1 |1 | measles pre-elimination and resurgence in the african region balcha masresha ivd afro global...

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Measles pre-elimination and Measles pre-elimination and resurgence in the African regionresurgence in the African region

Balcha MasreshaBalcha MasreshaIVD AFROIVD AFRO

Global Measles Management MeetingGlobal Measles Management Meeting

GenevaGeneva

1515 - - 1717 March 2011March 2011

Global measles management meeting.15 - 17 March 20112 |

OutlineOutlineOutlineOutline Regional goal

Routine immunization

Second opportunity immunization through SIAs

Measles case-based surveillance

Measles resurgence in AFR

Challenges

Opportunities


98% mortality reduction by 2012 compared to estimates for 2000

Measles incidence <5 cases/106 per year in all countries; >90% MCV1 national level coverage in all countries, and >80% in all

districts;

>95% SIAs coverage in all districts;

All countries meeting the 2 main surveillance performance indicator targets 80% districts reporting > 1 suspected measles case with a specimen per year

Non measles febrile rash illness rate of > 2:100,000 per year

Regional measles pre-elimination goal; Regional measles pre-elimination goal; targets to be met by end 2012.targets to be met by end 2012.

Regional measles pre-elimination goal; Regional measles pre-elimination goal; targets to be met by end 2012.targets to be met by end 2012.


Routine immunisationRoutine immunisationRoutine immunisationRoutine immunisation


MCV1 coverage (WHO UNICEF estimates) and reported MCV1 coverage (WHO UNICEF estimates) and reported measles cases: AFR. 1980 - 2009measles cases: AFR. 1980 - 2009

MCV1 coverage (WHO UNICEF estimates) and reported MCV1 coverage (WHO UNICEF estimates) and reported measles cases: AFR. 1980 - 2009measles cases: AFR. 1980 - 2009

-

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,0001

98

0

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

year

nu

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of

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0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

me

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measles case reports measles coverage

Catch up SIAs

Follow up SIAs


Countries in AFR by MCV1 coverage category. Countries in AFR by MCV1 coverage category. (WHO-UNICEF estimates). 2001 - 2009(WHO-UNICEF estimates). 2001 - 2009

Countries in AFR by MCV1 coverage category. Countries in AFR by MCV1 coverage category. (WHO-UNICEF estimates). 2001 - 2009(WHO-UNICEF estimates). 2001 - 2009

0

5

10

15

20

25

30

35

40

45

50

2001 2002 2003 2004 2005 2006 2007 2008 2009

nu

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less than 50% 50 - 59 % 60 - 69 % 70 - 79 % 80 - 89 % 90 % and above


MCV1 coverage > 80% (WHO UNICEF estimates) MCV1 coverage > 80% (WHO UNICEF estimates) for > 3 years including 2009. AFRfor > 3 years including 2009. AFR

MCV1 coverage > 80% (WHO UNICEF estimates) MCV1 coverage > 80% (WHO UNICEF estimates) for > 3 years including 2009. AFRfor > 3 years including 2009. AFR

+/- MCV2 +/- MCV2 introductionintroduction


Second opportunity measles vaccination through Second opportunity measles vaccination through SIAsSIAs

Second opportunity measles vaccination through Second opportunity measles vaccination through SIAsSIAs


Measles SIAs. 2010Measles SIAs. 2010Measles SIAs. 2010Measles SIAs. 2010

Follow up SIAs planned in 14 countries ~ target pop. 60.2 million SIAs implemented in 9 countries targeting ~ 25 million

5 countries had to postpone to 2011 for lack of partner and local resources

Outbreak response mass immunization in 5 countriesTarget population ~ 22.6 million

13 countries raised USD 21 million (51%) locally out of the expected USD 41 million for ops costs

Funds raised locally for measles SIAs Funds raised locally for measles SIAs (in USD per child targeted). AFR. 2010(in USD per child targeted). AFR. 2010

Funds raised locally for measles SIAs Funds raised locally for measles SIAs (in USD per child targeted). AFR. 2010(in USD per child targeted). AFR. 2010

0.00

0.20

0.40

0.60

0.80

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1.20

1.40

1.60

1.80

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~ 50% of ops costs (USD 0.32 per child)


Proportion of districts with Proportion of districts with >>95% coverage 95% coverage during measles SIAs. 2009 – 2010.during measles SIAs. 2009 – 2010.

Proportion of districts with Proportion of districts with >>95% coverage 95% coverage during measles SIAs. 2009 – 2010.during measles SIAs. 2009 – 2010.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Countries that had SIAs in 2009 or 2010

pro

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Nationwide outbreak response


Measles case based surveillanceMeasles case based surveillanceMeasles case based surveillanceMeasles case based surveillance

Selected surveillance performance Selected surveillance performance indicatorsindicators2009200920102010

Number of reporting countries4040

Number of suspected measles cases35,984172,824

Number of confirmed measles cases14,545133,412 Incidence of confirmed measles per 100,000 population1.917.2 Non-measles febrile rash illness rate (target >2:100,000)2.14.1 % districts reporting at least 1 suspected case with blood sample (target >80%)75%86%

Number of countries that met both targets14/4023/40

Measles case based surveillance Performance Measles case based surveillance Performance Indicators. AFR. 2009 - 2010Indicators. AFR. 2009 - 2010

