Desirée Pastor, MD, MPHRegional Immunization Advisor

PAHO/WHO

JOINT REGIONAL MEETING FOR THE AMERICAS & EUROPE Sabin Vaccine Institute: International Association of Immunization Managers

Update on the Regional ImmunizationSituation in the Americas

Outline• Background

• Regional Progress and Impact in Vaccination

• Measles and Rubella elimination

• Challenges

2

Vaccination as a publicgood

Shared responsibility Pan-Americanism

Partners

Governments of MemberStates

Civil Society

International Organizations

Creation of the Expanded Program on Immunization: 1977 PAHO Directing Council Resolution, DC25.R27

LIFE COURSE

15

LIFE

COURSE

1979 Creation of the Revolving Fund

1980 Creation of international evaluation methodology for the EPI

1983 “Days of Tranquility”

1985 Creation of the EPI Technical Advisory Group

1985 Creation of the Interagency Cooperation Committee

1991 Last indigenous case of polio in Peru

1994 Declaration of the goal to eliminate measles

1994 1st Region certified free of polio

2003 1st Vaccination Week in the Americas

2006 Launch of the Pro-Vac initiative

2010 Directing Council resolution on strengthening the EPI (RIVS)

2012 1st World Immunization Week

2013 Directing Council resolution on the principles of the Revolving Fund

2015 1st Region declared free of rubella

2015 Directing Council resolution on the Regional Immunization Action Plan

2016 Polio Switch

1st Region declared free of Measles

Milestones in the 39 years of the EPI in the Americas

1977 2016PAHO’s

Directing Council

establishes the EPI

2017

40 years of the EPI in the Americas

15 years of VWA

We are going for more…elimination of measles and perinatal hepatitis B

Introduction of New Vaccines

Neumo, Rota, VPH

Neumo, Rota

Neumococo

1. El Salvador2. Guatemala 3. Honduras4. Nicaragua5. Rep. Dominicana 6. Bolivia 7. Venezuela

1. Aruba2. Bahamas3. Barbados4. Bermuda5. Costa Rica6. Curacao

1. Haití

Rotavirus

1. Argentina2. Brasil3. Colombia4. Ecuador5. Estados Unidos6. Guyana7. Islas Caimán8. México9. Panamá10. Perú 11. Paraguay

Neumo, VPH

1. Canadá2. Chile3. Departamentos franceses ((3)4. Municipios holandeses (3)5. Trinidad & Tobago6. Uruguay

Fuente: Country Reports to PAHO-WHO-UNICEF (JRF), 2016

PCV: 28 countries and 6 territoriesRV: 17 countries and 1 territoriesVPH: 16 countries and 7 territories

VPH

1. Surinam2. Belize

PAHO’s Ongoing Work to Face Challenges through Strategic Technical Cooperation

Planning•RIAP adoption & adaption

•Financial resources

•Annual/Multi-annual plans

•Adequate provision of supplies through the RF

Information•Data quality

•Data analysis

•Electronic Immunization Registries

Surveillance• Timeliness

• High quality

• Completeness

Human Resources• Well-trained and technically up-to-

date

• Training in research and the generation of evidence

Structure and Organization

• Fortified management

• Integrated service delivery

• Immunization services adapted to individual communities

Monitoring & Evaluation

• International EPI Evaluations

• Supportive supervision

Efforts are adapted to the characteristics of each country with the goal of achieving a high level of commitment at the national and local level to improve IM coverage and

reduce inequities at the local level

Outline

• Background

• Regional Progress and Impact in Vaccination

• Measles and Rubella elimination

• Challenges

8

212426

3945

4952

56

6468

76727070

73737271727272737375767879808284858585858586

0

20

40

60

80

10019

80

198

1

198

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198

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198

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198

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198

6

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199

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199

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% c

ove

rag

e

Global African American Eastern Mediterranean

European South East Asian Western Pacific

Source: WHO/UNICEF coverage estimates 2015 revision. July 2016

Immunization Vaccines and Biologicals, (IVB), World Health Organization.

