measles elimination in the western pacific region

World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization

Measles Elimination in the Western Pacific Region

2007 Partners Meeting

Wayne A. Antkowiak, PMO-WHO/WPROErnest Smith, MO-EPI (Measles)-WHO/WPRO

David H. Sniadack, CDC/Atlanta


Presentation Outline

• Introduction• Status of Measles Elimination in WPR • Plan for 2007-2008• Partner Contributions• Unmet Needs


WHO Region for the Western Pacific

Population: 1.7 billionCountries/areas: 37 (including 20 PICs)


WHO/WPRO Indicators for Measles Elimination

• Low Incidence– Confirmed measles cases < 1/1,000,000 population

• Excellent Surveillance– Suspected cases > 1 per 100,000 in 80% of districts– >80% of samples adequate serum for IgM – virus isolation in select outbreaks

• Maintaining high population immunity to measles – >95% coverage with 2 doses of MMR – Outbreaks

• <100 cases<3 month duration


Measles Incidence Rate, 2005Measles Incidence Rate, 2005(per 1 Million Population)(per 1 Million Population)

< 1.0 (21)

1.0 – 9.9 (5)

10.0 – 99.9 (6)

LEGEND:

≥ 100 (1)No data (4) * 2005 data, from 2006

JRF


Countries Reporting Surveillance Data to WPRO, 2006

Case based (10)

Aggregate data (2)

Hospital-Based Active Surveillance (20)

Not yet reporting regularly (5)


Indicators for Measles Elimination in WPR, 2005 & 2006

Indicator TargetPNG5.9

LAO5.9

CAM13.3

VTN83.3

MOG2.6

PHL84.8

CHN1303.7

• Low Incidence

- confirmed case rate < 1/1,000,000 207.6 48.8 15.3 6.8 9.7 1.3 81.2

• Excellent Surveillance

- suspected case rate > 1/100,000 ND 5.0 3.5 16.7 0.97 0.34 ND

- % districts with >1/100,000 suspected cases

> 80%ND ND 32% 82% ND 10% ND

- % cases with sera > 80% ND ND 63% 31% 100% 31% ND

- % transmission chains with virus isolates

100%ND ND MD ND ND ND ND

• Maintaining high immunity

- MCV2 coverage > 95% 49%NOMCV2

NOMCV2

NOMCV2 98%

NOMCV2 98%

- # cases/outbreak <100 ND ND ND ND ND ND ND

- duration of outbreaks <3 months ND ND ND ND ND ND ND

2006 case based or aggregate data 2005 case based or aggregate data


MCV1 Coverage, WPR, MCV1 Coverage, WPR, 2005*2005*

85 – 94% (4)

≥ 95% (14)

75 – 84% (7)

50 – 74% (5)

LEGEND:

< 50% (2)No data (5) * 2005 data, from 2006

JRF


MCV2 Coverage, WPR, MCV2 Coverage, WPR, 2005*2005*

85 – 94% (0)

≥ 95% (9)

75 – 84% (6)

50 – 74% (3)

LEGEND:

< 50% (1)No Data (9)

No MCV2 (9) * 2005 data, from 2006 JRF


Priority Countries, WPR

I. GAVI eligible

1. Papua New Guinea

2. Lao People’s Democratic Republic

3. Cambodia

4. Viet Nam

5. Mongolia

II. Not GAVI-eligible

1. The Philippines

2. China


-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

74 75 76 77 78 79 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 05Year

Cases

0%

20%

40%

60%

80%

100%Coverage

SIAss

Reported Measles Cases and MCV1 CoveragePapua New Guinea, 1974 to 2005


-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

74 75 76 77 78 79 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

Year

Cases

0%

20%

40%

60%

80%

100%Coverage

SIAs

Reported Measles Cases and MCV1 CoverageLao PDR, 1974 to 2005


Reported Measles Cases and MCV1 CoverageCambodia, 1980 to 2005

-

10,000

20,000

30,000

40,000

50,000

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

Year

Cases

0%

20%

40%

60%

80%

100%Coverage

SIAs


Reported Measles Cases and MCV1 CoverageViet Nam, 1974 to 2005

-

20

40

60

80

100

120

140

74 75 76 77 78 79 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 05Year

Cases (in Thousands)

