Transcript Measles Mortality Reduction - Measles & Rubella Initiative

Measles Mortality Reduction:
the risk of resurgence
Global Immunization Meeting
Geneva, Switzerland
1-3 February 2010
Balcha Masresha, WHO/AFRO
Overview
 Achievements to date
 Resurgence; examples from AFR
 How can resurgence be avoided?
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Measles disease burden
 Major cause of global
morbidity and mortality
1980: >2.5 m deaths
2000: 733,000 deaths
(4th leading cause of
child mortality in 2000)
 Major component to
achieving MDG4
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Measles Mortality Reduction
47 UNICEF / WHO Priority Countries, 2000 - 2009
94% of measles deaths
No 2nd dose MCV
2000
Nationwide catch-up SIAs as of end 2008 (46)
No catch-up campaign yet ( 1 )
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2009
Global Achievements, 2000-2008
 MCV1 coverage 72% to 83%
 Over 600 million vaccinated in SIAs
 78% reduction in global measles deaths
 12.7 m. estimated measles deaths prevented since 2000
– 8.4 million deaths prevented as a result of maintaining routine
immunisation coverage
– 4.3 million deaths prevented due to accelerated control efforts
 Measles elimination in The Americas since 2002
– strategies proven to work
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Number of reported measles cases and estimated
MCV1 coverage, WHO African Region, 2000–2008
100%
90%
measles cases
500,000
80%
70%
400,000
60%
300,000
50%
40%
200,000
30%
20%
100,000
10%
0
0%
2000 2001 2002 2003 2004 2005 2006 2007 2008
 Since 2000:
– 398 m vaccinated in
SIAs
– 94% reduction in
reported cases
– 92% reduction in
estimated deaths
MCV1 coverage
600,000
 MCV1 increased from
52% to 73%
measles casesyear MCV1 coverage
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Source: Wkly Epid Rec, Sept 2009, 84:397-404
Confirmed measles cases. AFR. 2009
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Confirmed measles cases by proportion of age
category. 2009. Selected countries in AFR
100%
80%
60%
40%
20%
Missing
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< 1 year
1 - 5 years
5 - 14 Years
Ta
nz
an
ia
Zi
m
ba
bw
e
ca
fri
A
So
ut
h
Se
ne
ga
l
ig
er
ia
N
Et
hi
op
ia
ha
d
C
C
am
er
oo
n
an
a
ot
sw
B
B
en
in
0%
15 years +
Vaccination status of confirmed measles cases.
Burkina Faso (n=10,012)*
1 or more
doses
9%
unknown
37%
unvaccinated
54%
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Why Resurgence?
 Measles no longer perceived as a major threat :
decreased political and financial commitment
 Gaps in immunisation coverage
– 7.8 million infants did not get MCV in 2008 in AFR
– Only 3 of 18 AFR countries achieved >95% coverage in
90% districts in SIAs in 2009
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Immunization coverage with measles containing
vaccines in infants, 2008
60% of 21 m unvaccinated
infants in 6 countries:
India
7.6 m
Nigeria
2.0 m
China
1.0 m
DRC
0.8 m
Pakistan 0.7 m
Ethiopia 0.7 m
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<50% (3 countries or 1%)
50-79% (46 countries or 24%)
80-89% (33 countries or 17%)
>=90% (111 countries or 58%)
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 lines on maps represent
approximate border lines for which there may not yet be full agreement.
 WHO 2009. All rights reserved
Source: WHO/UNICEF coverage estimates 1980-2008, July 2009
193 WHO Member States. Date of slide: 21 July 2009
Measles Initiative donations 2001-2009 and Funds projected or
pledged, 2010 - 2011
180
160
2001-2008 Total donations:
$673m
$ US Million
140
120
100
80
60
40
20
0
2001
2002
2003
Donations
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2004
2005
2006
2007
2008
2009
2010
Funds projected or pledged
2011
Measles Initiative Donations 2001-2008 and Financial Resource
Requirements, 2010-2011*
180
160
$ US Million
140
2010: Funding gap $59m
2011: Funding gap $47m
120
100
80
60
40
20
0
2001
2002
2003
Donations
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2004
2005
2006
2007
2008
Funds projected or pledged
Excluding activities in India and
anticipated country contributions
for 2010-2011 SIAs
2009
2010
2011
Funding Gap
Risk of resurgence; scenario 2010 - 2013
1000000
Estimates
Worst case projection
No. of deaths
800000
600000
400000
200000
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Year
 Projected worst case scenario: none of 47 priority countries
carry out SIAs during 2010-2013.
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Source: WHO/IVB measles deaths estimates,
October 2009; Lancet 2007;369:191-200
How can resurgence
be avoided?
Keys to maintaining the success of
measles mortality reduction
High
quality SIAs
Routine
immunization
strengthening
Sustainable
financing
Linking with other
interventions
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Effective
lab-based
surveillance
Full implementation of existing strategies
and innovative approaches
 Uniform, high routine vaccination coverage
– RED approach, PIRI, continued efforts to strengthen
immunisation systems
 High quality SIAs
– Integration of best practices into SIAs
 Effective laboratory-backed surveillance
– Case confirmation and virus tracking through Global LabNet
– New tools for specimen collection
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Measles Genotype B3 distribution 2007-9
As of 28 Jan 2010
(Stars may not represent exact location of cases)
Year of detection
Acknowledgements:
WHO Measles LabNet
Measles Surveillance
Programmes
B3
2007
B3
2008
B3
2009
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 lines on maps represent approximate border lines for which there may not yet be full
agreement.
 WHO 2008. All rights reserved
New Tools to Support Surveillance
 Oral fluid (OF) & Dried blood (DBS) samples fully
validated as alternative to serum
– OF = Non invasive , DBS = minimally invasive
– OF used for measles surveillance in UK for >12 years
– Five AFR countries to use OF starting 2010
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Continue promoting linkages with other
programs and health systems strengthening
 Measles SIAs integrated with polio, malaria, de-worming,
Vit A, praziquantel
 Using SIAs to strengthen immunisation systems:
– Training, logistics, social mobilisation, microplanning, injection
safety
 Linkages with other initiatives:
– the global action plan for the prevention of pneumonia
– the global initiative for the elimination of avoidable blindness
 Integrated VPD surveillance supported by a lab network
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Sustainable financing
Conduct focused advocacy efforts to increase
country financing
– Involvement of “Global Elders”
– Lions International
Advocate with donors: risk of resurgence
– Need for multi year commitments
Demonstrate positive impact on health systems
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Conclusion
 "So much has been achieved [in measles control] in the
past several years thanks to the hard work and
commitment of national governments and donors. But …,
there are signs of stalling momentum. This is a highly
contagious disease that will quickly take advantage of any
lapse in effort."
– Dr Margaret Chan, WHO Director-General.
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Measles Initiative
Japanese
Government
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