Update of the Regional Immunization Programme2015” (WHA58.15) World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization Programme Objectives

World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization WHO Region for Western Pacific

November 2010 SAGE Meeting

Update of the Regional Immunization Programme

Geneva October 9, 2010

Dr David H. Sniadack, Ag. Team Leader, EPI

World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization

Outline

•  Technical Strategic Framework (TSF) •  Targeted disease and EPI mandates •  Targeted disease updates and linkages to routine

immunization and health systems and child health


EPI Mandates - GIVS

“58th WHA urges Member States to adopt the Global Immunization Vision and Strategy as the framework for strengthening of national immunization programmes between 2006 and 2015” (WHA58.15)


Programme Objectives (Level B) PO 1: Maximize equitable access of vaccine of assured quality to

control VPDs, including pandemic vaccine PO 2: Achieve targeted disease eradication, elimination and control

(polio, measles/rubella, Hep B, MNTE) PO 3: Promote rational introduction of new vaccines PO 4: Strengthen VPD surveillance, lab, monitoring and data use PO 5: Strengthen partnerships, advocacy & communication, and

integration

EPI Technical Strategic Framework

Reduce mortality, morbidity, and disability from vaccine-preventable diseases

Health Goal (Level A)


Targeted Disease Mandates: RC Resolutions Eradication, Elimination & Control of Specific VPDs

•  Polio eradication (1988-2001, 2003, 2005, 2010)

•  Measles elimination (2003, 2005, 2010)

•  Rubella Control & CRS Prevention (2003, 2010)

•  Hepatitis B Control (2003, 2005, 2010)

WPRO EPI Technical Strategic Framework Programme Objective 2


Routine Immunization Strengthening through Targeted

Disease Approaches The Regional Committee

•  recognizing the positive impact of poliomyelitis eradication in the Western Pacific Region on the Expanded Programme on Immunization (EPI) and the wider health sector

•  DECIDES that, in the Western Pacific Region, measles elimination and hepatitis B control should be the two new pillars to strengthen the EPI; WPR/RC54.R3

54th Regional Committee Resolution (2003)


SIA Linkage to “Routine” Immunization Vax/Log/CC forecast

Vax/Log/CC Management

Operational Planning

Approach Staffing Supplies Safety/Waste

Fixed Site Outreach Temporary Mobile

Monitoring

Supervision Registration Books

Report Forms Tally Forms

Wall Charts

Data Management Coverage Surveillance Indicators

Advocacy, Soc Mob, Communication Partnerships & Financing

Risk Management/ AEFI Surveillance

SIAs incorporate

all aspects of routine

immunization


SIA Linkage to Child Health

•  Multi-antigens (OPV, DTP/Pentavalent, Measles, TT) •  Referral slips for drop-outs/left-outs •  Vitamin A, other micronutrients •  Deworming medicine •  Insecticide-treated bednets •  Hand washing/soap •  Ante-natal care / Family Planning

1

World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization • Source: WHO/UNICEF JRFs ,1980-‐2009

Reported Measles Cases and MCV1 Coverage Western Pacific Region 1980 – 2009*

93%


Measles “Catch-‐Up” SIAs Western Pacific Region,

1994-‐2010

2008

2003 – 2007

2009

2010

LEGEND:

None

1994 – 2002

1990-1995: measles control 1996-2002: accelerated measles control 2003-2012: measles elimination Source: country SIAs reports


SIAs in China   2004-2009 (rolling by province)

•  Catch up – 8m-14y: 25/31 provinces •  Follow up – 8m-6y: 6 provinces •  160 million vaccinated; coverage ~95%

  2010 (nationwide) •  8m-14y: 5 provinces •  8m-6y: 3 provinces •  8-59m: 23 provinces •  102.3 million vaccinated; coverage ~97%

(unoffical, as of Sept 29, 2010)


At/near (25)

Likely (5)

LEGEND

Hopefully (7)

4.1% of the regional popula]on



Feasibility of Measles Elimina]on by 2012, Western Pacific Region

World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization Source: WHO/IVB database, 2010

Reported Vaccination Coverage, Western Pacific Region 1980-2009


Percent of Districts, by Category of DTP3 Coverage, WPR 2007 - 2009

2007 2008 2009

77% ≥ 90% 70% ≥ 90% 76% ≥ 90%


Completeness and Timeliness of Country Repor]ng to the Western Pacific Regional Office, 2007-‐2010*

• Reporting through September 2010. Source: WPR surveillance database


Rubella Rou]ne Immuniza]on Western Pacific Region, 2009

Not Offering (6)

MR (7)

MMR (23)

Type of vaccine:

