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Measles Elimination Update in Western Pacific

Dr. David H. Sniadack provided updates on measles elimination at the 10th Annual Measles Initiative Meeting in Washington, DC. The meeting focused on accelerating control of rubella and preventing congenital rubella syndrome to achieve regional immunization goals.

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Measles Elimination Update in Western Pacific

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  1. 10th Annual Measles Initiative Meeting Update on Measles Elimination in the Western Pacific Region Washington, DC September 13, 2011 Dr David H. Sniadack, Medical Officer, EPI WHO Region for Western Pacific

  2. Urged member states to commit 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! Accelerate rubella control and CRS prevention!

  3. Reported Measles Cases and MCV1 Coverage Western Pacific Region 2000 – 2012 97%

  4. LEGEND: < 1.0 (22) 1.0 – 4.9 (4) 5.0 – 9.9 (3) 10.0 – 19.9 (4) 20.0 – 29.9 (0) 30.0 – 39.9 (0) 40.0 – 49.9 (0) ≥ 50.0 (3) Measles Incidence*Western Pacific Region 2008 * per million population (29 <10/mill) Incidence 82 per million Source: WPRO measles-rubella monthly country reports and WHO-UNICEF Joint Reporting Form (data for 2008)

  5. Percent of Districts at Different Levels of MCV1 Coverage in Five Priority Countries,* WPR 2007 – 2010 (≥ 90%) 78% 77% 74% * KHM,LAO,MNG,PNG,VNM

  6. <50% 50-79% 80-89% ≥ 90% Reported Routine Measles Vaccination Coverage, by Operational District, Cambodia 2007, 2010 2010: 93% 2007: 79% <50% 1% (n= 1) <50%: 5% (n=4) 50-79%: 14% (n=11) 50-79%: 55% (n=42) 80-89% 40% (n=31) 80-89%: 25% (n=19) ≥ 90% 44% (n=34) ≥ 90%: 15% (n=11)

  7. Reported Routine Measles Vaccination Coverage, by District, Lao PDR 2007 and 2010 2007: 40% 2010: 64% <50% 23% (n=33) <50% 58% (n=81) 50-79% 59% (n=84) 50-79% 35% (n=49) 80-89% 8% (n=12) 80-89% 3% (n= 4) ≥ 90% 10% (n=14) ≥ 90% 4% (n= 6)

  8. CHN 102.3 million Measles SIAs in 2010-2012, Western Pacific Region 5 provinces: 8m-14y 3 provinces: 8m-6y 23 provinces: 8m-4y LAO (9m-19y) 3.0 million PHL (9-95m) 18.5 million KHM 9-59 m: 1.5 million (100%) 5-9 y: 433,000 VNM (9-71m) 7.0 million (97%) FSM (12m-8y, Chuuk) 6,800 (90%) PNG (6-35m) 500,000 KIR (9-47m): 8,400 TUV (12-71m) 1,100 (79%) SOL (9-47m) 48,500 SMA (12-47m):11,500 VAN (9-47m) 22,600 LEGEND 2010 (CHN, FSM, PNG, TUV, VNM) 2011 (KHM, LAO, PHL) 2012 (KIR, PNG, SMA, SOL, VAN)

  9. LEGEND: < 1.0 (24) 1.0 – 4.9 (4) 5.0 – 9.9 (3) 10.0 – 19.9 (1) 20.0 – 29.9 (1) 30.0 – 39.9 (1) 40.0 – 49.9 (1) ≥ 50.0 (1) Measles Incidence*Western Pacific Region 2011 * per million population (31 <10/mill) Incidence 16 per million Source: WPRO measles-rubella monthly country reports, data through June 2011

  10. Indicators of Progress Towards Measles Elimination Western Pacific Region 2007-2011¹ Source: WPRO surveillance database ¹ Data as of July 2011 ² Annualized numbers

