measles pre-elimination and resurgence in the african region
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Measles pre-elimination and resurgence in the African region. Balcha Masresha IVD AFRO. Global Measles Management Meeting Geneva 15 - 17 March 2011. Outline. Regional goal Routine immunization Second opportunity immunization through SIAs Measles case-based surveillance - PowerPoint PPT PresentationTRANSCRIPT
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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
Global measles management meeting.15 - 17 March 20113 |
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.
Global measles management meeting.15 - 17 March 20114 |
Routine immunisationRoutine immunisationRoutine immunisationRoutine immunisation
Global measles management meeting.15 - 17 March 20115 |
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
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year
nu
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as
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s
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me
as
les
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measles case reports measles coverage
Catch up SIAs
Follow up SIAs
Global measles management meeting.15 - 17 March 20116 |
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
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5
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25
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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
Global measles management meeting.15 - 17 March 20117 |
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
Global measles management meeting.15 - 17 March 20118 |
Second opportunity measles vaccination through Second opportunity measles vaccination through SIAsSIAs
Second opportunity measles vaccination through Second opportunity measles vaccination through SIAsSIAs
Global measles management meeting.15 - 17 March 20119 |
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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ais
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d)
~ 50% of ops costs (USD 0.32 per child)
Global measles management meeting.15 - 17 March 201111 |
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%
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100%
Countries that had SIAs in 2009 or 2010
pro
po
rtio
n o
f d
istr
icts
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h 9
5%
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Nationwide outbreak response
Global measles management meeting.15 - 17 March 201112 |
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
Global measles management meeting.15 - 17 March 201114 |
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)
Global measles management meeting.15 - 17 March 201115 |
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
Global measles management meeting.15 - 17 March 201116 |
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
Global measles management meeting.15 - 17 March 201118 |
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
Global measles management meeting.15 - 17 March 201119 |
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.
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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.
Global measles management meeting.15 - 17 March 201125 |
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
Global measles management meeting.15 - 17 March 201126 |
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
Global measles management meeting.15 - 17 March 201128 |
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)
Global measles management meeting.15 - 17 March 201129 |
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
Global measles management meeting.15 - 17 March 201130 |
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