Update on Progress toward Measles Situation in EMR

September 2008

Dr B. NaouriVPI/DCD/EMRO

Overview

• Current situation

• Status of implementation of measles elimination strategies

• Challenges

• Future Plans

Regional Committee Resolution, 1997

Eliminate measles in all member states of the Eastern

Mediterranean region by 2010

Measles Elimination in EMRO

Current situation

EMRO Reported Measles Cases and MCV1 Coverage 1990-2007

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

199019911992199319941995199619971998199920002001200220032004200520062007

Mea

sles

cas

es

0

10

20

30

40

50

60

70

80

90

100

MC

V1 C

over

age

Cases

MCV1

Measles Mortality in EMR 1999 - 2006

2005 target: 50% reduction

compared to1999

2010 target (GIVS):

90% reduction

103,800 106,000

93,600

68,700 70,000

47,60039,000

34,000

0

20,000

40,000

60,000

80,000

100,000

120,000

1999 2000 2001 2002 2003 2004 2005 2006

Year

Dea

ths

EMR target: elimination, 2010

Total Measles Cases by Country, Jan 1 - July 7 2008

0

500

1,000

1,500

2,000

2,500

Afghanistan

Bahrain

Djibouti

Iran

Iraq

Jordan

Egypt

Kuw

ait

Lebanon

Libya

Morocco

Om

an

Pakistan

Palestine

Qatar

Saudi A

rabia

Som

alia

Sudan

Syria

Tunisia

UA

E

Yem

en#

Co

nfi

rmed

Mea

sles

Cas

es

Vaccination Status of EMRO Confirmed Measles Cases Jan 1 - July 7 2008

0%

10%

20%

30%

40%

50%

60%

missing 0 doses 1 dose 2 doses 3 doses 5 doses

Status of implementation of measles elimination strategies

Strengthening routine infant immunization

95% coverage MCV1 in all districts

Palestine

Bahrain

Less than 50% (1 country & S. Sudan)

50% to 79% (5 countries)

More than 90% (14 countries)

MCV1 Coverage in countries of the EMR 2007

90% is not achieved in all districts

MCV1: 67% in 1990 85% in 2007

80% to 90% (2 countries)

Palestine

Bahrain

2nd opportunity of Measles Immunization

18 countries with routine second dose

4 countries with one dose and follow-up SIAs

Distribution of the 2.7 million children who did not receive measles vaccine, in 2007, EMRO

Yemen, 7%

Others, 8%

Pakistan, 42%

N.Sudan, 7%

S.Sudan, 8%

Somalia, 7%

Afghanistan, 12%

Iraq, 8%

Supplemental Immunization activities

Catch-up campaigns

• All countries have conducted catch-up campaign• 1994-2008: 220 M children were immunized

through catch-up campaigns• Repeated campaigns• 2008 Pakistan, Morocco, Lebanon Planned: Egypt

Reported Measles/Rubella Cases in Egypt (1996 – mid 2008)

21

2587

1023

85908019

5670

2287

4597

2154

77

953

2084

382261

11689

12249254327 274

52080

163

653

0

2000

4000

6000

8000

10000

12000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008years

no of casesRubella Measles

MMR

Lab

Rubella outbreak

MR Campaign Phase 1, 2008Budget Short Fall (21%)

Egypt (74%)

Vaccine and Logistics

Budget short fall

21%

($ 4.3 million)

SIA’s

Training

SM

MP

CM

UNICEF

5%

Planned SIA, EMRO, 2008-2009

Measles Case-Base Surveillance

Palestine

Bahrain

Nationwide case-based measles surveillance with laboratory investigation (18)

Case-based needs to be strengthened (4 & South Sudan)

Case-based Measles Surveillance 2008

Countries with serology plus virus isolation (12) Utilizing Polio infrastructure

Capacity of Measles/Rubella Laboratory Network in the EMR, 2008

Palestine

Bahrain

All Countries have NML serology

Regional Reference Laboratories

(22)

Sub-Regional Reference Laboratories

Challenges

Measles outbreaks EMRAugust 2008

• Iraq: 3322 cases

74% non-immunized

• Afghanistan: 20 outbreaks, 5-30 cases/outbreak• South Sudan: 147 cases, 9 deaths

Challenges (cont.)

• Repeated catch-up campaigns (Egypt)

• Support to non GAVI countries

• Implementation of an Integrated Disease Surveillance System

• Weakness of routine immunization programs

Future Plans (2009)

• Achieve and maintain a high routine measles vaccination coverage

Implementation of RED strategy• Ensure high quality of follow-up SIAs

• Strengthening of measles surveillance in all EMR countries by end of 2009

Regional Guidelines• Guidelines for validation of measles elimination

• Assistance to Somalia and South SudanSpecial efforts are needed

Thank you!