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“SPEED-UP” CAMPAIGNS IN THE AMERICAS Siena, Italy May 10-11, 2016 DESIREE PASTOR MD, MPH Regional Immunization Advisor PAHO/WHO

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  • “SPEED-UP” CAMPAIGNS

    IN THE AMERICAS

    Siena, Italy

    May 10-11, 2016

    DESIREE PASTOR MD, MPH

    Regional Immunization

    Advisor

    PAHO/WHO

  • OUTLINE

    • Historic perspective on measles and rubella

    elimination in the Americas

    1

    • Speed-up campaigns: a magnificent vaccination strategy

    • Lessons learned and conclusions

    • Next steps towards maintaining measles and rubella elimination in the Americas

  • WE CAME A LONG WAY

  • 3

    XXIV PAN-AMERICAN SANITARY

    CONFERENCE,WASHINGTON

    PAHO, SEPTEMBER 1994

    “To congratulate all the Member States, their health authorities, their health workers and the

    communities themselves on their continuing commitment and efforts toward attainment of the historical

    accomplishment represented by the eradication of poliomyelitis from the Western Hemisphere, as

    well as other major advances in their immunization programs…

    To establish the regional goal of elimination of measles by the year 2000 and urge the Member

    Governments to make every effort to achieve this goal as soon as possible.”

  • MEETING OF AD-HOC PANEL OF EXPERTS ON

    RUBELLA AND MEASLES ELIMINATION

    6

  • 4

    ALIGNMENT OF MEASLES AND

    RUBELLA ELIMINATION STRATEGIES

    VACCINATION SURVEILLANCE

    “Catch-up” campaign; children

    aged 1 to 14 years

    “Keep-up: to maintain coverage

    ≥95%in the routine program;

    children aged 1 year

    “Follow-up” campaign;

    preschool-aged children

    Introduction of MMR or MR

    In routine program; children

    aged 1 year

    “Speed-up” campaign in

    adolescents and adults

    Integrated measles/rubella

    surveillance

    CRS surveillance

    Laboratory activities

    • Serological diagnosis

    • Viral detection/isolation

  • ‘80 ‘81 ‘82 ‘83 ‘84 ‘85 ‘86 ‘87 ‘88 ‘89 ‘90 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 ‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ’06 ’07 ’08 ’09 ’10 ‘11 ’12 ‘13 ‘14 ‘15

    050,0

    00

    100,0

    00

    150,0

    00

    200,0

    00

    250,0

    00

    020

    40

    60

    80

    100

    %

    MEASLES CASESRUBELLA CASES MEASLES COVERAGE

    Confi

    rmed C

    ase

    s%

    Vaccin

    atio

    n C

    overa

    ge

    LAST ENDEMIC

    MEASLES CASE

    LAST ENDEMIC

    RUBELLA CASE

    FOLLOW-UP CAMPAIGNS FOR MEASLES

    SPEED-UP CAMPAIGNS

    FOR RUBELLA

    CATCH-UP CAMPAIGNS

    FOR MEASLES

    IMPACT OF MEASLES AND RUBELLA

    ELIMINATION STRATEGIES IN THE AMERICAS

    5

  • 8

    24

    68

    10

    12

    14

    16

    18

    20

    DISTRIBUTION OF IMPORTED RUBELLA CASES AFTER INTERRUPTION OF

    ENDEMIC TRANSMISSION, THE AMERICAS, 2010-2015*N

    UM

    BER O

    F R

    UBELLA C

    ASES

    2010 2011 2012 2013 2014 2015

    8 CRS CASESARGENTINA

    BRAZIL

    CANADA

    CHILE

    COLOMBIA

    EUA

    FRENCH GUAYANA

    MEXICO

    Source: ISIS, MESS and country

    reports to FGL-IM/OPS.

    * Data as of 31 March 2016.