30 (83%) already use RCV

MR at 8 months MMR at 18-‐24 months


< 1.0 (21)

1.0 – 9.9 (8)

10.0 – 19.9 (3)

LEGEND:

20.0 - 99.9 (4)

Rubella Incidence* Western Pacific Region, 2009

Source: WHO-UNICEF Joint Reporting Forms

* per million population


Hepatitis B Control Milestone Status, By Country and Area, WPR, 2010

ASM

NRU

FJI

MHL

SIN

COK

FSM

BRU

AUS

FRP

NEZ

PHL VTN

GUM

NEC

KIR

PNG

LAO

CAM

MAA

NIU

KOR

JPN MON

CHN

NMI

MAC

SMA

VAN

BLA

WAF

TOK

TON

HOK

TUV

SOL

Priority: have not reached coverage targets (≥85% HepB3 and ≥65% HepB BD)

On-track: reached coverage targets or conducted seroprevalence surveys

Certified: <2% chronic infection among 5y

9 priority countries Intersection of EPI and MCH


Hepatitis B Control Milestone Status, by Category, Western Pacific Region 2010

*At least 9 countries; some countries with prevalence data need more

Category Actions Countries and Areas

Low vaccination coverage

Detailed action plans 5 non -‐ PICs (CAM, PNG, PHL, LAO, VTN) 4 PICs (VAN, SMA, SOL, KIR)

Lack prevalence data

Survey options for certification

9 PICs (COK, FRP, FSM, GUM, NAU, NUI, TOK, TUV, WAF)*

Have prevalence data

ERP guidance to certify or get more data

5 non -‐ PICs (AUS, CHN, JPN, NEZ, SIN) 7 PIC (ASM, CMNI, FIJ, NEC, BLA,TON, MSI)

Surveys in process

Not Urgent 2 (BRU, MOG)

Certification in process

Not Urgent 2 (HOK, MAA)

Certified Not Urgent 2 (KOR, MAC)


Maternal and Neonatal Tetanus Elimination (MNTE)

•  All countries, except five (Cambodia, China, Laos, Philippines, Papua New Guinea) have achieved MNTE

•  New plan of action focusing on integrated approach with MCH programme in progress in three countries (Cambodia, Laos and the Philippines)

21


The Region has maintained polio free status

for more than consecutive years

18

Distribution of AFP and Laboratory-Confirmed Polio Cases, by District*, Tajikistan, 2010

= 1 Confirmed wild poliovirus type 1 - Total 455 cases

= Districts with AFP Cases

Data as of 20 Aug 2010 *Dots are placed randomly within district

Source: Weekly AFP reporting to WHO European Region 22

China


Wild Poliovirus Importation Risk Assessment Parameters

•  Population immunity - National and district coverage, trends, last SIA

•  Surveillance performance - NPAFP rate; % adequate stool; sub-national gaps

•  Programme performance - Dropout rates; stock outs; importation preparedness

plan •  Threat

- Probability of importation; bordering polio affected areas


Low risk (30 countries and areas)

Medium risk (CHN, MAA, PHL, VTN)

High risk (CAM, LAO, PNG)

LEGEND:

Risk Assessment of Wild Poliovirus Importation Western Pacific Region


Risk Assessment of Wild Poliovirus Importation Western Pacific Region

•  High risk –  Cambodia: subnational coverage gaps, seriously declining AFP

surveillance, last SIA in 2006 –  Lao PDR: low coverage levels, surveillance challenges –  Papua New Guinea: low coverage levels, large variance

subnationally, low surveillance quality

•  Medium risk –  China: subnational coverage and surveillance gaps, mainly due

to population movements (“floating population”) –  Malaysia: mainly surveillance challenges in some states –  Philippines: mainly based on inadequate AFP surveillance but

also subnational coverage gaps –  Viet Nam: mainly subnational surveillance challenges


Summary Impact of Targeted Disease Initiatives on Routine Systems

•  SIAs (polio, measles, rubella, TT, etc.) -  Focus on programmatic quality at several levels -  Opportunities for integrated health initiatives -  Advocacy for immunization

•  Hep B - Need for 65% Hep B BD creates linkages with MCH, HIV/AIDS

•  MNTE -  Need to vaccinate pregnant and/or CBA women creates linkages with

MCH and is being implemented in CAM, LAO, PHL •  Polio

-  Importation risk assessment and preparedness requires careful review of routine systems and addressing immunity and surveillance gaps

All targeted disease initiatives include strong routine immunization programmes as their #1 strategy


Thank You

Documents

Update of the Regional Immunization Programme2015” (WHA58.15) World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization Programme Objectives