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Updates in measles control in the African Region. Measles Partnership Annual Meeting September 2008 Dr Balcha G Masresha WHO AFRO. Outline of presentation. Regional measles control goal and current status Routine immunisation Supplemental immunisation activities

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updates in measles control in the african region

Updates in measles control in the African Region

Measles Partnership Annual Meeting

September 2008

Dr Balcha G Masresha

WHO AFRO

outline of presentation
Outline of presentation
  • Regional measles control goal and current status
  • Routine immunisation
  • Supplemental immunisation activities
  • Measles case-based surveillance
  • Programmatic challenges
  • The “pre-elimination” goal for the African Region
estimated reduction in measles mortality all ages in the african region 2000 2006
Estimated reduction in measles mortality (all ages) in the African Region, 2000-2006

91 %

reduction

dpt1 measles drop out rates who unicef estimates 2006
DPT1 – measles drop out rates.(WHO UNICEF estimates. 2006)
  • 33 of 46 countries with drop-out rates >10%
    • 11 countries with drop out rates ≥ 20%
  • 3 countries with DTP1 ≥ 90% with drop out rates ≥ 20%
stagnating coverage high drop out rates why
Stagnating coverage / high drop out rates… WHY?

Infrastructure, financial and human resource limitations

Limited geographic access and utilisation access for routine services

Gaps in implementing the RED strategy:

Outreach, community linkages, use of data for action, appropriate management of resources

Logistics gaps including vaccine stock outs, aging cold chain and EPI vehicle fleet

Inaccuracy of denominators…

Improved quality of coverage reporting (e.g., administrative coverage data from CHWs / IPDs)

mp support for focused routine immunisation strengthening
MP support for focused routine immunisation strengthening
  • In 2008, 9 countries were supported financially
    • A total of USD 1,050,000
    • Support focused to avert measles outbreaks, de-linked from the SIAs (i.e., these 9 countries were not scheduled for SIAs in 2008)
tag 2008 criteria for considering mcv2
TAG 2008. Criteria for considering MCV2
  • MCV1 coverage >80%, for > 3 consecutive years (using WHO/UNICEF coverage estimates)

and

  • Attainment of one of the two primary measles surveillance performance indicators for at least two consecutive years.
    • i.e.,
      • Non-measles febrile rash illness rate of > 2.0 cases per 100,000 population per year
      • At least 1 suspected measles case investigated with blood specimens in > 80% of districts per year.
measles sias results
Measles SIAs; results
  • 97 SIAs in 43 countries reaching 329.9 million children from 2001 – end of 2007
  • 12 rounds with admin coverage 90 – 94%
  • 20 rounds with admin coverage < 90%
  • By end of 2008, a further 63.4 million children will be targeted in 9 countries
integrated delivery of multiple interventions is it always synergistic
Integrated delivery of multiple interventions; is it always synergistic?
  • Integration may be seen as being “partner-led”
    • room for advocacy and local consensus building
  • Weakness of central coordination
    • Need for stronger involvement of all programs
  • Delays in program level decisions/ resources/ logistics
  • Stock-out of “commodities” disrupting acceptance of antigens;
    • appropriate and detailed logistic planning
  • Need for further operational research on the factors conducive to the synergy
the regional measles surveillance network
The Regional measles surveillance network
  • 40 countries (749.4 million population) under case based surveillance
    • with a network of National / Regional Referral measles laboratories
  • Heavily dependent on the Polio infrastructure
    • Staffing, vehicles, funding for activities …
measles incidence 2007
Measles incidence. 2007
  • Regional incidence: > 10 cases per million for the last 3 years;
  • Country incidence levels ranging from 0 – 60 cases per million
trends of measles case reports nigeria 2005 2008
Trends of measles case reports. Nigeria. 2005 - 2008

Measles catch up

campaign

in Northern states

Measles catch up

campaign

in Southern states

2007

2008

2005

2006

age vaccination status of confirmed measles cases nigeria jan dec 2007 n 2 297
Age & vaccination status of confirmed measles cases, Nigeria. Jan – Dec 2007 (n=2,297)
age vaccination status of confirmed measles cases nigeria jan jul 2008 n 8 887
Age & vaccination status of confirmed measles cases. Nigeria, Jan – Jul 2008 (n=8,887)
challenges for measles control in afr
Challenges for measles control in AFR
  • Limitations in SIAs operational funding
    • Currency exchange rates, Rising costs of fuel, Rising staff costs, …
  • Limited local mobilization of $ resources for operational component of SIAs
  • Complacency following significant reduction of measles case burden
    • Gaps in SIAs coverage, surveillance performance…
  • System-wide constraints preventing sustained increase of routine immunization coverage beyond 80%
  • New Regional measles targets: “pre-elimination”
plans for measles sias in 2009
Plans for Measles SIAs in 2009
  • 18 countries = 39.7 million children
  • Total cost of $49.7 million
    • including
      • surveillance support to 40 countries
      • Focused support to close routine immunization program gaps and avert outbreaks in countries scheduled for SIAs in 2010
    • Expected MP portion of $37.8 million
    • Local sources expected to raise $11.9 million
      • MP role in advocacy!!!
pre elimination regional goal to be achieved by end 2012
“Pre-elimination regional goal” to be achieved by end-2012
  • Targets:
      • >98% mortality reduction by 2012 as compared to estimates for 2000;
      • Measles incidence <5 cases/106 population/year at national level in all countries;
      • >90% routine MCV1 coverage at national level, and >80% in all districts;
      • >95% SIAs coverage in all districts;
      • AND…
slide30

“Pre-elimination regional goal” to be achieved by end-2012 (cont’d)

… continued

  • Measles surveillance performance:
    • Non-measles febrile rash illness rate of >2.0 cases per 100,000 population per year;
    • ≥1 suspected measles case investigated with blood specimens in at least 80% of districts per year; and
    • Routine district reporting from 100% of districts.
working towards the pre elimination targets anticipated challenges
Working towards the pre-elimination targets: anticipated challenges
  • Overcoming the complacency and maintaining the political will to scale up measles control activities to “pre-elimination” levels esp. while polio eradication still poses a challenge
  • Raising the required $ resources (at international and local levels)
  • Maintaining the surveillance infrastructure
  • Attaining the ambitious routine immunization goals of >90% MCV at national level and >80% in all districts