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Towards Measles Elimination in the Western Pacific Region Progress & Priorities

Towards Measles Elimination in the Western Pacific Region Progress & Priorities. Global Measles and Rubella Management Meeting Geneva, 15-17 March 2011. Dr. David Sniadack and Dr. Wang Xiaojun Western Pacific Regional Office, WHO. Presentation Outline. Progress towards measles elimination

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Towards Measles Elimination in the Western Pacific Region Progress & Priorities

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  1. Towards Measles Elimination in the Western Pacific RegionProgress & Priorities Global Measles and Rubella Management Meeting Geneva, 15-17 March 2011 Dr. David Sniadack and Dr. Wang Xiaojun Western Pacific Regional Office, WHO

  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 Reaffirmed the 2012 measles elimination goal

  4. Reported Measles Cases and MCV1 Coverage Western Pacific Region 1980 – 2010 Source: WPRO surveillance database WHO/UNICEF JRFs ,1980-2010

  5. Measles Incidence*Western Pacific Region 2010 * per million population LEGEND < 1.0 (22) 1.0 – 9.9 (6) 10.0 – 49.9 (5) 50.0 – 99.9 (2) Data pending (1) Source: WPRO surveillance database, 2010

  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) A chain is only as strong as its weakest link

  7. Measles SIAs in 2010-2011 Western Pacific Region SIA in China 5 provinces:8m-14y 3 provinces: 8m-6y 23 provinces: 8m-4y CHN 102.3 million LAO (9-59m) 3.0 million PHL (9-95m) 18 million LEGEND CAM (9-59m) 1.5 million 2010 (CHN, VTN, PNG, TUV, FSM*) VTN (9-71m) 7.0 million FSM (12m-83m,Chuuk) 6762 2011 (CAM, PHL, LAO) PNG (6-35m) 0.5 million TUV (12-71m) 1095 2010 2009 Measles Incidence 10.0 – 49.9 (4) 50.0 – 99.9 (2)

  8. Completeness and Timeliness of Country Reporting to WPRO Western Pacific Region 2007-2010 • Source: WPR surveillance database

  9. Indicators of Progress Towards Measles Elimination Western Pacific Region 2007-2010 Source: WPRO surveillance database

  10. Measles and Rubella Lab Network +331 prefectural labs 382 laboratories 1 GSL 3 RRLs 16 National (13 fully functional) 31 provincial + 331 prefectural

  11. LEGEND At/near (25) Likely (6) Hopefully (6) Probability of Measles Elimination by country, Western Pacific Region 88.4% of the regional population 4.1% of the regional population 7.5% of the regional population

  12. Measles Cases by Month Viet Nam 2008– 2010 Measles Cases by Age Viet Nam Oct 2008 – 2010 Source: Surveillance data

  13. Laboratory Confirmed and Epi-Linked Measles Cases, by Month, Viet Nam 2010 – 2011* Measles Cases, by Province Viet Nam 2010-11* December 2010 January 2011 Dec 2011– Jan 2011 Jan-Nov 2010 * Data from surveillance reports through March 2011

  14. Confirmed Measles Cases, by Week of Rash Onset, 2009-January 2011 Philippines 2010 1 dot = 1 case Lab Confirmed and Epi-linked Measles Cases, by Age, 2010

  15. < 1 1 – 1.9 ≥ 2 Lab-Confirmed Measles Cases, by Age Group and Vaccination Status, Cambodia 2010 Laboratory Confirmed Measles Cases and Discarded Rates, Cambodia 2010 1 dot = 1 lab case Discarded rate (per 100,000)

  16. Rubella Control in WPR Regional Plan for Control of Rubella and Prevention of Congenital Rubella Syndrome in the Western Pacific Region, 2010-2015 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 July 2010 Nov 2010

  17. WPR: 41 per million population Rubella Incidence Western Pacific Region 2009 LEGEND (per million population < 1.0 (21) 1.0 – 9.9 (8) 10.0 – 19.9 (3) 20.0-99.9 (4) Data source: JRFs History of RCV Use in WPR Protecting F & M ≥ 20 yrs (16) Protecting F ≥20 yrs (5) CAM, LAO, VTN Protecting F & M ≥ 15 yrs (4) Recent introduction of RCV (5) RCV to be introduced (6) PNG, SOL, VAN

  18. Rubella Cases by Sex and Age Group2008-2010 Viet Nam Females: 60% CBA Philippines 89% <20y Data source: WPRO surveillance and laboratory database

  19. Priority Activities of Measles Elimination Western Pacific Region, 2011-2012 Funding not secured 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. Priority Activities of Measles Elimination Western Pacific Region, 2011-2012 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 in2011 • Country level • Capacity building at country level: surveillance workshops • CAM, LAO, PNG, VTN • Country visits, followed by extensive follow-up actions

  21. Priority Activities of Measles Elimination Western Pacific Region, 2011-2012 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. Priority Activities of accelerating Rubella Control & CRS Prevention, Western Pacific Region, 2011-2012 • 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 * Priority countries/areas for funding support: CHN, CAM, LAO, MOG, PHL, PNG, VTN, PICs

  24. Thank You

  25. Additional slides

  26. Korea B3 from Libya Mongolia H1, 1 Japan D9 from Thailand, B3 from France Hong Kong D9 from Philippines, B3 from South Africa VietNam Macao H1, 2 D9, 2 Lao PDR Philippines Singapore Cambodia H1 from Vietnam Malaysia Australia New Zealand Genotypic distribution of Measles virus in WPR 2009-2010

  27. Reported MCV1 and MCV2 Coverage by Country/Area, Western Pacific Region 2009 16 Non-Pacific Island Countries 20 Pacific Island Countries * For five countries with 2009 data not available, historic coverage data were used, including AMS (2008), WAF (2007), GUM (MCV1 in 2005, MCV2 in 2008) Source: WHO/UNICEF JRFs, 2009

  28. Reported Measles Cases, China 2009 – 2011* Measles SIA Decrease from previous year 65% 44% 44% *Surveillance report through February 2011

  29. Trends in Age Distribution and Geographic Spread of Measles Viet Nam October 2008-2010 Jan-Jun09 Jul-Dec09 Jan-Dec10 Oct-Dec08

  30. Confirmed Measles Cases, by Month of Rash Onset, Philippines 2003 – January 2011 D3 D9 D9. G3

  31. Laboratory Confirmed Measles Cases Philippines 2010 - January 2011 Oct 2010 Nov2010 Dec 2010 Jan2011

  32. Measles Cases, by Month of Rash Onset and Method of Confirmation, Cambodia 2003 – 2011* Clinically Confirmed Lab confirmed * Data reported as of March 2011

  33. Reported Rubella Cases and RCV CoverageWestern Pacific Region 1993-2009 Incidence (2009): 41 per million population Reported coverage Coverage estimate with China data With disease data from China Data source: WHO/UNICEF Joint Reporting Forms, 1993-2009 and measles rubella surveillance data

  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. Challenges of Measles Elimination - Immunity Gaps • 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

  39. Confirmed Measles Cases, by Week of Rash Onset, 2009-January 2011

  40. Rubella Cases by Sex and Age GroupWestern Pacific Region 2008-2010 Data source: WPRO surveillance and laboratory database

  41. Laboratory Confirmed Measles Cases, by Age, Cambodia 2010 N = 457

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