  11. Confirmed Measles Cases, by Month of OnsetChina 2007—2011* National SIA 75% decrease in 2011 cases * Source: WPRO measles-rubella monthly country reports, data through July 2011

  12. Confirmed Measles Cases, by Month of OnsetJapan 2008—2011* Rolling SIA for 13 & 18 year olds each year from 2008-12; Improving routine MVCV1 and MCV2 coverage * Source: WPRO measles-rubella monthly country reports, data through July 2011

  13. Confirmed Measles Cases, by Month of OnsetPhilippines 2003—2011* SIA 9m - 7y SIA 9m - 7y SIA 9- 48 m * Source: WPRO measles-rubella monthly country reports, data through July 2011

  14. Confirmed Measles Cases, by Month of OnsetViet Nam 2008—2011* SIA * Source: WPRO measles-rubella monthly country reports, data through June 2011

  15. Lab-confirmed & Epi-linked Measles Cases, by ProvinceViet Nam 2010—2011* 2010 2011 1 dot = 1 case * Source: WPRO measles-rubella monthly country reports, data through June 2011

  16. Confirmed Measles Cases, by Month of OnsetMalaysia 2008—2011* 2004 SIA: 7-14 y; 93% * Source: WPRO measles-rubella monthly country reports, data through July 2011

  17. Discarded measles per 100K population: ≥ 2 1.0 - 1.9 < 1 No suspected measles cases Confirmed Measles Cases, by StateMalaysia 2010—2011* 2010 1 dot = 1 case 2011 * Source: WPRO measles-rubella monthly country reports, data through June 2011

  18. Confirmed Measles Cases, by Year of Age,Malaysia 2011* Routine schedule: MCV1 at 12-24m; MCV2 at 7y * Source: WPRO measles-rubella monthly country reports, data through June 2011

  19. Confirmed Measles Cases, by Month of OnsetAustralia 2007—2011* 1998 SIA: 5-12 y; 75% * Source: WPRO measles-rubella monthly country reports, data through July 2011

  20. Imported Measles Genotypes, by Territory, Australia 2011 Singapore India Indonesia – D9 Singapore – D9 Thailand – D4, D8 Indonesia – D9 Philippines Thailand Bangladesh France – D4 Italy – D4 Philippines – D9 France – D4 Kenya/Tanzania Cambodia – D8 England – D4 France India – D4, D8 Malaysia – D4 New Zealand – D4 Singapore – D9 Thailand – D8 * Source: WPRO measles-rubella monthly country reports, data through July 2011

  21. A B3 D4 Japan D8 Korea D9 China D11 G3 H1 Hong Kong UT D9-1 D8-1 Macao D8-1 Philippines G3-2 A-2 D9 - 12 A-1 Malaysia D9-2 D9-18 Singapore D9-11 D4-9 D8-3 D4-1 D8-1 D8-1 New Zealand Australia D9-4 Genotype Distribution of Measles Virus, WPR 2011 * Data up to July 2011

  22. <= 10 (25) 11 – 25 (1) 26 – 49 (3) >= 50 (0) No data (7) Rubella Incidence, Western Pacific Region, 2010 LEGEND (per million population) 15% of regional population Common rubella genotypes: 1E and 2B Data source: JRFs and surveillance data

  23. Rubella Protection and Plans in the Western Pacific Region F & M ≥ 20 yrs protected (16) F ≥ 20 yrs protected (5) F & M ≥ 15 & < 20yrs protected (4) Recent introduction of RCV (5) RCV not yet introduced (6) Legend LAO: introduction late 2011 KHM, VNM: under discussion PNG, SOL, VAN: considering Data source: JRFs

  24. Priority Activities for Measles Elimination & Rubella Control, Western Pacific Region, 2011-2012 • Conducting quality SIAs, incorporating RCV when feasible • 2011: CHN (Xinjiang, others?), KHM (Oct/Nov), LAO (Nov) • 2012: PNG, 4 PICs – KIR, SOL, SMA, VAN; also ORI • Improving routine MCV1, MCV2 and RCV coverage and schedules • Strategies for immunizing adults (if needed) • Strengthening surveillance • Sub-national sensitivity • Contact tracing; epidemiologic linkages • Measles virus detection • Verification

