Transcript Guidance on rubella control, SAGE, April 2011

Global Overview of Measles & Rubella
11th Annual Meeting
The Measles Initiative
Washington, DC
18-19th September, 2012
Major causes of annual under 5yrs child mortality: 1990-2010
1990: 12.1 million
2000 : 9.6 million
2008: 8.8 million
2010 : 7.6 million
Source: Van den Ent et
al, J Infect Dis Suppl July 2011
Source: Li, Liu, at all
The Lancet 379, June 9, 2012):
800
1000
Estimated measles deaths down by three - quarters, 2000 - 2010
0
200
400
600
74%
2015 Target
2000
2001
2002
2003
2004
Estimated mortality
2005
Year
2006
2007
2008
2009
95% confidence interval
2010
Trends in 1st and 2nd dose Measles delivery
various strategies
Number of MCV doses (in millions)
500
450
400
Number of doses of measles vaccine administered,
by delivery strategy, 2000-2010
350
Measles Initiative
300
1 billion vaccinated
as of July 2011
250
200
150
100
50
0
2000
2001
2002
2003
2004
1st routine dose
4|
2005
2006
2007
2nd routine dose
2008
SIA
1st routine dose: WHO/UNICEF coverage estimates, The World
Population Prospects New York, 2011. 2nd routine dose:
WHO/UNICEF Joint reporting form, (not all countries report 2nd
dose). SIA dose;: WHO SIA database, July 2011 (Provisional data)
2009
2010
Measles
and other interventions supplementary activities, 2011
Legend
maskline_general
COUNTRY
Abyei border
Abyei border1
Bline_Kosovo
Bline_Sudan
Cont_ja_ka
Fline
Gaza
0
1,625
3,250
6,500 Kilometers
South_sud
Wline
Measles_SIAs
<all other values>
Measles_2011_2012.ImpStatus
<Null>
MR
OPVMeasles
OPVVitAMeasles
VitADewormingMeasles
VitAMeasles
all*
measles
maskpoly_general
*OPV+VitA+Deworming+Mealses
AREA
Abyei
Jammu and Kashmir
Vitamin A – 12
De-worming – 10
Bed nets – 2
OPV – 16
Other interventions -5
WHO;August 2012
Annual Number of Reported Measles Cases and 1st Dose Measles
Vaccination Coverage, Worldwide, 1980-2011
number of cases
100
4,500,000
90
4,000,000
80
3,500,000
70
3,000,000
60
2,500,000
50
2,000,000
40
1,500,000
30
1,000,000
20
500,000
10
Number of cases
6|
WHO/UNICEF estimates
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
0
1980
0
84%
immunization coverage (%)
2015 Target
5,000,000
Reduction in Estimated Measles Deaths by
WHO Region 2000 to 2010
26%
100%
87%
79%
85%
76% 74%
78%
2010 reduction goal (90%)
7|
Source: WHO/IVB, November 2009
Pareto-Juran principle
20% of the work (the first 10% and the
last 10%) consume 80% of your time
and resources
8|
India
14 states with MCV1 < 80% are
implementing measles SIAs
Phase 1 (45 districts covered)
JA M M U & K AS H M IR
Phase 2 (157 districts)
H IM A C H A L
PR A D E SH
PU N J A B
C H AN D IG AR H
Remaining (159 districts)
U TTA R AK H A N D
H AR Y A N A
17 states with MCV1 coverage
≥ 80% introduced a routine
second dose by August 2011.
D ELH I
AR U N A C H A L P R .
SIK K IM
U TTA R PR A D E SH
R AJ A ST H AN
AS S AM
B IH AR
N AG AL AN D
Target
pop
(millions)
Vaccinated
(millions)
Coverage
Phase-1
13.8
12.1
88%
Phase-2
42.9
28.6
67%*
Phase-3
72.7
Planned
--
Total
129.4
40.7*
--
ME GH A LA Y A
MA N IP U R
JH A R K H A N D
TR IPU R A
MA D H Y A P R A D E SH
WE ST B EN G AL
MIZ OR A M
GU J A R AT
C H H AT TISG AR H
OR IS SA
D AM A N & D IU
D & N H AV E LI
MA H A R A SH TR A
AN D H R A P R AD E S H
GOA
K AR N A TA K A
A& N IS LA N D S
PO N D IC H ER R Y
TAM IL N A D U
LAK SH A D W EE P
K ER A LA
9|
Source: Based on target population available with GoI
* Phase-2 campaigns ongoing; data as on 23 Jan 2012.
Measles and Rubella Elimination Goals
by WHO Region, February 2012
Americas, Europe, E. Mediterranean, W. Pacific, Africa have measles elimination goals
Americas and Europe have rubella elimination goals
2015
2015
2000
2010
2015
2020
10 |
2012
SEAR: 95%
Mortality
Reduction by
2015
Challenges 1: Communication
Political advocacy,
mobilizing decision makers
Point of
service
promotion
Inter-personal
communication
Targeted selling
Volunteer Social
Mobilization
Networks
Branding,
advertising &
Researched &
Evidenced multipronged
communication:
Experience from
GPEI
‘edu-tainment’
with national,
provincial and
community
mass media
Community
engagement
Meetings, forums,
film showings and
events
COMBI Star adapted for polio eradication
Challenges 2: Weak Immunization Systems
Measles 1st dose coverage among infants, 2010
 1st dose:
– 67 Countries have
MCV1 coverage < 90%
 2nd dose ( routine ):
– 54 countries do not
have routine 2nd dose
 Campaigns:
– Variable quality
<50% (2 countries or 1%)
50-79% (41 countries or 21%)
80-89% (24 countries or 12 %)
>=90% (126 countries or 66%)
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Challenges 3: Some set backs in Africa
 4-fold increase since 2008
600,000
100
90
500,000
70
400,000
60
300,000
50
N u m b e r o f ca se s
40
W H O /U N IC EF e stim a te s
M C V 1 co ve rage (% )
N o . o f case s (in th o u san d s)
80
 Large outbreaks in Burkina
Faso (2009), S. Africa
(2010), and DRC (2011)
200,000
A d m in istra tive co ve ra ge
30
20
100,000
10
0
0
2000
2001
2002
2003
2004
2005
Year
2006
2007
2008
2009
2010‡
 Outbreaks in drought
affected Horn of Africa
– High case-fatality
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Weekly Epidemiological Record
(2011) 86:129-135
Historical procurement of Measles and MR vaccine through
UNICEF in 2000-2012 and forecasts for 2013-2016 (in doses)
14 |
Summary
 Achievements
–
–
–
–
1st dose coverage up to 85%
1 billion doses delivered in campaigns
2 / 3 reduction in cases
3 / 4 reduction in deaths
 Challenges
– Catch - up in India; Outbreaks in Africa; Weak systems
 New Strategic Plan, 2012 – 2020
– Addressing rubella together with Measles
– Taking the Initiative towards achieving regional goals
 More Harambee
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