Measles case based surveillance Performance Measles case based surveillance Performance Indicators. AFR. 2009 - 2010Indicators. AFR. 2009 - 2010


Measles Resurgence in AFR. 2010Measles Resurgence in AFR. 2010Measles Resurgence in AFR. 2010Measles Resurgence in AFR. 2010

28 countries reported measles outbreaks> 223,000 suspected measles cases and ~ 1,200 deaths reported

through the aggregate reporting system vs 37,010 suspected cases reported thru the JRF in 2008

Outbreaks started at a median of 17 months after measles follow up SIAs (range: 1 to 44 months)


Incidence of confirmed measles per 100,000 Incidence of confirmed measles per 100,000 population. AFR. 2010population. AFR. 2010

Incidence of confirmed measles per 100,000 Incidence of confirmed measles per 100,000 population. AFR. 2010population. AFR. 2010

Regional incidence: 17.4 per 100,000 population

10 countries (with 112.6 million total population) have measles incidence of >10 cases per 100,000


Measles outbreaks in AFR. Measles outbreaks in AFR. Measles outbreaks in AFR. Measles outbreaks in AFR.

Surveillance data and preliminary investigations:B3 serotypes in isolates

Reasons for outbreaksgaps in routine immunization coverage suboptimal coverage during recent SIAs (ZIM, NAM, ANG, BOT)Pockets of unvaccinated & resistant populations (ZIM)Critical accumulation of susceptibles in older age groupstoo long (> 3 yrs) interval between follow-up SIAs (ZAM, LES, SEN)

Global measles management meeting.15 - 17 March 201117 |17

Regional measles pre-elimination goal and current Regional measles pre-elimination goal and current statusstatus

Regional measles pre-elimination goal and current Regional measles pre-elimination goal and current statusstatus

Targets to be met by end 2012:Status (2010):

98% mortality reduction by 2012 compared to estimates for 2000

92% reduction by end 2008

Measles incidence <5 cases/106 per year in all countries;

22 countries in 2009, and 15 countries in 2010 respectively [quality of surveillance]

>90% MCV1 national level coverage in all countries, and >80% in all districts;

13 countries with >90% MCV1 coverage as of end 2009

>95% SIAs coverage in all districts;Only 5/24 countries have > 90% districts achieving > 95% coverage in 2009 - 2010

All countries meeting the 2 main surveillance performance targets

14/ 40 countries in 2009, and 23/ 40 countries in 2010 met both targets


Planned Measles SIAs 2011Planned Measles SIAs 2011Planned Measles SIAs 2011Planned Measles SIAs 2011

Target population: 56.7 million

Total budget: USD 56.7 million

Expected MI contribution thru WHO and UNICEF: USD 29.6 million


Timing of scheduled measles SIAs. AFR. 2010Timing of scheduled measles SIAs. AFR. 2010Timing of scheduled measles SIAs. AFR. 2010Timing of scheduled measles SIAs. AFR. 2010

MI funding OK MI funding not yet in place

Age group distribution of confirmed measles cases. 2010.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

15+ years

10 - 14 years

5 - 9 years

1 - 4 years

<1 year

Age group distribution of confirmed Age group distribution of confirmed measles. AFR. 2010. measles. AFR. 2010.

Age group distribution of confirmed Age group distribution of confirmed measles. AFR. 2010. measles. AFR. 2010.


ChallengesChallengesChallengesChallenges

Slow pace of routine immunization coverage improvement

Inadequate partner and local funding for SIAs Delayed and inadequate preparations for measles SIAs

Continued measles outbreaks related to program gaps

Limited capacity for high quality outbreak investigation


OpportunitiesOpportunitiesOpportunitiesOpportunities

Updating technical guidelines: to disseminate by end of March 2011

EPI managers’ meetings

Best practices documentation: Ethiopia

Measles TAG: April 28 – 29, 2011 in Accra

Africa Vaccination Week

RC 61 – resolution on measles elimination for 2020

African Vaccination Week. 2011African Vaccination Week. 2011African Vaccination Week. 2011African Vaccination Week. 2011 38 countries have been conducting CHDs, MCH days etc

RC 60 resolution “to institutionalize an annual African Vaccination Week for sustaining advocacy, expanding community participation and improving immunization service delivery"

AVW to comprise of advocacy, education & outreach activities Expected to

Improve access to high-risk populations and hard to reach areas; Increase media interest in immunization; create opportunities for pooling resources and coordinating efforts, engage partnersbuild on the existing implementation framework of the maternal and

child health initiatives


AVW slogan is “Vaccinated communities, Healthy community”

AVW Theme for 2011 is "Put mothers and children first; Vaccinate and stop polio now”.

Last week of April 2011

African Vaccination Week. 2011 (2)African Vaccination Week. 2011 (2)African Vaccination Week. 2011 (2)African Vaccination Week. 2011 (2)


Proposed recommendationsProposed recommendationsProposed recommendationsProposed recommendationsResurgence and loss of gains in mortality reduction

Better mobilization of partner resources Local resource mobilization for measles SIAs

Use the surveillance data and epidemiological information to determine the target age-groups for SIAs

Document and disseminate lessons learnt from the best practice SIAsEconomic impact of measles outbreaks


ThanksThanksThanksThanks

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