  25. Measles Elimination Funding Needs (in thousands), Western Pacific Region 2011-2012 Funding currently available: US$ 1,717,000 Expected funding in 2012: US$ 570,000 Total 2011-12 funding: US$ 2,387,000 Total Need: $5,728,000 SHORTFALL: $3,341,000 All funds are in US$ * PICs: KIR, SMA, SOL, VAN

  26. Thank You With malice toward none, with charity for all, with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in. - Abraham Lincoln 2nd Inaugural Address March 4, 1865

  27. Geographic Distribution of Reported Measles Cases, by Province, China, January-June 2011 1 dot =2 cases 27

  28. Confirmed Measles Cases, by Month of Onset,Cambodia 2007—2011* SIA SIA * Source: WPRO measles-rubella monthly country reports, data through June 2011

  29. Laboratory Confirmed Measles Cases, by Year of Age, Cambodia 2010 SIA Target N = 457

  30. Laboratory Confirmed Measles Cases with Rash Onset from May-July, by Year of Age and Vaccination Status, Cambodia 2011* SIA Target N = 108 * Source: WPRO measles-rubella monthly laboratory reports

  31. Discarded Measles Rate and Measles IgM Positive Cases, by District and Age Group, Cambodia 2011* Age of MIgM pos cases Discarded measles per 100K pop: ≥ 15yr 10 - 14yr ≥ 2 5 - 9yr 1 - 4yr 1.0 - 1.9 < 1yr < 1 No suspected measles cases 2010 2011: May - July * Source: WPRO measles-rubella monthly surveillance reports, data through June 2011

  32. Age of MIgM(+) cases Annualized discarded measles per 100K pop: ≥ 15yr 10 - 14yr ≥ 2 5 - 9yr 1 - 4yr 1.0 - 1.9 < 1yr < 1 Lab-Confirmed Measles Cases, by Operational District and Age Group, Cambodia May–July 2011* * Source: WPRO measles-rubella monthly surveillance reports, data through July 2011

  33. Confirmed Measles Cases, by Month of OnsetLao PDR 2008—2011* * Source: WPRO measles-rubella monthly country reports, data through June 2011 * Source: WPRO measles-rubella monthly country reports, data through July 2011

  34. Confirmed Measles Cases, by Province Lao PDR 2010—2011* Discarded measles per 100K population: ≥ 2 1.0 - 1.9 < 1 No suspected measles cases 2010 2011 1 dot = 1 case * Source: WPRO measles-rubella monthly surveillance reports, data through July 2011 * Source: WPRO measles-rubella monthly country reports, data through June 2011

  35. Confirmed Measles Cases, by Age Group & Vaccination StatusKuala Lumpur and Sabah (Malaysia) 2011* Kuala Lumpur Sabah * Source: WPRO measles-rubella monthly country reports, data through June 2011

  36. Confirmed Measles Cases, by Month of OnsetSingapore 2007—2011* * Source: WPRO measles-rubella monthly country reports, data through July 2011

  37. Confirmed Measles Cases, by AgeSingapore 2011* Routine schedule: MCV1 at 12-24m; MCV2 at 6-7y * Source: WPRO measles-rubella monthly country reports, data through June 2011

  38. Confirmed Measles Cases, by Age Group & Vaccination StatusAustralia 2010—2011* * Source: WPRO measles-rubella monthly country reports, data through June 2011

  39. Lab-confirmed & Epi-linked Measles Cases, by ProvinceAustralia 2010 & 2011* Measles incidence per 1M population: ≥ 50 20.0 - 49.9 10.0 - 19.9 5.0 – 9.9 1.0 – 4.9 < 1 2010 2011 1 dot = 1 case * Source: WPRO measles-rubella monthly country reports, data through July 2011