0%

20%

40%

60%

80%

100%Coverage

SIAs


Reported Measles Cases and MCV1 CoverageMongolia, 1976 to 2005

-

5,000

10,000

15,000

20,000

25,000

30,000

76 77 78 79 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

Year

Cases

0%

20%

40%

60%

80%

100%Coverage

SIA

SIA


-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

74 75 76 77 78 79 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 05Year

Cases

0%

20%

40%

60%

80%

100%Coverage

Reported Measles Cases and MCV1 CoveragePhilippines, 1974 to 2005

SIA SIA


Priorities for 2007-08: SIAs

SIAs are needed in high risk countries/areas to

interrupt measles virus circulation

1. Complete cMYPs for non-GAVI countries

• VTN, CAM, LAO, MOG, PNG completed

2. Identify adequate financing for planned SIAs

• IFFIm for GAVI-eligible countries

• Other financing mechanisms for countries that

are not GAVI-eligible

3. Ensure adequate technical assistance for high

quality operational planning, preparation and

implementation for campaigns


Papua New Guinea4th Quarter 2008Target age: 6m-10yrsTarget number: 1,800,000

Lao PDROct/Nov 2007Target age: 9m-15 yearsTarget number: 2,262,000

Viet Nam3rd Quarter 2007Target age: high risk 7-20 yrsTarget number: 3,537,1942008Target age: high risk 7-20 yrsTarget number: 1,073,050

CambodiaFeb/Mar 2007Target age: 9-59 monthsTarget number: 1,500,000

Planned SIAs, WPR,Planned SIAs, WPR, 2007-20082007-2008

MongoliaOct/Nov 2007Target age: 1-9 yearsTarget number:431,521

Philippines4th Quarter 2007Target age: 9-48 monthsTarget number: 8,600,000


Priorities for 2007-08: Surveillance

Surveillance is needed to identify high risk areas and

monitor progress

1. Provide technical assistance to establish case-based

reporting of measles throughout the region, integrated

with AFP surveillance

2. Work with countries to strengthen national monthly

reporting to WPRO

3. Publish monthly EPI bulletin based on data supplied

from countries


Priorities for 2007- 08: Routine ImmunizationStrengthened routine immunization is needed to sustain interrupted measles transmission

1. Assist GAVI-eligible countries to complete ISS, HSS plans and applications (e.g., LAO, CAM, MOG)

2. Encourage all countries on REDa. Microplanning (including vaccine management

and logistics)b. Outreachc. Supportive Supervisiond. Data collection and usee. Community participation

3. Focus on urban poor as high risk group

4. Introduce routine MCV2 where feasible

5. School entry checks


UNF Support to WPRO/UNICEF for SIAs in 2007-2008

Viet Nam $4,458,000 Papua New Guinea $1,788,000 Lao PDR $1,208,000 Cambodia $ 959,000 Mongolia $ 302,000 China $1,000,000 Philippines $ - Consultants $ 78,000

TOTAL $ 9,793,000


Additional Partner Support for Measles Elimination in WPR

• GAVI – MCV2 for– VTN: $2,500,000 for 5 years - conditionally approved– CAM: $600,000 - denied because MCV1=79%

• CDC– $200,000/year to WPRO for measles support – $500,000/year for measles SIA and other activities in

Sichuan Province, China• JICA

– $15 million to WPR for EPI• $525,000 for Cambodia SIAs in 2007

– Feasibility study for project to strengthen measles and polio surveillance for provinces in Western China

• CIDA - $200,000/year to WPRO for EPI and surveillance• AUSAID - $900,000/year to WPRO for EPI and surveillance


Unmet SIA Needs in WPR, 2007- 08

Lao PDR $ 986,000 Philippines $ 7,334,000 China $19,412,000 *

TOTAL $27,732,000

* For 2007-2012


Philippines SIA 4th Quarter 2007

Target Population – 8.6 million (9 - 48 months)

Operational Costs $3,420,000 Vaccine/Syringe/SB $3,580,500 Surveillance $ 870,000 Advocacy $ 60,000

Total Requirement $7,930,500

Government Contribution $ 600,000

Shortfall $7,333,500


China SIAs (2007 – 2012)

Requirement supported by Govt. funds Vaccine $ 9,907,000 Vaccinators $ 2,810,000AEFI $ 133,000

Total Government Contribution $ 12,852,000

Unfunded requirementSyringe/needle $ 3,820,000Cold Chain/Transport/Disposal $ 7,444,000Social Mobilization $ 8,147,000

