Measles elimination in the African Region- Regional updates

Dr Balcha MASRESHA IVD/AFRO

Annual MRI Partners’ MeetingWashington DC

10 – 11 September 2013

Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 20132 |

Regional measles elimination targets for 2020

• > 95% measles immunization coverage at national level and in all districts;

• > 95% SIAs coverage in all scheduled measles SIAs, and in outbreak response immunization activities;

• measles incidence of <1: 1,000,000 population at national level;

• > 80% of districts investigating > 1 suspected measles cases within a year, and a non measles febrile rash illness rate of > 2 per 100000 population at national level.

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Routine Immunisation

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MCV1 coverage WHO UNICEF estimates. AFR. 2000 – 2012.

40

45

50

55

60

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70

75

80

MCV

1 co

vera

ge e

stim

ates

(per

cent

age)

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MCV1 coverage WHO UNICEF estimates in AFR countries. 2008 – 2012.

05

101520253035404550

2008 2009 2010 2011 2012

Num

ber o

f cou

ntrie

s

90 plus80 - 8970 - 7960 - 69<60

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MCV2 introduction in AFR (as of August 2013)

• MCV2 in routine services in 20 countries by end 2014

• MCV2 in ~ 25 countries by the end of 2015.

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Supplemental Immunisation activities

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Measles SIAs in 2013

• 16 countries doing SIAs• MR SIAs in 4 countries

• A total of 88.9 million targeted

• 16,118,351 reached in 3 countries,

• awaiting results from 2 more countries

• 11 countries doing SIAs in the last quarter

• MR used in 4 of the 16 SIAs

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Measles SIAs national and district level coverage. 2012 – August 2013. AFR.

0%

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100%

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ERI GUB GUI SWZ KEN ETH UGA NIE SIL CAE BUR RWA ZIM STP NAM CHA ZAM

% d

istric

ts w

ith >

/=95

% co

vera

ge

Nati

onal

adm

in c

over

age

National coverage Districts >=95%

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Case based surveillance

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Key Measles Surveillance Performance Indicators, African Region 2010 – end July 2013.PERFORMANCE INDICATORS 2010 2011 2012 2013

Number of suspected measles cases reported 163,575 74,896 55,717 58,657

Number of confirmed measles cases 127,422 32,323 20,935 35,558

Non-measles febrile rash illness(target >2/ 100,000 population ) 3.7 4.4 3.7 2.9

% districts reporting at least 1 case with blood sample (target >80%) 84% 81% 84% 77%

Incidence of confirmed measles per million population 165 42 27 41

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Measles case based surveillance performance. AFR. 2012.

Measles Incidence rate per million population. AFR. 2012

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100%

0

200,000

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1,600,00019

8019

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WHO

-UN

ICEF

M

CV1

cove

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Mea

sles

case

repo

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Measles case reports

MCV1 coverage estimates

Catch up SIAs

Follow up SIAs

Measles case reports & MCV1 coverage (WHO-UNICEF estimates). AFR. 1980 - 2012

• 64% of case reports in 2010 = from Malawi• 69% and 68% of case reports in 2011 and 2012= from DR Congo

Performance against the 2020 measles elimination targets (as of Dec 2012)

• > 90% MCV1 coverage nationally (WHO UNICEF estimates) • 15 countries (2012)

• > 95% coverage during measles SIAs in every district.• 3/12 countries (2012)

• incidence < 1 confirmed measles /1,000,000 pop’n /year

• 16 countries

• NMFRI rate of > 2:100,000• 25 countries

• > 80% districts reporting per year• 25 countries

Weekly trends of measles reporting in DR Congo by province. 2010 – week 33, 2013

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Measles Resurgence in AFR; Key factors

• Gaps in routine coverage

• Delays and gaps in SIAs coverage

• Resistant groups

• Shift in epidemiological susceptibility

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Confirmed measles. Case based surveillance data. AFR. 2003 – July 2011

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Age breakdown of confirmed measles cases. Ethiopia. 2005 – 2012.

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Attempts to address the resurgence: Routine immunisation program

• Ongoing efforts to strengthen immunisation systems• The opportunity of new vaccine introduction• “RED approach”

• Ministerial conference on implementing GVAP – early 2014

• MCV2 introduction and Post introduction evaluations

• Linking GAVI HSS support to immunisation outcomes

• Using SIAs as an opportunity to support strengthening routine immunisation

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• Planning and budgeting for SIAs in the context of national strategic plans & cMYPs

• Timely mobilisation of local and partner resources for SIAs• Timely conduct of scheduled SIAs

• Emphasising on high quality SIAs ( > 95% coverage in every district)

• SIAs targeting age groups as determined by the epi. picture:• Zambia, Niger in 2012• Togo, 2 provinces in DRC in 2013

Attempts to address the resurgence: SIAs

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2005 2006 2007 2008 2009 2010 2011 2012Pe

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ases

Age breakdown of measles cases in selected provinces in DRC. 2005 – 2012.

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2005 2006 2007 2008 2009 2010 2011 2012

Perc

enta

ge o

f cas

es

unknown

15 yrs and above

10 - 14 yrs

5 - 9 yrs

9 - 59 months

< 9 months

Equateur province, DRC. Orientale province, DRC.

Measles SIAs in 2014• 14 countries (incl. S Sudan)*• A total of 78.6 million to be

targeted– MR SIAs in 2 countries– GAVI support for CHA, DRC, BUR,

TAN– 3 non GAVI eligible

• MRI support = 5 countries with 11.6 million to target: – ~ USD 13.1 million for BV, ½ ops

costs, surveillance and TA

* CAR and MOZ = SIAs in 2013???

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• SIAs:• Mostly francophone countries • Angola• S Sudan!

• Areas for MRI support:• SIAs:

• Logistics • Planning and coordination of coverage survey• Advocacy with non-GAVI eligible countries

• MCV-2 Post-Introduction Evaluation• Surveillance reviews:

Technical support needs in 2014

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Anne Ray Charitable Trust

Thank you