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Global Overview of Measles Partners for Measles Advocacy 7th Annual Meeting Washington D.C., 27 – 28 February 2007. Edward J. Hoekstra, MD, MSc Senior Health Advisor UNICEF HQ, New York Peter Strebel , MBChB, MPH WHO HQ, Geneva Jeff Mcfarland, MD

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slide1

Global Overview of Measles

Partners for Measles Advocacy 7th Annual Meeting

Washington D.C., 27 – 28 February 2007

Edward J. Hoekstra, MD, MSc

Senior Health Advisor

UNICEF HQ, New York

Peter Strebel, MBChB, MPH

WHO HQ, Geneva

Jeff Mcfarland, MD

UNICEF HQ, New York

slide3

Measles Mortality Reduction 47 UNICEF / WHO Priority Countries 1999

94 % of all measles deaths

No second opportunity 2005 ( 47 )

slide4

Measles Mortality Reduction 47 UNICEF / WHO Priority Countries 2005

Nation - wide second opportunity 2005 ( 34 )

Partial implementation of second opportunity 2005 ( 11 )

No second opportunity 2005 ( 2 )

1 st dose measles coverage in 47 measles priority countries 1999 2005
1st Dose Measles Coverage in 47 Measles Priority Countries 1999 - 2005

77 %

Percent

71 %

Global Coverage 1st dose

65 %

54 %

Source: WHO / UNICEF coverage estimates, 1980 - 2005 as of August 2006

estimated global measles deaths 1999 2005

60%

reduction

Estimated Global Measles Deaths1999 - 2005

2005

Goal

High-low lines indicate uncertainty bounds

Source: Lancet 2007, L Wolfson, P Strebel, M Gacic-Dobo, E Hoekstra, J McFarland, B Hersh

2005 mortality reduction goal achieved
2005 Mortality Reduction Goal Achieved !!
  • > 360 million vaccinated in SIAs
  • 2.3 million additional deaths prevented
  • Phone - in press conference
  • > 220 media reports
how was this possible
How was this possible ?
  • Caring … Parents
  • Commitment … Countries and Governments
  • Cash …. Partnership
  • Measles control benefited from other investments
    • Strengthening routine immunization systems ( GAVI )
    • Polio eradication infrastructure and field staff

Photo: Aung

slide11

Measles Mortality Reduction 47 UNICEF / WHO Priority Countries 2005

Nation - wide second opportunity 2005 ( 34 )

Partial implementation of second opportunity 2005 ( 11 )

No second opportunity 2005 ( 2 )

slide12

Measles Mortality Reduction 47 UNICEF / WHO Priority Countries 2006

Nation - wide second opportunity 2006 ( 42 )

Partial implementation of second opportunity 2006 ( 3 )

No second opportunity 2006 ( 2 )

a d syringes shipped by unicef 1998 2006 safe injection practices
A - D Syringes Shipped by UNICEF1998 - 2006Safe Injection Practices

Number A-D Syringes in millions

0.5 ml Auto Disable Syringes

measles malaria
Measles & Malaria

Foto: Mark Grabowsky

slide18

Rapid ITN scale - up

LLINs delivered during integrated campaigns, 2002-2007

2006

Pre-2006

2007

In 2006, most LLINs are being delivered during integrated measles campaigns.

Source: Global Fund

measles control goals by who region
Measles Control Goalsby WHO Region

Americas, Europe, E. Mediterranean, W. Pacific have elimination goals

GIVS Goal:

90% reduction in deaths

by 2010 (vs. 2000)

2010

2010

2012

2000

Africa and SE Asia have

mortality reduction goals

reported measles incidence by who region 1980 2005
Reported Measles Incidence by WHO region, 1980 - 2005

Elimination

Source: Joint Reporting Form, WHO/IVB database, August 2006

americas measles eliminated since 2002
Americas: Measles Eliminated since 2002
  • Importations cause limited outbreaks
  • No persistent genotype

Genotype

D4

D5

D6

D8

D9

B3

H1

Unknown / other

D6 transmission ends

D9 transmission ends

2001

2002

2003

2004

2005

2006

Sources: PAHO, Country reports, Global Measles Laboratory

what will it take to achieve the goal
What will it take to achieve the goal ?

90%

Source: WHO/IVR projections, February 2007

what will it take to achieve the goal1
What will it take to achieve the goal ?

90%

Source: WHO/IVR projections, February 2007

what will it take to achieve the goal2
What will it take to achieve the goal ?

90%

Source: WHO/IVR projections, February 2007

what will it take to achieve the goal3
What will it take to achieve the goal ?

90%

Source: WHO/IVR projections, February 2007

planned measles campaigns january december 2007
Planned measles campaignsJanuary – December 2007

Other interventions:

Vitamin A – 19

De-worming – 10

Bed nets – 9

OPV - 4

Measles activities only

MR

MMR

WHO/IVB SIA database, as of 31 January 2007

challenges
Challenges
  • Completecatch-up
  • Sustainthe gains
      • Stronger routine
      • Quality follow – up
      • Low incidence  declining support
      • Government financing of follow - up SIAs
  • Integratewith other child health programmes

… going down hill is also going forward ..

slide29

Funding

Source: Orenstein WA. Pediatr Infect Dis J 2006; 25: 1093-1101

slide30

Measles

Good spots, bad spots

“ … But the fight against disease

is like any battle. It is unwise

to let your guard drop when you are on top … "

…The Economist, 20 Jan 2007

funding for measles mortality reduction 2007 2010 in million usd
Funding for Measles Mortality Reduction2007 - 2010 ( in million USD )

Estimated Total Funds needed = 479 million USD ( Measles Investment Case II )

Excludes country contributions

summary
Summary
  • Most ambitious measles goals ever
    • Less than 4 years to go
  • Comprehensive strategy required
  • Inverse relationship: funding down, measles up
    • Some 2.3 m lives are saved; But don\'t fail now
slide33

Myanmar January 2007

… Next step

… We are going to ASIA …

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