  40. Thailand Thailand New Zealand Singapore Malaysia Italy Philippines India India France Indonesia England Cambodia Total: 10 Total: 10 Total: 8 Total genotypes in 2011: D4=19; D8=22; D9=30 Genotypes and Countries of Imported Measles Cases, Australia 2011* * Source: WPRO measles-rubella monthly country reports, data through July 2011

  41. Confirmed Measles Cases, by Month of OnsetNew Zealand 2007—2011* * Source: WPRO measles-rubella monthly country reports, data through July 2011

  42. Confirmed Measles Cases, by Region New Zealand 2010—2011* Measles incidence per 1M population: ≥ 50 20.0 - 49.9 10.0 - 19.9 5.0 – 9.9 1.0 – 4.9 < 1 2010 2011 1 dot = 1 case * Source: WPRO measles-rubella monthly country reports, data through June 2011

  43. Confirmed Measles Cases, by Age Group & Vaccination Status,New Zealand 2010—2011* * Source: WPRO measles-rubella monthly country reports, data through June 2011

  44. Reported Rubella Cases, Western Pacific Region 1993-2010 No. cases Reporting from China Data source: WHO/UNICEF Joint Reporting Forms (1993-2010) and measles rubella surveillance data

  45. <= 10 (25) 11 – 25 (1) 26 – 49 (3) >= 50 (0) No data (7) Protecting F & M ≥ 20 yrs (16) Protecting F ≥ 20 yrs (5) Protecting F & M ≥ 15 & < 20yrs (4) Recent introduction of RCV (5) RCV not yet introduced (6) Rubella Incidence Western Pacific Region, 2010 15% of regional population LEGEND (per million population) Common rubella genotypes: 1E and 2B Protection from RCV in WPR LAO: will introduce in late 2011 CAM, VTN: under discussion PNG, SOL, VAN: considering Data source: JRFs and surveillance data

  46. Susceptibility to Rubella, Vientiane, Lao PDR % Age group (years) Study (2010): among 784 women of child bearing age (15-45 y): 36% were susceptible to rubella at 15-19 y; - 78% of these are infected by rubella during CBA years Source: MOH, Lao PDR

  47. Updated WHO PositionPurpose and Approaches for Rubella Vaccination • The primary purpose is to prevent the occurrence of congenital rubella infection including CRS • Countries should use the two dose measles vaccine strategy to use MR or MMR vaccine • Preferred approach: MR or MMR vaccine in a wide-age range campaign followed immediately with introduction of routine MR or MMR vaccine • Achieve and maintain ≥ 80% RCV immunization coverage delivered through routine services and/or regular SIAs Wkly Epid Rec, 15 July 2011, vol 86:301-316

  48. CRS Cases Hospitalized in Two Children Hospitals, Viet Nam, April 2011 PDA/ASD/PS/PH, thrombocytopenia, Cataract (bilateral) LBW, hydrocephalus, PDA, CoA Petechia, Cataract, PDA Cataract, Nystagmus, PDA, ASD Petechia, Cataract, PDA Credits: Dr. Kohei Toda , EPI Officer, WHO/Viet Nam

  49. Reported Measles Cases and MCV1 Coverage Western Pacific Region 1980 – 2011* 97% * Data as of June 2011 Source: WPRO surveillance database WHO/UNICEF JRFs ,1980-2011

  50. LEGEND: < 1.0 (23) 1.0 – 4.9 (6) 5.0 – 9.9 (0) 10.0 – 19.9 (2) 20.0 – 29.9 (3) 30.0 – 39.9 (0) 40.0 – 49.9 (0) ≥ 50.0 (2) Measles Incidence*Western Pacific Region 2010 * per million population (29 <10/mill) Incidence 27 per million Source: WPRO measles-rubella monthly country reports

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