1 / 30

Do we need a measles vaccine stockpile for more effective measles outbreak response?

Do we need a measles vaccine stockpile for more effective measles outbreak response?. Global Measles and Rubella Management Meeting Salle B, WHO Headquarters, Geneva, Switzerland, 15 - 17 March 2011 Maya Van den Ent, PharmD , MPH Robin Nandy , MBBS, MPH Edward Hoekstra, MD. MSc

gzifa
Download Presentation

Do we need a measles vaccine stockpile for more effective measles outbreak response?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Do we need a measles vaccine stockpile for more effective measles outbreak response? Global Measles and Rubella Management Meeting Salle B, WHO Headquarters, Geneva, Switzerland, 15 - 17 March 2011 Maya Van den Ent, PharmD, MPH Robin Nandy, MBBS, MPH Edward Hoekstra, MD. MSc Measles and Emergencies , Health Section, UNICEF HQ

  2. Measles Emergencies • Disasters • Measles Outbreaks

  3. Funding Disasters through emergency funding Measles vaccination campaign part of initial response SPHERE Core Commitments For Children

  4. Measles Outbreak Response WHO Measles Outbreak Response Guidelines (2009) http://whqlibdoc.who.int/hq/2009/WHO_IVB_09.03_eng.pdf

  5. Critical Aspects Of Measles Outbreak Response Immunisation • Timing • As soon as possible after confirmation of the outbreak • Age range • Based on susceptibility profile, analysis of outbreak data, etc • Geographical area • Affected areas plus adjacent areas • Other high risk areas or population groups • Campaign coverage/quality

  6. Proportion Cases Prevented By Intervention Coverage & Time: 6 – 59 m, Niamey, Niger 100 2 months 3 months 90 4 months + 6 months 80 70 60 Proportion of Cases Prevented (%) 50 40 30 20 10 0 30 40 50 60 70 80 90 100 Intervention Coverage (%)

  7. Proportion Cases Prevented By Intervention Coverage & Time: 6 – 15 y, Niamey, Niger 100 90 80 70 60 Proportion of cases prevented(%) 50 40 2 months 3 months 30 4 months 20 10 0 30 40 50 60 70 80 90 100 Intervention Coverage (%)

  8. Overview Of Recent Outbreaks & Response Efforts

  9. Measles Outbreaks in Africa • Small fraction of number of cases compared to pre-SIA era • 28 countries experience outbreaks in June 2009 – Dec 2010 • Malawi, S. Africa, Zimbabwe, Zambia, Lesotho, Nigeria, DRC, Angola… • > 200,000 reported cases • > 127,000 confirmed cases • > 1,400 measles deaths Reported Measles Cases by Month andWHO Regions, 2006-2010

  10. Measles deaths, June 2009 – Dec 2010 (n = 1,463)

  11. Type of Outbreak Response Immunization (ORI) by Number of Confirmed Cases

  12. Timing Of Outbreak Response Immunization* * Outbreaks reported cases between June 2009 and Dec 2010

  13. Estimated Number of Doses Used for Outbreak Response in 2010 • About 30 million doses • About $11 million for bundled vaccines

  14. Issues • Lack of capacity and preparedness • Insufficient use of Government Emergency funds • Measles not always included in preparedness plans

  15. Is a stockpile the solution?Learning from Meningitis

  16. Global Stockpile Meningitis • Global shortage of vaccines as compared to demand • Mechanism to ensure access for most in need • Processing requests full time job during outbreak season • WHO-HQ hosts ICG secretariat • ICG: IFRC, MSF, UNICEF and WHO • Time between outbreak and response : 4 - 8 weeks

  17. Measles Stockpile? • Measles stockpile • Make funding available to respond to outbreaks • Questionable whether donors are willing to fund • Where should it be managed? • At global level? • In AFRO? • At national level? • What are criteria for allocation? • Does stockpile address the current problems?

  18. Stockpile Managed at Global/Regional Level (The Meningitis & YF Model) Requires: • Clear decision mechanism • Outbreak investigation standards • Risk analysis standards • Outbreak response standards • Interagency decision body • Emergency shipping mechanism • Monitoring and Evaluation

  19. Pros and ConsStockpile Managed at Global / Regional Level Pros Cons No country ownership Time consuming at global level Possible disincentive for other non contributing donors to support outbreak response Maydetract countries from focusing on improving the quality of routine programmes • Enabling systematic outbreak response • Response time can be short, if mechanism well developed • Potential new source of funds

  20. Stockpile Managed at National Level Requires: • Full country buy-in to reserve % of RI stock for outbreak response preparedness

  21. Pros and Cons Stockpile Managed at National Level Pros Cons Quality of outbreak response depending on country level understanding of ORI Local politics may interfere in decision making Difficult to monitor & follow up from global & regional level • Country buy in • Part of program planning & preparedness • Faster response, as vaccines are already in country

  22. QuestionsMeasles Stockpile? • Can we raise the funds? • $ 10 - 15 million annually • Revolving Fund? • What is the best mechanism? • Global / Regional vs National • Country/region specific? • Will the stockpile address the problems in Outbreak Response Immunization?

  23. Acknowledgements • EPICENTRE • Rebecca Freedman-Grais • WHO • Peter Strebel • Alya Dabbagh • Balcha Masresha • William Perea • ICG secretariat • CDC • Robb Linkins • UNICEF • Robin Nandy • Rouslan Karimov

  24. Extra slides

  25. Simulated Measles Cases In Niamey, Niger (2003-2004) 8.1% [4.9, 8.9] averted with intervention on day 161

  26. Reasons for outbreaks • Still gaps in routine immunization coverage • Suboptimal coverage during recent SIAs (ZIM, NAM, ANG, BOT) • Too long (> 3 yrs) interval between SIAs (ZAM, LES, SEN) • Pockets of unvaccinated & resistant populations (ZIM) • Lower demand due to disappearing disease • Accumulation of susceptibles in older age groups

  27. Type Of Outbreak Response Immunization* * Outbreaks reported cases between June 2009 and Dec 2010

  28. Measles reported cases, 2009-2010 (1 dot = 50 cases)

  29. Measles confirmed cases, 2009-2010 (1 dot = 50 cases)

More Related