Measles elimination in the African Region- Regional updates
Dr Balcha MASRESHA IVD/AFRO
Annual MRI Partners’ MeetingWashington DC
10 – 11 September 2013
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 20132 |
Regional measles elimination targets for 2020
• > 95% measles immunization coverage at national level and in all districts;
• > 95% SIAs coverage in all scheduled measles SIAs, and in outbreak response immunization activities;
• measles incidence of <1: 1,000,000 population at national level;
• > 80% of districts investigating > 1 suspected measles cases within a year, and a non measles febrile rash illness rate of > 2 per 100000 population at national level.
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 20133 |
Routine Immunisation
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 20134 |
MCV1 coverage WHO UNICEF estimates. AFR. 2000 – 2012.
40
45
50
55
60
65
70
75
80
MCV
1 co
vera
ge e
stim
ates
(per
cent
age)
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 20135 |
MCV1 coverage WHO UNICEF estimates in AFR countries. 2008 – 2012.
05
101520253035404550
2008 2009 2010 2011 2012
Num
ber o
f cou
ntrie
s
90 plus80 - 8970 - 7960 - 69<60
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 20136 |
MCV2 introduction in AFR (as of August 2013)
• MCV2 in routine services in 20 countries by end 2014
• MCV2 in ~ 25 countries by the end of 2015.
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 20137 |
Supplemental Immunisation activities
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 20138 |
Measles SIAs in 2013
• 16 countries doing SIAs• MR SIAs in 4 countries
• A total of 88.9 million targeted
• 16,118,351 reached in 3 countries,
• awaiting results from 2 more countries
• 11 countries doing SIAs in the last quarter
• MR used in 4 of the 16 SIAs
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 20139 |
Measles SIAs national and district level coverage. 2012 – August 2013. AFR.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0%
20%
40%
60%
80%
100%
120%
ERI GUB GUI SWZ KEN ETH UGA NIE SIL CAE BUR RWA ZIM STP NAM CHA ZAM
% d
istric
ts w
ith >
/=95
% co
vera
ge
Nati
onal
adm
in c
over
age
National coverage Districts >=95%
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 201310 |
Case based surveillance
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 201311 |
Key Measles Surveillance Performance Indicators, African Region 2010 – end July 2013.PERFORMANCE INDICATORS 2010 2011 2012 2013
Number of suspected measles cases reported 163,575 74,896 55,717 58,657
Number of confirmed measles cases 127,422 32,323 20,935 35,558
Non-measles febrile rash illness(target >2/ 100,000 population ) 3.7 4.4 3.7 2.9
% districts reporting at least 1 case with blood sample (target >80%) 84% 81% 84% 77%
Incidence of confirmed measles per million population 165 42 27 41
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 201312 |
Measles case based surveillance performance. AFR. 2012.
Measles Incidence rate per million population. AFR. 2012
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,00019
8019
8119
8219
8319
8419
8519
8619
8719
8819
8919
9019
9119
9219
9319
9419
9519
9619
9719
9819
9920
0020
0120
0220
0320
0420
0520
0620
0720
0820
0920
1020
1120
12
year
WHO
-UN
ICEF
M
CV1
cove
rage
esti
mat
es
Mea
sles
case
repo
rts
Measles case reports
MCV1 coverage estimates
Catch up SIAs
Follow up SIAs
Measles case reports & MCV1 coverage (WHO-UNICEF estimates). AFR. 1980 - 2012
• 64% of case reports in 2010 = from Malawi• 69% and 68% of case reports in 2011 and 2012= from DR Congo
Performance against the 2020 measles elimination targets (as of Dec 2012)
• > 90% MCV1 coverage nationally (WHO UNICEF estimates) • 15 countries (2012)
• > 95% coverage during measles SIAs in every district.• 3/12 countries (2012)
• incidence < 1 confirmed measles /1,000,000 pop’n /year
• 16 countries
• NMFRI rate of > 2:100,000• 25 countries
• > 80% districts reporting per year• 25 countries
Weekly trends of measles reporting in DR Congo by province. 2010 – week 33, 2013
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 201317 |
Measles Resurgence in AFR; Key factors
• Gaps in routine coverage
• Delays and gaps in SIAs coverage
• Resistant groups
• Shift in epidemiological susceptibility
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 201318 |
Confirmed measles. Case based surveillance data. AFR. 2003 – July 2011
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 201319 |
Age breakdown of confirmed measles cases. Ethiopia. 2005 – 2012.
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 201320 |
Attempts to address the resurgence: Routine immunisation program
• Ongoing efforts to strengthen immunisation systems• The opportunity of new vaccine introduction• “RED approach”
• Ministerial conference on implementing GVAP – early 2014
• MCV2 introduction and Post introduction evaluations
• Linking GAVI HSS support to immunisation outcomes
• Using SIAs as an opportunity to support strengthening routine immunisation
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 201321 |
• Planning and budgeting for SIAs in the context of national strategic plans & cMYPs
• Timely mobilisation of local and partner resources for SIAs• Timely conduct of scheduled SIAs
• Emphasising on high quality SIAs ( > 95% coverage in every district)
• SIAs targeting age groups as determined by the epi. picture:• Zambia, Niger in 2012• Togo, 2 provinces in DRC in 2013
Attempts to address the resurgence: SIAs
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 201322 |
0
10
20
30
40
50
60
70
80
90
100
2005 2006 2007 2008 2009 2010 2011 2012Pe
rcen
tage
of c
ases
Age breakdown of measles cases in selected provinces in DRC. 2005 – 2012.
0
10
20
30
40
50
60
70
80
90
100
2005 2006 2007 2008 2009 2010 2011 2012
Perc
enta
ge o
f cas
es
unknown
15 yrs and above
10 - 14 yrs
5 - 9 yrs
9 - 59 months
< 9 months
Equateur province, DRC. Orientale province, DRC.
Measles SIAs in 2014• 14 countries (incl. S Sudan)*• A total of 78.6 million to be
targeted– MR SIAs in 2 countries– GAVI support for CHA, DRC, BUR,
TAN– 3 non GAVI eligible
• MRI support = 5 countries with 11.6 million to target: – ~ USD 13.1 million for BV, ½ ops
costs, surveillance and TA
* CAR and MOZ = SIAs in 2013???
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 201324 |
• SIAs:• Mostly francophone countries • Angola• S Sudan!
• Areas for MRI support:• SIAs:
• Logistics • Planning and coordination of coverage survey• Advocacy with non-GAVI eligible countries
• MCV-2 Post-Introduction Evaluation• Surveillance reviews:
Technical support needs in 2014
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 201325 |
Anne Ray Charitable Trust
Thank you