“speed up” campaigns · 2016-05-16 · speed-up campaign 10-29 yr. women only r 98% follow-up...

“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 reinforcement

National 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