    65 RUBELLA CASES

  • DEVASTATING CONSEQUENCES OF CRS

    7

    Cataract, High Myopia,

    Severe Deafness

    Infant with CRS

    (3 days old)

    CRS with Autism,

    Mental Retardation

    Sensorineural,

    Profound Deafness

    Congenital Glaucoma

    Photo credit: Louis Z. Cooper, MD

  • Seated from left: Isabel Pachón (member), Louis Cooper (member), Merceline Dahl-Regis (president), Mirta Roses (former PAHO’ Director), Jose

    Cassio de Moraes (member), Natasha Crowcroft (member) and Jose Ignacio Santos (member). Standing: Jon K. Andrus (former PAHO’s Deputy

    Director).

    FIRST MEETING OF THE INTERNATIONAL EXPERT

    COMMITTEE IN THE AMERICAS (2010)

  • Bye-bye, rubella! ¡Adiós rubéola!

  • HOW DID WE ACHIEVE THE

    ELIMINATION GOAL?

  • SPEED-UP CAMPAIGNS:

    A MAGNIFICENT STRATEGY

  • How to get commitment from the governments and

    donors to financially support the vaccination of nearly

    the 40% of the Latin American and the Caribbean

    population?

    15

  • COST-SAVING

    INTERVENTIONS

    MEASLES

    Vaccination strategy costs

    $1.10/individual

    PAHO strategy saves

    $280 million in treatments

    To contain outweigh costs

    to treat

    16

  • COST-SAVING

    INTERVENTIONS

    RUBELLA AND CRS

    Saves $3 billion

    Prevented >112,500

    cases in Latin America

    and Caribbean

    No more children born

    with CRS-led birth defects

    17

  • 19

    How to plan, implement and monitor High-

    Quality Speed-Up Campaigns to vaccinate ~250

    million adolescents and adults?

  • THE TARGET POPULATION…?

    • Every country conducted an analysis regarding the susceptible population and the analysis of the burden of disease in the population.

    • Some seroprevalence studies were implemented (i.e. Argentina, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Haiti, Mexico, Panama, Peru) to complement the analysis, before and after the campaigns.

    • Most of the countries targeted the age group to be vaccinated in adolescents and young adults aged 15-39 years old.

  • MONTH 1 2 3 4 5 6 7 8 9

    PLANNING AND ORGANIZATION

    NATIONAL

    SUB NATIONAL AND LOCAL

    EXECUTION

    EVALUATION

    SENSITIZATION, POLITICAL COMMITMENT, AND SUPPORT

    ADVOCACY

    MONITORING AND SUPERVISION

    VACCINATION SAFETY

    Action Plan

    Organization

    Resources

    Guidelines and operative manuals

    Strategy and communication

    materials

    Information system

    Training

    Microplanning

    Management resources

    Communication and

    mobilization

    Supply distribution

    Communication

    and mobilization reinforcementNational vaccination

    campaign

    Launch post-partum

    vaccinationCoverage verification

    Campaign evaluation

    Final report

    STAGES FOR SPEED-UP CAMPAIGN: ORGANIZATION,PLANNING, DEVELOPMENT, AND VERIFICATION

  • WEEK 1 2 3 4 5 6

    CAPTIVE POPULATION

    HOUSE TO HOUSE

    COVERAGE

    VERIFICATION

    CENTRAL DAY ADDITIONAL

    OPPORTUNITYANNOUNCEMENT

    POST PARTUM AND POST ABORTION VACCINATION

    NATIONAL LAUNCHING

    COMMUNICATION

    REINFORCEMENT

    SOCIAL

    COMMUNICATION

    Rapid Coverage Monitoring

    School

    Institutional

    Labor

    Transient populations and places of

    high circulation

    Fixed and mobile posts

    SPEED-UP VACCINATION CAMPAIGN PHASES

  • 50

    ,00

    01

    00

    ,000

    150

    ,000

    1996 1998 2000 2002 2004 2006 2008

    RUBELLA

    MEASLES

    CANADA, CUBA, PANAMA

    UNITED STATES, URUGUAY

    ENGLISH-SPEAKING

    CARIBBEAN

    CHILE**

    BRAZIL** (2001-02)

