Measles in EMR

1

• Measles in EMR

7th Annual Meeting of Partners for Measles
AdvocacyWashington, 2007
2

• Outline

• Regional progress in measles elimination
• Key constraints
• Indicators to monitor measles elimination in EMR
  

3

• Strategy for Measles Mortality Reduction and
  Elimination in EMRO

• Routine infant immunization
• gt 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
• gt 90 coverage in all districts

• Case-based surveillance

• Optimized case management

4
Trends in Measles Case Counts and MCV1 Coverage
in EMR, 1995-2006
Preliminary, 2006
5
Geographic Distribution of Children not Receiving
MCV1 in EMRO, 2005 (n2.8 million)
6
Supplemental Immunization ActivitiesMeasles
Campaigns in EMRO through 2005
Palestine
Bahrain
Preschool and school age (15)
School age (5)
Ongoing (2)
7
Measles Campaign Coverage in South Sudan Status
by County (Jan 28, 2007)
Renk
Fashoda
Ruweng
Tonga
Aweil North
Sobat
Rubkoana
Aweil East
Mayom
Twic
Old Fangak
Atar
Aweil West
Latjor
Raja
Guit
Nyirol
Gogrial
Aweil South
Koch
Ayod
Waat
Leer
Wuror
Diror
Panyijar
Tonj
Akobo
Wau
North Bor
Rumbek-Cueibet
Pochalla
Pibor
Yirol
Completed Ongoing Micro plans
ready Not yet micro-planned
South Bor
Awerial
Tambura 103.4
Terekeka 101.3
Maridi 87.3 Maruko Payam missed out
Kapoeta 64.2
Mundri
Yambio
Ezo 105.4
Juba 74.2
Budi 91.1
Torit
Yei
Magwi
Kajo Keji
8
Catch-up Campaign in Somalia, 2005-06
Area of campaign of country targeted Target pop No. children vaccinated coverage
2005 2005 2005 2005 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
2006 2006 2006 2006 2006
NWZ(14 dist) 15.4 542,104 387,787 71.5
CSZ (78 dist) 67.7 2,266,917 1,838,729 81
9
Measles Vaccine Doses Administered in Catch-up
Campaigns, 1999-2006 EMRO
10
Reduction in Measles Mortality in EMR, 1999-2005
50 mortality reduction target
11
Planned Supplemental Measles Immunization
2007-08 .
Catch-up campaigns
Follow-up campaigns
High-risk/mop-up campaigns
12
Recommended SIAs in EMR that are not Planned
2007-08 .
Catch-up campaigns
Follow-up campaigns
High-risk/mop-up campaigns
13
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

14
Second Dose of Measles Immunization in EMRO, 2005
Palestine

• 19 countries with 2 dose schedule
• 12 at 12 24 mos
• 7 at 4-6 yrs
• 16 use MMR
• 1 countries with periodic SIAs
• 2 countries with periodic SIAs and 2 dose
  schedule
• 2 countries with no second opportunity

Bahrain
Routine second dose
1 dose SIAs
2 doses SIAs
1 dose schedule
15
Measles Surveillance in EMRO
Palestine
Bahrain
Case based (17)
Case-based, needs to be improved (3)
Aggregate data (2)
16
Status of Measles Reporting in EMRO, Jan-Dec,
2006
No. countries reporting Total susp cases Total with lab test No. lab- conf measles No. epi-linked measles No. clinical measles Total measles
20 (90) 19,950 7031 2259 935 9750 12,944
Provisional data, reporting not complete
17

• Feedback of Surveillance and Coverage Data

• Monthly Bulletin
• Case counts by country and case classification
• Key indicators
• Mapping through EPIINFO
• Website
• Monitoring of susceptibility profiles

18

• Outline

• Regional progress in measles elimination
• Key constraints
• Indicators to monitor measles elimination in EMR
  

19

• 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

20
Measles Case Counts and Vaccination Coverage,
1988-2005, Saudi Arabia
Coverage
21
Age Distribution of Measles Cases in Saudi
Arabia, Jan-Dec 2006
lt 1 yr
1 to 4 yrs
5 to 9 yrs
10 to 14 yrs
15-20 yrs
gt 20 yrs
n697 5 vaccinated
22
(No Transcript)
23
Age Distribution and Vaccination Status of
Measles Cases in Selected EMR Countries, Jan-Dec
2006
lt 1 yr
1 to 4 yrs
5 to 9 yrs
10 to 14 yrs
15-20 yrs
gt 20 yrs
24
Geographic Distribution of Measles Cases, Jan-Dec
06
25

• Outline

• Regional progress in measles elimination
• Key constraints
• Indicators to monitor measles elimination

26
Indicators for Measles Elimination
Recommendations from EMR-TAG, 2006
Completeness of reporting Indicator gt 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 gt 80 of suspect
measles cases are tested for measles IgM
antibody, excluding cases epidemiologically
linked to a laboratory confirmed case from the
denominator
27
Indicators for Measles Elimination
Recommendations from EMR-TAG, 2006
Adequacy of epidemiologic investigation Indicator
gt 80 of suspect measles cases have an adequate
epidemiologic investigation. Adequacy of
laboratory testing Indicator gt 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)
28
Completeness of Reporting to Regional Office,
Countries Reporting on a Monthly Basis, 2006
Palestine
Bahrain
Reporting on a timely basis (n16)
Delayed reporting (n4)
Inconsistent/not reporting (2 countries)
29
Suspect Cases per 100,000 in EMR, Jan-Dec-2006
Proposed regional target 2/100,000
Suspect cases lab and epi confirmed cases
Adjusted for annualized rate
30
Serologic Testing of Suspect Cases (Jan-Dec 06,
EMR) Indicator gt 80 of suspect cases with
testing
Palestine
Bahrain
gt 80 of suspect cases (10 countries)
50-80 (3 countries)
lt 50 (7 countries)
Not reporting (2 countries)
31
Adequacy of Epidemiologic Investigation, Jan-Dec
06 EMR Indicator gt80 of measles case reports
with complete investigation
Palestine
Bahrain
gt 80 (6 countries)
50-80 (5 countries)
lt 50 (6 countries)
Not reporting (5 countries)
32
Recommended Criteria for Measles Elimination
EMR-TAG, 2006

• Measles incidence of lt 1 confirmed case per
  million per year, excluding cases confirmed as
  imported.
• All districts with gt 90 vaccination coverage for
  the first dose of measles vaccine and 95
  coverage national coverage for the second dose.
• 90 of outbreaks are lt 10 cases in size
• Epidemiologic and laboratory data indicate that
  measles viruses are imported.

33
Measles Cases per Million in EMR, Jan-Dec-2006
provisional
34
MCV1 Coverage Indicator gt 90 coverage in all
districts
Palestine
Bahrain
MCV1 gt 90 in all districts (7 countries)
MCV1 gt 80 in all districts (2 countries)
MCV1 gt 50 in all districts (4 countries)
MCV1 lt 50 in some districts (8 countries)
Based on 2005 JRF, data is unavailable for
Lebanon
35
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

36
Summary

• Surveillance is improving
• Impact on program activities
• Countries have accepted agreed upon indicators
• RTAG will address issue of certification

37
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

38
(No Transcript)
39
EMR MCV Coverage and Percent of Games Won-Chicago
Cubs, 1995-2006