all detected/reported
measles outbreaks
• Case based measles surveillance within
integrated surveillance systems in countries
that completed catch-up campaigns
• Provide a second opportunity for measles
immunization
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
WHO/UNICEF estimates for MCV1 coverage 2001-05
Regional coverage increased from 59% in 1999 to 65% in
2005
MCV1 Coverage (%)
100
80
60
40
20
0
BAN
BHU
DPRK
2001
IND
INO
2002
MAV
MMR
2003
NEP
2004
SRL
THA
TLS*
2005
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
Continue to use the surveillance staff in five priority
countries in measles surveillance and SIAs
Country
Bangladesh
Number of
Surveillance
Medical Officers
(SMO) and
Coordinators
Number of
Laboratories
Polio
Measles
SMO (43)
1
1
Bhutan
Govt.
-
1
DPR Korea
Govt.
1
1
SMO (307)
8
3
Indonesia
SO (37)
3
4
Maldives
Govt.
-
1
Myanmar
SMO (20)
1
1
Nepal
SMO (10)
-
1
Sri Lanka
Govt.
1
1
Thailand
Govt.
1
1
Timor-Leste
Govt.
-
1
421
16
16
India
Total
IVD
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health
Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted
UpdatedIMMUNIZATION
Sep 2006
lines on maps represent approximate border lines for which there may not yet be full agreement.  WHO 2005. All rights reserved
AND VACCINE DEVELOPMENT
Reported incidence rates of clinically confirmed
measles cases in selected countries 2000-05
Incidence rate per 100,000 population
60
50
40
30
20
10
0
2000
2001
2002
2003
2004
2005
2006
Year
Bangladesh
India
Indonesia
Nepal
Thailand
Timor-Leste
Source: WHO/UNICEF JRF 2000-2004; Monthly Reporting Form, 2005-2006
Data as of 19 Feb 2007
Myanmar
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
Status of SEAR measles laboratory network
• 16 National Measles laboratories – Expansion in
India continues
• 1 Regional reference laboratory – NIH Bangkok
• GSL for SEAR - CDC Atlanta
• Labs perform IgM ELISA confirm Measles / rubella
• Virus isolation in Vero SLAM - 6 labs in the region.
• Isolates referred to RRL / GSL - CDC for genotyping
• 2006 Proficiency testing – 14 laboratories
participated – 13 laboratories passed
• Data management software - MLIS developed
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
Measles and Rubella Serology (IgM) Results in 2006
All laboratories report data monthly
Country
Laboratories
Dhaka
Thimphu
Pyongyang
Chennai
India
Bangalore
Coonoor
India Total from three labs
Bandung
Jakarta
Indonesia
Surabaya
Yogyakarta
Indonesia Total from four labs
Male'
Maldives
Yangon
Myanmar
Kathmandu
Nepal
Colombo
Sri Lanka
Thailand
Bangkok 3
Dilli
Timor-Leste
Total
Bangladesh
Bhutan
DPR Korea
Number of
Serum Samples
Received1
448
67
14
366
169
0
366
215
151
394
101
861
17
254
214
73
481
NR
2795
Number
Tested for
Measles &
Rubella
448
62
14
350
169
0
519
215
151
294
101
761
17
254
214
73
481
NR
2781
Positive Results 2
Measles
#
198
2
0
273
141
0
414
168
123
214
11
516
0
203
7
0
196
NR
1534
%
44.2
3.2
0.0
78.0
83.4
0.0
79.8
78.1
81.5
72.8
10.9
67.8
0.0
79.9
3.3
0.0
40.7
NR
55.2
Rubella
#
164
9
0
14
1
0
15
24
16
14
61
115
9
0
106
2
24
NR
444
%
36.6
14.5
0.0
4.0
0.6
0.0
2.9
11.2
10.6
4.8
60.4
15.1
52.9
0.0
49.5
2.7
5.0
NR
16.0
Number of Samples
Negative for Measles
and Rubella 2
#
%
74
16.5
50
80.6
14
100.0
48
13.7
23
13.6
0
0.0
71
13.7
22
10.2
12
7.9
65
22.1
30
29.7
129
17.0
8
47.1
35
13.8
75
35.0
69
94.5
192
39.9
NR
NR
717
23.9
Number of
Outbreaks
Investigated, If
Known
82
0
0
70
34
0
104
32
21
47
18
118
0
19
31
1
4
NR
277
Date of Last
Report
Received in
SEARO
7-Jan-07
10-Jan-07
11-Dec-06
8-Jan-07
2-Jan-07
10-Nov-06
2-Jan-07
3-Jan-07
5-Jan-07
9-Nov-06
12-Jun-06
11-Dec-06
10-Jan-07
8-Jan-07
9-Jan-07
NR
1
Samples from fever & rash cases are first tested for measles; negative samples are then tested for rubella.