    COSTA RICA

    HONDURAS

    EQUADOR

    EL SALVADOR

    COLOMBIA,

    NICARAGUA,

    PARAGUAY,

    VENEZUELA

    ARGENTINA**,

    BOLIVIA,

    DOMINICAN REP.,

    PERU

    ARGENTINA (2),

    BRAZIL (2),

    HAITI, MEXICO

    BOLIVIA (2), CHILE (2),

    CUBA,

    GUATEMALA, HAITI,

    VENEZUELA (2)

    SOURCE: Country reports to FCH/IM

    * Includes rubella and measles cases reported to PAHO as of epidemiological week 52/2009

    ** Countries that implemented “speed-up” campaigns (1st phase) in women only

    NU

    MBER O

    F C

    ASES

    YEAR

    ADOLESCENT AND ADULT RUBELLA VACCINATION

    “SPEED-UP” CAMPAIGNS

  • MEXICO2008

    19-29 yr., 99% MR

    Pop. 22,231,820

    EL SALVADOR2004

    15-39 yr., 98% MR

    Pop. 2,796,391

    GUATEMALA2007

    9-39 yr., 99% MR

    Pop. 7,172,847

    HAITI2007-2008

    1-19 yr., 99% MR

    Pop. 6,242,197

    CUBA2007

    12-24 yr., 97% MMR

    Pop. 1,991,513

    DOMINICAN

    REPUBLIC2006

    7-39 yr., 95% MR

    Pop. 4,847,150

    THE CARIBBEAN1998-2001

    20-39 yr., 84% RVM/MR/MMR

    Pop. 4,847,150

    COSTA RICA2001

    15-39 yr., 98% MR

    Pop. 1,635,445

    ARGENTINA2006

    15-39 yr., WOMEN, 98% MR

    Pop. 6,718,314

    2008

    16-39 yr., 90% MR

    Pop. 6,478,313

    BOLIVIA2006

    15-39 yr., 93.7% MR

    Pop. 4,015,554

    2007

    2-14 yr., 98% MR

    Pop. 3,086,545

    BRAZIL2001-2002

    12-39 yr., WOMEN, 96% MR

    Pop. 29,006,806

    2008

    20-39 yr., 96% MR

    Pop. 67,197,649

    VENEZUELA2005-2007

    12-17 yr., 99% MR

    Pop. 4,657,332

    2007

    18-39 yr., 99% MR

    Pop. 10,278,024

    CHILE1999

    10-29 yr., WOMEN, 98% RMV

    Pop. 2,467,495

    2007

    19-29 yr., MALE, 93% MR

    Pop. 1,348,315

    COLOMBIA2005

    14-39 yr., 96.6% MR

    Pop. 17,619,141

    EQUADOR2004

    16-39 yr., 98% MR

    Pop. 4,982,760

    NICARAGUA2005

    6-39 yr., 99% MR

    Pop. 3,845,869

    HONDURAS2002

    5-39 yr., 98% MR

    Pop. 3,234,375

    PARAGUAY2005

    5-39 yr., 99% MMR

    Pop. 3,753,392

    PERU2006

    5-39 yr., 99% MR

    Pop. 20,070,343

  • FINANCIAL SOURCE

    FOR RUBELLA CAMPAIGN

    PARAGUAY, 2005

    43%Local

    financing

    44%National

    financing13%Other

    sources

    18

  • THREE KEY FACTS OF

    SPEED-UP CAMPAIGNS

  • BETWEEN 2003-2008

    ALTOGETHER

    FAST-PACED

    SYNCHRONIZED CAMPAIGNS IN LAC

    15-39 YEARS OLD, MEN AND WOMEN

    LARGE IN SCOPE

  • WE MET OBSTACLES

  • 50

    100

    150

    200

    250

    300

    600

    350

    400

    450

    500

    550

    2000 2001 2002 2003 2004 2005 2006 2007 2008*

    SOURCE: COVERCGDT/DEVEP/SVS/MS

    * Preliminary data

    n = 15,413

    CONFIRMED RUBELLA CASES BY WEEKBRAZIL, 2000-2008*

    Mass campaign, 26 million

    women12-39y, 2001-2002,

    96% coverageSpeed-up campaign,

