Lessons from Measles outbreaks in the African Region

1. Lessons from Measles outbreaks in the African Region Annual Measles Partnership meeting Feb 2007 Washington DC

3. Outline • Quality of surveillance • Measles outbreaks in 2006 • Lessons learnt

4. Quality of surveillance • Measles outbreaks in 2006 • Lessons learnt

5. The AFR measles surveillance and lab network (Feb 2007) • A total population of 668.5 million • under case based surveillance for measles

6. Measles surveillance performance indicators in AFR. 2002 - 2006

7. Measles surveillance performance & results. AFR. 2006

8. Measles surveillance performance & results. AFR. 2006 (2) • 22 countries > 2 suspected cases investigated per 100,000 population • 15 countries >80% districts reporting • 24 countries > 60% districts reporting • 25 countries < 1: 100,000 incidence of confirmed measles

9. Incidence of confirmed measles per 100,000 population by country. 2006

10. Quality of surveillance • Measles outbreaks in 2006 • Lessons learnt

11. Measles outbreaks in the African Region (2004 - 2006) • In 2004, 80 (5%) of a total of 1590 districts covered by the case based surveillance system reported outbreaks • In 2005, outbreaks in 47 (3%) districts out of 1850 • In 2006, 178 (6%) of 2923 districts in 12 countries have experienced outbreaks. NB: Tanzania database incomplete

12. Probable causes of measles outbreaks in the African Region in 2006 • Accumulation of unvaccinated cohorts (~ over 3 -4 years) due to a combination of factors • sub-national gaps in routine EPI coverage: • Angola, Benin, DR Congo, Ethiopia, Mali, Tanzania, Uganda • delays in conducting follow up SIAs: • Kenya, Zambia, Ghana • cross border spread of outbreaks: • DR Congo, Rwanda

13. Outbreak countries. AFR. 2006

14. Outbreak countries. AFR. 2006

15. Outbreak countries. AFR. 2006

16. Outbreak countries. AFR. 2006

17. Outbreak countries. AFR. 2006

18. Trends of confirmed measles cases. Kenya. 2003 –2006. F-up SIAs done July ‘06 F-up SIAs postponed Catch-up SIAs: June ‘02

19. Measles cases in Kenya. 2006

20. Confirmed measles cases by age and vaccination status. Kenya. 2006

21. Outbreak countries. AFR. 2006

22. Trends of confirmed measles cases. Uganda. 2002 – 2006. F-up SIAs: Nov 2006 Catch-up SIAs: Oct 2003

23. Measles cases in Uganda. 2006

24. Confirmed measles cases by age and vaccination status. Uganda. 2006

25. Probable causes of measles outbreaks in the African Region in 2006 (2) • Program gaps leading to a cohort of older children (ages 6 – 7.5 years) unprotected in some districts • Tanzania (124 districts) • 1999 / 2000 SIAs: all 9 – 59 months (in 91 districts) • 2001 SIAs: 9 months – 14 years (in 31 districts) • 2002 SIAs: 7 – 14 years (in 89 districts) • 2005 SIAs: 9 - 59 months (nation-wide follow up)

26. Age distribution of measles cases. Dar es Salaam, Tanzania July – mid Oct. 2006

27. Disturbing gaps in the quality of data

28. Quality of surveillance • Measles outbreaks in 2006 • Lessons learnt

29. Lessons learnt • Postponing measles follow-up SIAs beyond 36 months is risky even in “high” coverage countries • Other platforms available for integration • Disparities in the district level coverage • Surveillance and outbreak investigation should provide better quality epidemiological information • Training and technical support for outbreak investigation

30. Lessons learnt (2) • Political visibility of outbreaks; • an opportunity to advocate for routine EPI and good quality follow up SIAs • Identify districts at high risk for outbreaks for extra support to intensify immunization activities

31. Thank you