Source: Reported by SEAR Measles Laboratory Network
Percentages may not add to 100%; Equivocal results not included and some samples are in process with results pending.
2
3
Includes samples not tested for measles first but tested for rubella only.
NR=No Report
IVD
Data as of 31 IMMUNIZATION
Dec 2006
AND VACCINE DEVELOPMENT
Number of suspected measles Outbreaks
Investigated SEAR, 2003-2006
250
200
150
100
50
2003
2004
2005
Source: SEAR EPI Annual Reporting Form, 2003-2005; Monthly Reporting Form, 2006 (Feb 2007)
Data as of 19 Feb 2007
Ti
m
or
-L
es
te
ai
la
nd
Th
ep
al
N
ar
M
ya
nm
M
al
di
ve
s
In
d
on
es
ia
ia
In
d
hu
ta
n
B
an
g
la
de
sh
0
B
Number of Outbreaks Investigated
300
2006
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
Vaccine Preventable Diseases reported to SEARO
2006
10 out of 11 countries are reporting monthly
Measles
Routine
Measles Outbreak
Number of Number of
cases
outbreaks
Bangladesh2
Number of
cases
Timeliness and Completeness of reports
received in SEARO, 2006
Number of Cases
Measles
Deaths4
NT
Dipththeria
Pertussis
Rubella
Encephalitis
Number
of cases
of AEFI5
Date of last
report
Number of
% Complete- % Timelireports
ness
ness
expected
2283
51
3942
44
265
35
46
3389
0
2076
15-Feb-07
12
100
100
Bhutan
0
0
0
0
1
0
1
0
0
11
14-Feb-07
12
83
50
DPR Korea
0
0
0
0
0
0
260
63
0
0
21-Dec-06
12
75
33
NR
India
NR
NR
NR
Indonesia
20304
81
1472
Maldives
43
0
0
Myanmar
301
23
2
NR
NR
NR
NR
NR
NR
NR
12
0
0
113
146
2131
0
0
0
14-Feb-07
12
67
50
0
0
0
0
0
0
13
13-Dec-06
12
83
67
459
4
45
2
0
0
0
6
19-Feb-07
12
100
92
411
3
629
0
15
0
0
0
1479
33
14-Feb-07
12
100
100
Sri Lanka
41
0
0
0
1
0
67
6
131
3972
09-Feb-07
12
33
17
Thailand
3121
6
501
1
3
2
96
414
255
74
19-Dec-06
12
100
50
24
0
0
0
1
1
22
0
0
0
15-Dec-06
12
50
25
7003
49
444
186
2623
3872
1865
6185
Nepal
Timor-Leste
Total
26528
1
During the ninth TCG Meeting 2003, SEAR member countries agreed to monthly VPD reporting to SEARO/IVD.
2
In Bangladesh & Nepal, measles outbreaks may include rubella and mixed (measles and rubella) outbreaks.
4
Includes routine and outbreak reporting.
5
Adverse Events Following Immunization.
3
Source: Monthly Reports from Countries
Data as of 19 Feb 2007
Reporting to SEARO/IVD: Timeliness determined by the receipt of data on or before 15th of each month.