    65.9 million men and

    women 20-39y, 96%

  • 50

    01

    00

    01

    50

    02

    00

    02

    50

    03

    00

    03

    50

    04

    00

    04

    50

    05

    00

    0

    20

    40

    60

    80

    10

    0

    ‘97 ‘98 ‘99 ‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09

    OUTBREAKS IN MALE POPULATIONS

    SPEED-UP CAMPAIGN

    10-29 YR. WOMEN ONLY

    R

    98%

    FOLLOW-UP CAMPAIGN

    1-4 YR.

    M

    99%

    FOLLOW-UP CAMPAIGN

    1-5 YR.

    MR

    93%

    SPEED-UP CAMPAIGN

    19-29 YR. MEN ONLY, MR 93%

    CO

    NFIR

    MED

    CASES

    RO

    UTIN

    E IN

    FAN

    T V

    ACCIN

    ATIO

    N C

    OVERAG

    E (%

    )

    CASESROUTINE

    COVERAGE

    * Data until EW 52/2009

    SOURCE: Country reports to PAHO

    ROUTINE MCV1 COVERAGE, MEASLES-RUBELLA ELIMINATION

    CAMPAIGNS AND CONFIRMED RUBELLA CASES, CHILE, 1997-2009*

  • LAC countries that implemented “speed-up” campaigns in women and men did not re-establish endemic measles transmission, after an importation.

    Brazil, however, is the exception: a ~5% left out during “speed-up” resulted in thousands of susceptible individuals. A “ drop by drop transmission” was interrupted, after indiscriminate vaccination of adolescents and adults (5-29yr).

    37

    CONTRIBUTION OF SPEED-UP CAMPAIGNS IN

    SUSTAINING MEASLES ELIMINATION

  • WE LEARN THROUGH

    EXPERIENCE

  • STRONG LEADERSHIP

    IMPLEMENTATION OF SPEED-UP

    AS A MASTER STRATEGY TO ELIMINATE RUBELLA

    AND MEASLES

    AT THE HIGHEST LEVELS OF POWER

    PAN-AMERICANISMALL LATIN AMERICAN LOW AND MIDDLE

    INCOME COUNTRIES DECIDED TO INVEST

    IN ELIMINATION

  • Lessons learned

    Promote a pool of leaders

    at national, and local level

    Build a timeline for

    planning synchronized,

    rapid, and massive

    vaccination strategies

    Strategies tailored for

    conflict areas (violence,

    armed groups, crisis, etc)

    31

  • FEB 2016Request update

    from countries

    APRIL-MAY

    2016Review of the

    countries’

    updates

    AUGUST

    4-5 2016Presentation

    of regional report

    SEPTEMBER

    2016Declaration of

    measles

    elimination in the

    Americas

    MAY

    2017WHA resolution

    for global

    eradication

    MR goal

    SEPTEMBER

    2017Regional

    Framework for

    Sustainability

    Standardized template

    2012-2015 period

    Signed by National Verification

    Commission

    PAHO + IEC PAHO + IEC To be presented

    at PAHO Sanitary Conference

    (2017)

    ROADMAP TO DECLARE MEASLES

    ELIMINATION IN THE AMERICAS2016-2017

    35

  • PARTNERS FOR MEASLES, RUBELLA,

    AND CRS ELIMINATION

    32

  • “Any measles vaccination campaign that does not include the rubella vaccine is a missed opportunity”

    Ciro de Quadros

  • THANK YOU