Towards Measles Elimination in the Western Pacific Region Progress Priorities

1. Towards Measles Elimination in the Western Pacific RegionProgress & Priorities Global Measles and Rubella Management Meeting Geneva, 15-17 March 2011

2. Presentation Outline Progress towards measles elimination Updates on rubella control Priority activities in 2011-2012 Unmet funding needs

3. Urged member states to commit the human and financial resources to develop and implement work plans to regularly report surveillance data to WPRO to establish independent national verification process following the establishment of standardized regional verification mechanisms by WPRO to accelerate control of rubella and the prevention of congenital rubella syndrome Requested the RD to establish regional verification mechanism to strengthen technical cooperation with Member States to achieve regional immunization goals to seek additional resources to achieve regional goals utilizing frequent ICC meetings and other mechanisms to report progress periodically to the Regional committee Regional Committee Resolution, 2010 WPR/RC61.R7 

6. Initiatives to Improve Routine Measles Coverage,Western Pacific Region, 2010-2011 District approach: tackling low performing districts Region: Capacity building through an inter-country workshop China: Yellow-card warning mechanism (Guangxi, Guizhou) Service delivery: responding to under-served populations LAO PDR: planned increase in frequency of outreach services (4 to 6 times) Philippines: Reaching Every Barangay strategy (REB) and urban poor project Cambodia: Reaching Every Community Strategy (REC)

12. TAG recommends in 2009: addressing bimodal age distribution, target age group (19-26ys) and 12-83 months TAG recommends in 2009: addressing bimodal age distribution, target age group (19-26ys) and 12-83 months

14. Age distribution and immunization status of infant cases Age distribution and immunization status of infant cases

16. Rubella Control in WPR Goal: To achieve and maintain control of rubella and prevention of CRS in the WPR Rubella: = 10 / 1 million population, excluding imported cases CRS: = 10 / 1 million Live births, excluding imported cases

18. Rubella Cases by Sex and Age Group2008-2010

19. Priority Activities of Measles Elimination Western Pacific Region, 2011-2012 Closing immunity gaps, focusing on priority countries Conducting quality SIAs, incorporating MR when feasible 2011: CAM (Feb-Mar, MV, ? Oct), PHL (Apr, MR), LAO (Nov, MR) 2012: PNG and several Pacific island countries Improving routine MCV1 and MCV2 coverage Introduction of MCV2 (CAM > 80% since 2008) Exploring practical approaches to identifying under-served population groups/communities and improving their access to immunization services Link to needed solution to address quality gaps in previous SIAs (vaccination of children 5-14 years old in CAM) Identify and implement appropriate approach to and strategies for immunizing adults Key constraints: funding, vaccine production capacity (MV or MR) Epidemiologic analysis of adult measles cases in Beijing, China in collaboration with US CDC and WHO

20. Continue to improve surveillance, maintain accredited lab network, and provide more support to priority counties Regional Level Publish Measles and Rubella Bulletin monthly (planned in April 2011) Frequent data analysis of countries Update/revise field measles guidelines, incorporating rubella Accreditation of all RRLs and NMLs in 2011 Country level Capacity building at country level: surveillance workshops CAM, LAO, PNG, VTN Country visits, followed by extensive follow-up actions

21. Initiate preparation for verification of measles elimination Establish regional verification committee for measles elimination Develop guidelines on verification of measles elimination for the region Organize 1st regional verification commission meeting (September 2011) Assist countries in initiating preparation upon country requests

22. Encourage introduction of RCV in Member States With > 80% MCV coverage: CAM (GAVI support), VTN With a need for frequent SIAs: LAO, PNG, SOL, VAN Establish CRS sentinel surveillance (CHN, VTN) Studies on disease burden of CRS (LAO, PHL, VTN)

23. Unmet Funding Need in Priority Countries*Western Pacific Region, 2011

24. Thank You

25. Additional slides

27. Reported MCV1 and MCV2 Coverage  by Country/Area, Western Pacific Region 2009

30. Genotyping information Genotyping information

34. Challenges of Measles Elimination Western Pacific Region High measles incidence in several countries Evolving epidemiology Shifting to infants and adults Increased risk of measles transmission in densely populated urban areas Importation and exportation Importation: to Australia and New Zealand from several countries and Regions Exportation: from Philippines to Australia, Canada, Japan, New Zealand and U.S.

35. Difficulty in ‘eliminating’ immunity gaps Inadequate monitoring to identify low coverage areas/ populations Inadequate systems and/or resources to increase responsiveness to under-served populations Identifying and addressing quality gaps in previous SIAs Identifying and implementing appropriate strategies to address measles in infants and adults

36. Challenges of Measles Elimination - Surveillance Low sensitivity of surveillance at sub-national levels Difficulty in timely obtaining accurate epidemiologic data Delayed and incomplete case investigation data Discrepancies between lab reports and national reports Large proportion of clinically confirmed cases in some countries Inadequate attention to collecting specimens for virus detection

37. Challenges of Measles Elimination Funding gaps: Increasing needs and decreasing resources/sources Competing priorities and stretched HRs High level and broad political commitment Interest and confidence in measles elimination

38. Reasons for Missed Opportunities to Rubella Control Lack of evidence Although rubella case are identified in greater numbers, CRS is under-reported and under-recognized in most developing countries in the region, resulting in less priority Lack of motivation Perception that control of rubella and prevention of CRS is an additional task: health officials are not motivated especially under pressure of eliminating measles by 2012

40. Rubella Cases by Sex and Age GroupWestern Pacific Region 2008-2010