NR=No Report
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
Age distribution of measles outbreaks
Target age group for SIA was based on country age
distribution of cases
Country
Year*
Bangladesh
2005
10146
13.4
36.2
33.6
10.8
5.8
Target
Age group
for SIA
9 M-10Y
DPR Korea
2007
2257
4.3
5.3
12.3
30.5
47
6 M-45Y
Indonesia
2005
2393
12.4
52.3
31.5
3
0.7
6 M-12Y
Myanmar
2004
1639
7.1
45.8
39
7.1
1
9 M-10 Y
Nepal
2004
6050
5.4
36.6
38.7
14.5
4.5
9 M-15 Y
Maldives
2005
2000
1395
6,392
4
7.7
8.6
25.4
54.3
6-25 Y
7.7
5.3
16.3
16
54.8
10-20Y
Sri Lanka
Number
of
cases**
Age (yrs) distribution of cases (%)
≤1
1-4
5-9
10-14
≥15
Source: Annual EPI Reporting Form
*Most recent year of outbreak in country
**Country Report
*** only the cases with age known considered
Updated as of 19 Feb 2007
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
Second Opportunity for Measles Immunization,
SEAR, 2007
Measles 2nd Opportunity through
Measles 2nd Opportunity through
Routine Immunization
Catch-up/Follow up Campaigns
4 Countries providing MR/MMR
Catch-up Campaigns completed
Catch-up/Follow-up Campaigns planned in
2007
Data as of: Feb 2007
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
Number of children vaccinated during measles SIA
2000-06 and planned SIAs in 2007- SEAR
120 million would be vaccinated by August 2007
Planned
50,000,000
45,000,000
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
2000
2002
2003
Indonesia
Nepal
Bhutan
2004
2005
Myanmar
Bangladesh
DPR Korea
2006
2007
Sri Lanka
Maldives
Timor Leste
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
Strengthening of measles surveillance and Impact of
measles catch-up campaign Bangladesh, 2003-2006
Clinically confirmed
cases
Measles Catch-up
Campaign
Source : Monthly VPD MDB submitted to SEARO
Data as of 19 Feb 2007
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
Cases reported from serologically confirmed suspected
Measles Outbreaks Bangladesh, 2005-2006
4000
After the SIA
•Few measles outbreaks.
•Rubella outbreaks continue to be detected
3500
3000
2500
Measles Catch-up
Campaign
2000
1500
1000
500
2005
Outbreak - Measles
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
0
2006
Outbreak - Mix (Measles & Rubella)
Outbreak - Rubella
Source : Monthly VPD XLS
Data as of 19 Feb 2007
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
Strengthening of Measles surveillance and impact of measles
catch-up campaign, Nepal, 2003-2006
Number of outbreaks
1800
1600
1400
1200
1000
Types of outbreaks
2004
2005
2006
Total outbreaks
reported
195
39
27
Serologically
confirmed Measles
137
1
3
Serologically
confirmed Rubella
13
36
24
Serologically
confirmed Mixed
11
2
0
800
Measles Catch-up Campaign
Phase1 Phase2 Phase3
600
400
0
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
200
2005
2004
2003
Outbreak
Data as of 19 Feb 2007
2006
Routine
Source: Monthly VPD MDB
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
Adding other interventions to measles SIAs
Country
Year
Measles
Rubella
Sri Lanka
2004
√
√
Nepal
2004/05
√
Maldives
2005
√
√
Bhutan
2006
√
√
2005
√
Indonesia
√
2006
OPV
Vit A
Bed
nets
Under 5 Y
Nationally
Under 5 Y
in 2
provinces
6-59 M
In 2
provinces
Under 5 Y
in 9
provinces
6-59 M
In 9
provinces
Selected
districts in 8
provinces
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
Summary of achievements
• Large countries emphasis on strengthening
routine immunization and enhancing coverage
• Established integrated surveillance and regional
lab network (16 labs)
• Major increase in reporting and outbreak
investigations
• Catch up campaigns; above 95% coverage
Notable examples: Nepal , Bangladesh, Bhutan,
Indonesia
• Built strong partnerships: SEAM
