Transcript Africa Regional Workshop – Coordinated approaches to

12th Annual Meeting
The Measles & Rubella Initiative
Western Pacific Regional Update:
The Final Push
10-11 September 2013
American Red Cross
National Headquarters
Washington, DC
1
Regional Measles and Rubella Goals
• 2003: Measles elimination to be used to
strengthen routine immunization
• Sept 2005: By 2012, the Region should aim to
eliminate measles;
• Oct 2010: Reaffirms the 2012 measles elimination
goal and calls to accelerate control of rubella and
the prevention of congenital rubella syndrome;
• Sept 2012: Reaffirms the commitment to
eliminate measles and accelerate rubella control;
Technical Advisory Group on Immunization
Recommendations, June 2013
• Measles
– The TAG urges countries to make intensified efforts to
accelerate progress towards achieving and sustaining
measles elimination.
• Rubella
– The TAG recommends establishing a regional goal of
eliminating rubella, with a target date to be determined
Measles and rubella reported cases and
coverage of MCV1 and MCV2, 1980-2012
1400
100%
90%
1200
80%
1000
70%
60%
800
50%
600
40%
30%
400
20%
200
0
10%
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Measles cases
Rubella Cases
4
Source: WHO-UNICEF Joint Reporting Form (data for 2012)
0%
Measles Cases by Month and Year, Region, 2008-Jul 2013
Number of measles cases
30 000
25 000
20 000
15 000
10 000
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
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
5 000
2008
2009
China
Source: National measles and rubella monthly report
2010
Japan
Philippines
2011
Viet Nam
2012
2013
Others
Data as of 20 August 2013
Measles incidence per million population by
country/area, WPR, 2013*
30
28
26
24
22
Incidence rate
20
18
16
14
12
10
8
6
4
2
0
BRN
KHM
MNG
PNG
PIC
NEZ
JPN
VNM
AUS
KOR
HOK
SGP
MAC
PHL
MYS
LAO
CHN
6
*Annualized as of July 2013
Source: National measles and rubella month reports as of 20 August 2013
2013年麻疹疫情回升
The resurgence of measles in 2013
Reported incidence and confirmed Measles Cases,
by Province, China, 2013*
2013年1～5月全国各省麻疹发病率
measles incidence by province in 2013 from JAN to MAY
2013年1～5月全国麻疹病例按区县分布（1点=1病
例）
measles distribution by county in 2013 from JAN to
MAY (1dot equals 1case)
* Source: National Notifiable Disease Reporting System , data through May
数据截至2013年5月
Measles cases by age group and vaccination status,
China, January - May 2013
Source: National surveillance report as of May 2013
数据截至2013年5月
Select Recommendations from National / International
Consultation on Measles, China, June 2013
• Provincial (or smaller) SIAs needed to fill
immunity gap
• Survey population coverage among young
children at national and subnational levels
• Develop stronger immunization practice
standards to reduce missed opportunities
• Reduce nosocomial transmission of
measles by reducing admissions, isolating
cases, and vaccinating health workers
Confirmed Measles Cases, Lao PDR and Viet Nam, 2013
Legend:
Cases with onset in 2013
Cases with onset in 2012
1 dot = 1 case
Source: National measles and rubella report as of 20 August 2013
Confirmed measles cases by month of rash onset, Philippines, 2013
1800
1600
Number of measles cases
1400
1200
1000
800
600
400
200
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
Jan
Feb
Mar
Apr
May
Jun
Jul
0
2009 (N=1490)
Lab & Epi=668
Clinically=822
2010 (N=6388)
Lab & Epi=3020
Clinically=3368
Laboratory
*National measles and rubella monthly reports as of 20 August 2013
2011 (N=6555)
Lab & Epi=3411
Clinically=3144
Epi-Linked
2012 (N=1441)
Lab & Epi=601
Clinically=840
Clinically
2013 (N=410)
Lab & Epi=410
Laboratory and epi-linked confirmed measles cases by province,
Philippines, 2012 and 20131
2012
2013
1 dot = 1 case
1National
measles and rubella monthly reports from January to July 2013
Dots are placed at random within the corresponding
province, and might not reflect the exact location of the case.
Laboratory and epi-linked confirmed measles cases by age group and
vaccination status, Philippines, 2013 (N=410)
250
Measles cases
200
150
100
50
0
<1 yr
1-4 yrs
5-9 yrs
0 dose
*National measles and rubella monthly reports as of 20 August 2013
10-14 yrs
1 dose
15-24 yrs
≥2 doses
25-39 yrs
Unknown
≥40 yrs
Confirmed measles cases by month of onset,
Malaysia, 2008–2013
300
Number of measles cases
250
200
150
100
50
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
Jan
Feb
Mar
Apr
May
Jun
Jul
0
2009 (N=56)
Lab & Epi=55
Clinically=1
2010 (N=74)
Lab & Epi=70
Clinically=4
Laboratory
*National measles and rubella monthly reports as of 20 August 2013
2011 (N=1603)
Lab & Epi=1556
Clinically=47
Epi-Linked
2012 (N=1868)
Lab & Epi=1712
Clinically=156
Clinically
2013 (N=140)
Lab & Epi=140
Laboratory and epi-linked confirmed measles cases,
Malaysia, 2012–20131
2012
1 dot = 1 case
2013
Source: National measles and rubella monthly country reports
1 Reports received for January to July 2013
*Dots are placed at random within the country,
and might not reflect the exact location of the case.