Total Shortfall $19,412,000


Thank You

The moment one definitely commits oneself,then Providence moves too - Goethe


Indicators forMeasles Elimination in PNG

WHO’s indicators Papua New Guinea• Low Incidence

– Less than one confirmed measles case reported per million population

– 207.57 cases / million *

• Excellent Surveillance– incidence of suspected case per

100,000 in 80% of all district– >80% of adequate serum for IgM – virus isolation

– No data

– No data– No data– No data

• Maintaining high immunity to measles – >95% coverage with 2 doses – <100 case in outbreak

<3 month duration

– 49% MCV1; 48.9% MCV2 *– No data– No data

* 2005 data, from 2006 JRF


Indicators forMeasles Elimination in Lao PDR

WHO’s indicators Lao PDR• Low Incidence





– 4.98/100,000 (nationwide) *



<3 month duration

– 41% MCV1 (no MCV2) **– No data– No data

* from 2005 aggregate data** 2005 data, from 2006 JRF


Indicators forMeasles Elimination in Cambodia

WHO’s indicators Cambodia• Low Incidence





– 3.54/100,000 (nationwide) *

– 31.87% (58/182 districts) *– 63.39% (322/508 cases) *– No data


<3 month duration


* from 2006 case-based data** 2005 data, from 2006 JRF


Indicators forMeasles Elimination in Viet Nam

WHO’s indicators Viet Nam• Low Incidence





– 16.65/100,000 (nationwide) *

– 82% (50/61 provinces) *– 31% (4341/14024 cases) *– No data

• Maintaining 95% immunity to measles – >95% coverage with 2 doses – <100 cases in outbreak

<3 month duration




Indicators forMeasles Elimination in Mongolia

WHO’s indicators Mongolia• Low Incidence





– 0.97/100,000 (nationwide) *

– No data

– 100% (26/26 cases) *– No data

• Maintaining high immunity to measles – >95% coverage with 2 doses – <100 imported case

<3 month duration

– MCV1 >97%, MCV2 98.3% **– No data– No data



Indicators forMeasles Elimination in the Philippines

WHO’s indicators Philippines• Low Incidence





– 0.34/100,000 (nationwide) *

– 10.10% (10/99 provinces) *– 31.34% (89/284 cases) *– No data


<3 month duration




Indicators forMeasles Elimination in China

WHO’s indicators China• Low Incidence





– No data



<3 month duration

– 98.6% MCV1; 97.9% MCV2 **– No data– No data

* from 2006 aggregate data** 2005 data, from 2006 JRF


SIA Budget Breakdown, Western China, 2007-2012

Province

Government Request for possible donor support

TOTALVaccines,

Vaccinators, Adverse Events

Sub-total

Syringe+ Needle

Cost of cold chain and

transportation

Cost of social promotion,

training, supervising,

etc

Waste Disposal

Sub-total

Guizhou 1,029,482 306,935 261,665 451,913 306,935 1,327,448 2,356,930

Tibet 95,849 28,305 24,130 242,928 28,305 323,668 419,517

Shaanxi 2,181,577 661,947 564,317 1,737,677 661,947 3,625,888 5,807,465

Gansu 1,924,559 580,539 494,915 1,614,328 580,539 3,270,321 5,194,879

Qinghai 141,488 43,119 36,759 137,856 43,119 260,853 402,341

Ningxia 142,026 43,236 36,859 101,043 43,236 224,375 366,401

Xinjiang 479,606 145,103 123,702 313,145 145,103 727,053 1,206,659

Guangxi 2,578,963 785,948 670,029 757,097 785,948 2,999,022 5,577,985

Chongqing 1,499,055 453,911 386,964 672,093 453,911 1,966,878 3,465,933

Sichuan 4,213,406 1,272,479 1,084,801 2,565,663 1,272,479 6,195,421 10,408,827

Yunnan 2,980,751 901,323 768,387 856,633 901,323 3,427,666 6,408,417

Neimeng 235,488 71,766 61,181 259,302 71,766 464,015 699,503

Hunan 3,048,439 884,090 941,965 1,618,654 884,090 4,328,800 7,377,239

Hebei 2,883,299 836,583 891,348 2,160,208 836,583 4,724,721 7,608,020

Total 23,433,988 7,015,283 6,347,022 13,488,540 7,015,283 33,866,128 57,300,117

Provinces proposed for donor support 19,412,766

measles elimination in the western pacific region

Documents