Global Overview of Measles
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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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Edward J. Hoekstra, MD, MSc Senior Health Advisor UNICEF HQ, New York

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Edward j hoekstra md msc senior health advisor unicef hq new york

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


Edward j hoekstra md msc senior health advisor unicef hq new york

2005 Mortality Reduction Goal

Achieved !!


Edward j hoekstra md msc senior health advisor unicef hq new york

Measles Mortality Reduction 47 UNICEF / WHO Priority Countries 1999

94 % of all measles deaths

No second opportunity 2005 ( 47 )


Edward j hoekstra md msc senior health advisor unicef hq new york

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


Percent reduction in estimated measles deaths by who region between 1999 and 2005

Percent reduction in estimated measles deaths by WHO region between 1999 and 2005

81 %

62 %

60 %

75 %


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


Progress in 2006

Progress in 2006


Edward j hoekstra md msc senior health advisor unicef hq new york

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 )


Edward j hoekstra md msc senior health advisor unicef hq new york

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 )


Measles vaccines shipped by unicef 1999 2006

Measles Vaccines Shipped by UNICEF1999 - 2006

Doses Millions


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


Expenditures measles mortality reduction unicef hq and who hq 1999 2007

Expenditures Measles Mortality ReductionUNICEF HQ and WHO HQ , 1999 - 2007

$ Millions


M m integration

m & m integration


Measles malaria

Measles & Malaria

Foto: Mark Grabowsky


Edward j hoekstra md msc senior health advisor unicef hq new york

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


Strategies

Strategies


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 ..


    Edward j hoekstra md msc senior health advisor unicef hq new york

    Funding

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


    Edward j hoekstra md msc senior health advisor unicef hq new york

    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


    Edward j hoekstra md msc senior health advisor unicef hq new york

    Myanmar January 2007

    … Next step

    … We are going to ASIA …


    Edward j hoekstra md msc senior health advisor unicef hq new york

    So … Where in the world is Peter Strebel ??

    Thanks


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