Measles pre-elimination and resurgence in the African region

1. Measles pre-elimination and resurgence in the African region Balcha Masresha IVD AFRO Global Measles Management Meeting Geneva 15 - 17 March 2011

2. Outline • Regional goal • Routine immunization • Second opportunity immunization through SIAs • Measles case-based surveillance • Measles resurgence in AFR • Challenges • Opportunities

3. Regional measles pre-elimination goal; targets to be met by end 2012. • 98% mortality reduction by 2012 compared to estimates for 2000 • Measles incidence <5 cases/106 per year in all countries; • >90% MCV1 national level coverage in all countries, and >80% in all districts; • >95% SIAs coverage in all districts; • All countries meeting the 2 main surveillance performance indicator targets • 80% districts reporting > 1 suspected measles case with a specimen per year • Non measles febrile rash illness rate of > 2:100,000 per year

4. Routine immunisation

5. MCV1 coverage (WHO UNICEF estimates) and reported measles cases: AFR. 1980 - 2009

6. Countries in AFR by MCV1 coverage category. (WHO-UNICEF estimates). 2001 - 2009

7. MCV1 coverage > 80% (WHO UNICEF estimates) for > 3 years including 2009. AFR +/- MCV2 introduction

8. Second opportunity measles vaccination through SIAs

9. Measles SIAs. 2010 • Follow up SIAs planned in 14 countries ~ target pop. 60.2 million • SIAs implemented in 9 countries targeting ~ 25 million • 5 countries had to postpone to 2011 for lack of partner and local resources • Outbreak response mass immunization in 5 countries • Target population ~ 22.6 million • 13 countries raised USD 21 million (51%) locally out of the expected USD 41 million for ops costs

10. Funds raised locally for measles SIAs (in USD per child targeted). AFR. 2010

11. Proportion of districts with >95% coverage during measles SIAs. 2009 – 2010. Nationwide outbreak response

12. Measles case based surveillance

13. Measles case based surveillance Performance Indicators. AFR. 2009 - 2010

14. Measles Resurgence in AFR. 2010 • 28 countries reported measles outbreaks • > 223,000 suspected measles casesand ~ 1,200 deaths reported through the aggregate reporting system • vs 37,010 suspected cases reported thru the JRF in 2008 • Outbreaks started at a median of 17 months after measles follow up SIAs (range: 1 to 44 months)

15. Incidence of confirmed measles per 100,000 population. AFR. 2010 Regional incidence: 17.4 per 100,000 population 10 countries (with 112.6 million total population) have measles incidence of >10 cases per 100,000

16. Measles outbreaks in AFR. • Surveillance data and preliminary investigations: • B3 serotypes in isolates • Reasons for outbreaks • gaps in routine immunization coverage • suboptimal coverage during recent SIAs (ZIM, NAM, ANG, BOT) • Pockets of unvaccinated & resistant populations (ZIM) • Critical accumulation of susceptibles in older age groups • too long (> 3 yrs) interval between follow-up SIAs (ZAM, LES, SEN)

17. Regional measles pre-elimination goal and current status 17

18. Planned Measles SIAs 2011 Target population: 56.7 million Total budget: USD 56.7 million Expected MI contribution thru WHO and UNICEF: USD 29.6 million

19. Timing of scheduled measles SIAs. AFR. 2010 MI funding not yet in place MI funding OK

20. Age group distribution of confirmed measles. AFR. 2010.

21. Challenges • Slow pace of routine immunizationcoverage improvement • Inadequate partner andlocal fundingfor SIAs • Delayed and inadequate preparations for measles SIAs • Continued measles outbreaks related to program gaps • Limited capacity for high quality outbreak investigation

22. Opportunities • Updating technical guidelines: to disseminate by end of March 2011 • EPI managers’ meetings • Best practices documentation: Ethiopia • Measles TAG: April 28 – 29, 2011 in Accra • Africa Vaccination Week • RC 61 – resolution on measles elimination for 2020

23. African Vaccination Week. 2011 • 38 countries have been conducting CHDs, MCH days etc • RC 60 resolution “to institutionalize an annual African Vaccination Week for sustaining advocacy, expanding community participation and improving immunization service delivery" • AVW to comprise of advocacy, education & outreach activities • Expected to • Improve access to high-risk populations and hard to reach areas; • Increase media interest in immunization; • create opportunities for pooling resources and coordinating efforts, • engage partners • build on the existing implementation framework of the maternal and child health initiatives

24. African Vaccination Week. 2011 (2) • AVW slogan is “Vaccinated communities, Healthy community” • AVW Theme for 2011 is "Put mothers and children first; Vaccinate and stop polio now”. • Last week of April 2011

25. Proposed recommendations • Resurgence and loss of gains in mortality reduction • Better mobilization of partner resources • Local resource mobilization for measles SIAs • Use the surveillance data and epidemiological information to determine the target age-groups for SIAs • Document and disseminate • lessons learnt from the best practice SIAs • Economic impact of measles outbreaks

26. Thanks Japanese Government