reaching the 2010 measles mortality reduction goal-can searo get there? meeting of the partners for...

IMMUNIZATION AND VACCINE DEVELOPMENTIVD

Reaching the 2010 Measles Mortality Reduction Goal-can

SEARO get there?

Meeting of the Partners for Measles Advocacy

Washington DC, 23-24 September 2008

Dr. Pem NamgyalRegional Adviser, Vaccine Preventable Diseases

Immunization and Vaccine DevelopmentDepartment of Family and Community Health, SEARO

Immunization and Vaccine Development, FCH |

Regional Strategic Plan 2007-2010

Goal By 2010 reduce the number of estimated measles deaths by

90% in comparison to 2000Specific objectives

• 1st dose measles coverage >90%, nationally and >80% coverage in all districts by 2010

• Provide a second opportunity for measles immunization by 2010 while achieving >90% coverage

• Case based measles surveillance within integrated surveillance systems in countries that completed catch-up campaigns

• Fully investigate all detected/reported measles outbreaks


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Estimated Measles Deaths WHO/UNICEF estimated MCV 1 coverage

41 million people were vaccinated in SIAs in 2007

Sources: Mortality estimate WHO/HQ MCV1 coverage: WHO/UNICEF best estimates

Estimated measles mortality reduced by 26% between 2000 and 2006


Measles 2nd Opportunity through

Routine Immunization

Catch-up Campaigns completed

Measles 2nd Opportunity through

Catch-up Campaigns

Provide MR/MMR vaccine

Bhutan, Maldives and Sri Lanka provided MRFollow up campaigns planned : Nepal (2008), Bangladesh (2010)

116 million people have been vaccinated from 2000-07

Provide Measles Vaccine

Second Opportunity for Measles Immunization, SEAR, 2008


SEAR Measles Lab Network 2008 (July)

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2005. All rights reserved

NIV Pune

BJM Ahm IoS Kol

Ref lab for genotyping (India)

(18)

(1)

(1)


Cases from Serologically Confirmed Suspected Measles Outbreaks Nepal, 2003-2008 July

Source: Monthly case-based data, Jul 2008

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Phase 3Phase 2

Measles catch-up campaign

Phase 1


Cases from Serologically Confirmed Suspected Measles Outbreaks Bangladesh, 2004-2008 July

Source: Monthly case-based data, Jul 2008

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Measles Catch-up Campaign


Estimated Measles Mortality, India, 2006

94% deathsIn 10 states

~ 150,000 Deaths


Measles: routine coverage and surveillance in India

• Measles routine coverage in India is low, but showing progressive improvement

• Surveillance in general is poor; in six southern states WHO SMO network is supporting the state government to carry out measles surveillance

• Surveillance needs to be established in other states as well, but who is to do it is the current debate

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MCV1 coverage (%), India


Total cases- 678 Total cases- 1044

Total cases-1132

Andhra Pradesh Gujarat

Tamil Nadu

Total cases- 314

Kerala

Total cases-1838

West Bengal

Total cases- 2530

Karnataka

Serologically confirmed measles outbreaks India: cases by age, 2007

Cases from serologically confirmed measles outbreaks

% % %

% % %

* data as on 10th Jul, 2008


India Technical Advisory Group for Measles Control (ITAGM)

• In 2007 GoI formed the India Technical Advisory Group for Measles (ITAGM) comprising national and international experts to guide the government on the future steps for measles mortality reduction in India

• ITAGM held its 1st meeting in September 2007 and put up its recommendations to National Technical Advisory Group on Immunization (NTAGI)

• NTAGI met on 16 June 2008 endorsed ITAGM recommendations


ITAGM – State specific strategies

Group

1st dose coverage with MCV

Strategy

1 Low Improve RIOne-time catch-up SIA targeting children 9m-10 years*Repeat SIAs targeting new birth cohorts based on RI coverage and surveillance data

2 Medium Improve RIOne-time catch-up SIA targeting children 9m-10 years*Repeat SIAs targeting subsequent birth cohorts and/or introduction of a routine 2nd dose

3 High (>90%) Introduce a routine 2nd dose of measles vaccine

*Target age range for SIAs will be adjusted based on age distribution of recent cases


NTAGI Recommendations for Measles control

a) UIP second dose (MR): States with >=80% evaluated MCV1

b) Catch-up measles SIA campaigns (9mo-10 YR): States with <80% evaluated MCV1.

c) For UP, decision on catch-up SIA after consultation with State Government.

d) CFR studies: in selected high burden states.• Draft proposal developed, being reviewed

e) Expansion of measles surveillance will be done in UP and Bihar and other states with high mortality due to measles for SIA planning and having a baseline.


Recommendations of ITAG and regional priorities

• Implementation of NTAGI recommendations on accelerating measles mortality reduction in India.

– Most importantly, the 10 states of India that account for 90% of measles mortality need to conduct measles catch-up SIAs as soon as possible.

• Technical sub-group to develop SEAR regional rubella control policy

and providing more comprehensive guidance on implementation of measles control and surveillance.

• All countries that have completed catch-up campaigns should initiate measles case-based surveillance with laboratory confirmation and fully investigation of all detected/reported outbreaks.


Can SEA Region Make it?

• The answer is Yes if we can get India to accelerate the process

• The problem is neither financial nor technical

• The most influential partners and from the highest level need to emphasize to the highest authorities in India the importance of India’s achievement to the regional and global ability to achieve the goal for measles mortality reduction


THANK YOU

reaching the 2010 measles mortality reduction goal-can searo get there? meeting of the partners for...

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