• Identifying disease burden due to Rubella
• Integration of some public health interventions
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
Challenges/Issues
• Finishing polio
–
India and Bangladesh
• Funding for sustaining surveillance net works
and SIAs in India
• Coordinate integration in large countries
– Established programmes go alone
• e.g Vit A distribution in Nepal, Bangladesh and Myanmar
– Logistic difficulties in delivering bed nets in time
– Non availability of adequate stocks of OPV for large
countries
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
Plans for 2007-08
• India will be the focus
• Improving routine immunization to sustain gains of SIAs
– c MYP
– GAVI funded activities
• Surveillance
– Initiate case based surveillance after SIA
• Nepal and Bangladesh in 2007
• Indonesia and Myanmar in 2008
– India: Gradual expansion of measles surveillance to more states
– Improving the monthly reporting to SEAR and commence
monthly reporting to HQ
• WHO/UNICEF to ensure adequate technical support to
the countries
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
SIA plan 2007-08
Country
Time
Target area
Age
group
Target
Integrated
Interventions
February
Java Island
(catch-up)
6 M -12 y
14,800,000
Vit A, OPV
August
Remaining
islands
(Catch-up)
6 M -12 y
5,400,000
ITNs, Vit A,
OPV
Jan, Mach
May
National
(Follow-up)
9 M -5 Y
7,100,000
March April
National
(Catch-up)
9 M-45Y
16,200,000
Vit A
Nepal *
Q4
National
(follow-up)
9-59 M
3,700,000
? Vit A, ?OPV
Timor
Leste *
2008
National
(Catch-up)
9 M-15 Y
400,000
? OPV
India**
2008
1-2 states
(Catch-up)
9M-10 Y
29,000,000
? OPV
YEAR 2007
Indonesia
Myanmar
DPRK
Year 2008
* Subject to government confirmation
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT
THANK YOU
IVD
IVD
IMMUNIZATIONIMMUNIZATION
AND VACC
INE DEVELOPMENT
AND VACCINE DEVELOPMENT
Building on AFP Surveillance to Support Measles
and Other VPD Surveillance, SEAR - 2007
Measles Surveillance
Surveillance
Medical
Officers
(SMO)
Monthly VPD
& AEFI
Monthly Data
Reporting to Data Collection Reporting to
at National Level
SEARO***
SEARO
Surveillance
Type**
SMO (43)
Active (VPD)
Yes
Case-Based
Bhutan
Govt.
Passive
Yes
DPR Korea
Govt.
Passive
SMO (307)
Indonesia
Surveillance
Integrated
with AFP
Labs
Reporting
Monthly
Serology
Results
Case-Based
Yes
1
Aggregate
Aggregate
Yes
1
Yes
Aggregate
Aggregate
Yes
1
Passive
No
Aggregate
NR
No
3
SO (37)*
Passive (limited
active)
Yes
Aggregate
Aggregate
In-process
4
Maldives
Govt.
Passive
Yes
Aggregate
Aggregate
Yes
1
Myanmar
SMO (20)*
Active (VPD)
Yes
Case-Based
Case-Based
Yes
1
Nepal
SMO (10)
Active (VPD)
Yes
Case-Based
Case-Based
Yes
1
Sri Lanka
Govt.
Active
Yes
Case-Based
Aggregate
Yes
1
Thailand
Govt.
Passive
Yes
Aggregate
Aggregate
Yes
1
Timor-Leste
Govt.
Passive
Yes
Aggregate
Aggregate
Yes
NR
Country
Bangladesh
India
* Surveillance Officers partially supported by WHO
** Active surveillance also has passive surveillance components
*** Countries submitting case-based also submit monthly aggregate
IVD
Updated September 2006
IMMUNIZATION AND VACCINE DEVELOPMENT
17 SEAR Measles laboratory
Accreditation status 2006
Country
Laboratory
Accreditation status
Bangladesh
Dhaka
Accredited
Bhutan
Thimpu
Provisionally accredited
DPRK
Pyonang
Pending
India
Bangalore
Due in 2007
Chennai
Accredited
Coonoor
Accredited
Hyderabad
Due in 2007
Bandung
Accredited
Jakarta
Accredited
Surabaya
Accredited
Yogyakarta
Accredited
Maldives
Male
Not accredited
Myanmar
Yangoon
Accredited
Nepal
Kathmandu
Provisionally accredited
Thailand
Bangkok
Accredited
Timor Leste
Dilli
Not operational
Srilanka
Colombo
Accredited
Indonesia
IVD
IMMUNIZATION AND VACCINE DEVELOPMENT