Post on 19-Jan-2016
description
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!