Laboratory and epi-linked confirmed measles cases by age
group and vaccination status, Malaysia, 2013 (N=140)
60
Measles cases
50
40
30
20
10
0
<1 yr
1-4 yrs
5-9 yrs
0 dose
*National measles and rubella monthly reports as of 20 August 2013
10-14 yrs
1 dose
15-24 yrs
≥2 doses
25-39 yrs
Unknown
≥40 yrs
Verification of Measles Elimination
• Guidelines for verification finalized in March
2013
• First annual progress reports due 1 October
2013
– 5/16 National Verification Committees may
request verification of elimination: Australia,
Japan, Korea, Macao, Mongolia
• Training for the Subregional Verification
Committee for the Pacific islands in
September 2013
18
World Immunization Week: No more measles, for anyone
WIW launching in
Brunei Darussalam
WIW launching at Western Pacific
Regional Office by the Regional Director,
Dr Shin Young-soo
19
National MCV1 coverage and percentage of district with >=80% MCV1
coverage in non-pacific countries, WPR 2012
100
CHN
CH
N
MNG
MNG
VNM
VN
M
KHM
KOR
HOP
SG
K
AU
S
AUS
KH
M
MAC
MAC
90
NE
Z
NEZ
MYS
PHL
MYS
80
PH
L
LAO PDR
70
LA
O
PNG
30
40
50
60
PN
G
30
40
Source: WHO-UNICEF Joint reporting Forms
50
60
70
district_coverage
80
90
100
MCV2 introduction into routine EPI in (region) 2013
Only 5 countries or areas have not yet introduced
MCV2:
• Kiribati
• Lao People’s Democratic Republic
• Papua New Guinea: 2013 GAVI application
• Solomon Islands
• Vanuatu
With MCV2
With no MCV2
Measles SIAs in 2013,
Western Pacific Region
LEGEND
2013 (KHM, FSM (Chuuk State) & VUT)
2013-2015 SIA plans and budget
Vaccine
Target
Age
Dates
Geographic
Extent
Micronesia
MR
9-59 m
Jul
2013
Chuuk State
CDC/MoH
Vanuatu
MR
9-59m
Aug
2013
Nationwide
MRI/MoH
Cambodia
MR
9m-15y
Q4
2013
Nationwide
Viet Nam
MR
9m-15y
Q2 2014Q4 2014
Nationwide
Philippines
MR
9-59 m
Aug
2014
Nationwide
Lao PDR
MR
9-59 m
Q4
2014
Nationwide
Country
2014: FSM (Pohnpei State); Vanuatu (5-15 years);
2015: Papua New Guinea; Solomon Islands
Other
intervention
OPV, Vit A
Funding
source
GAVI
GAVI
OPV
MoH
MRI
23
Indicators of Progress Towards Measles Elimination and
Rubella Control, Western Pacific Region 2008-2013¹
Target
2013
2012
2011
2010
2009
2008
Incidence (% countries < 5 per million
population)
71%
59%
41%
59%
47%
53%
Incidence of confirmed measles per
million population2
21.7
5.9
11.7
27.0
34.0
81.6
4.3
2.4
2.8
1.7
2.8
1.6
38%
35%
40%
28%
23%
22%
96%
91%
73%
70%
71%
80%
% countries with MCV1 ≥90%
76%
70%
66%
57%
71%
% countries with MCV1 ≥80% in all dist
63%
41%
46%
46%
58%
Category
Low measles incidence
High quality surveillance
National reporting of discarded measles
cases
> 2 per
100,000
% of 2nd level admin units reporting
≥ 2/100 000 discarded measles cases
> 80%
% of suspected cases with adequate
blood specimens
> 80%
High population immunity
¹ Data as of August 2013
2 Only lab and epi linked cases for 2013
Source: WPRO surveillance database and WHO-UNICEF JRF
Rubella-containing vaccine introduction in (region) 2013
Only 4 countries and areas have not introduced
RCV in RI in 2013:
• Cambodia: 2013 MR SIA (9 mos to <15 years)
• Papua New Guinea: 2013 GAVI application
• Vanuatu: 2013 MR SIA (9 to 59 months)
• Viet Nam: 2014 MR SIA
With RCV
With no RCV
26
MRI Support Needed
• Achieving measles elimination goal
– China, Malaysia, Philippines
• Regional rubella elimination goal
• SIAs
– Lao follow up campaign
– Vanuatu (6-15 years)
– Kiribati, Samoa, Tuvalu
• Surveillance sensitivity
– Pacific islands countries, Papua New Guinea, Viet Nam
27
Acknowledgements
• China CDC (slides 7-9)
• NIID, Japan (slide 26)
28
29
Number of countries with MCV1 coverage of at least 90%,
WPR, 2008-2012
35
30
Number of countries
25
20
15
10
5
0
2008
Source: WHO-UNICEF Joint reporting Forms
2009
2010
Year
2011
2012