194 WHO Member States. Date of slide: 16 July 2016.

Global and Regional DTP3 Coverage, 1980-2015

Global coverage at 86% in 2015

10

Regional Coverage of DTP1, DTP3, MCV12010-2015

93 93 92

9694 94

9693 9495

9092

95

9092

96

9194

0

10

20

30

40

50

60

70

80

90

100

DPT1 DPT3 MMR1/Sar

2010

2011

2012

2013

2014

2015

%

Provisional data as of 6/30/16, susceptible to changes based on countries’ revisions. Source: Country reports through the PAHO-WHO/UNICEF Joint Reporting Form (JRF) 2016

72

73

74

78

80

85

87

87

89

89

90

91

91

91

91

92

92

92

93

94

94

94

94

95

95

95

95

95

96

96

96

97

97

98

99

100

100

100

100

100

100

100

100

0 10 20 30 40 50 60 70 80 90 100

Haiti

Panama

Guatemala

Ecuador

Paraguay

Dominican Republic

Venezuela

Mexico

Bolivia

Suriname

Peru

Jamaica

Canada

El Salvador

Colombia

Aruba

Costa Rica

Grenada

Cayman Islands

Saint Kitts and Nevis

Argentina

Turks and Caicos Islands

Belize

Uruguay

United States

Bahamas

Guyana

Bermuda

Chile

Trinidad and Tobago

Brazil

Virgin Islands (British)

Barbados

Dominica

Honduras

Sint Maarten

Anguilla

Antigua and Barbuda

Cuba

Montserrat

Nicaragua

Saint Lucia

Saint Vincent and The Grenadines

% de cobertura

95%DPT3 Coverage in the Countries of the Americas, 2015

100 100 100 100 100 100 100 100 100 100 100 100 99

92 9290 90 89 88 88

85 84 83

80

75 74 74 74 7473

71

64

56

44 44 43

40

32 32

0

20

40

60

80

100

% o

f m

un

icip

alit

ies

wit

h D

TP3

vac

cin

atio

n c

ove

rage

of

≥ 8

0%

.Classification of countries by % of municipalities with

DTP3 coverage ≥ 80% 2015

13

Number of children not vaccinated (DTP3) by yearSelected countries in the Americas, 2010-2015

Provisional data as of 6/30/16, susceptible to changes based on countries’ revisions. Source: Country reports through the PAHO-WHO/UNICEF Joint Reporting Form (JRF) 2016

Outline

• Background

• Regional Progress and Impact in Vaccination

• Measles and Rubella elimination

• Challenges

14

Bye-bye, rubella! ¡Adiós rubéola!

Declaration of the Elimination of Measles in the Americas, September 2016

Bye-bye measles! Adiós sarampión!

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

0

500

1000

1500

2000

2500

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Brazil Canada Mexico USA Venezuela Ecuador Regional rate

N=1,369

Confirmed measles cases following the interruption of endemic transmission.

The Americas, 2003-2016*

N=143

N=473

N=1,966

Source: ISIS, MESSS and country reports to FGL-IM/PAHO.

*Data as of epidemiological week 45, 2016.

Rate= 1.9 x 1,000,000

population

N=613

Nu

mb

er

of

co

nfi

rme

d C

as

es

Rate

pe

r 1

,00

0,0

00 p

op

ula

tio

n

N=65

Confirmed measles cases by second administrative levelThe Americas, 2011, 2014, 2015, and 2016*

2011

N=1,369 cases

2014

N=1,966 cases

Source: Country reports to FGL-IM/PAHO.

*Data as of epidemiological week 45, 2016

2015

N=613 cases

Brazil= 214Canada= 196Colombia=1Chile=9 Mexico= 1United States= 188Peru=4

Total (2015)= 613

2016*

N=65 cases

Canada= 11Ecuador=1United States= 53

Total (2016)= 65

Performance of Measles/Rubella surveillance

indicators

The Americas, 2012-2016*

79 81

97

8084

70

88 86

78

71

8481

88

80

72

54

82

9288

81

50

80

95

78 77

0

20

40

60

80

100

Sites reportingweekly (%)*

% adeqinvestigation

% adeq sample % of blood samplesin lab <=5 days

% of lab resultsreportd <=4 days

2012 2013 2014 2015 2016

*Data as of January 27, 2017

Source: ISIS, MESSS and country reports.

Outline

• Background

• Regional Progress and Impact in Vaccination

• Measles and Rubella elimination

• Challenges

21

Measles and Rubella elimination sustainability challenges in the Americas

1. Maintain the advocacy at the highest political level to protect the measles and rubella elimination goals, in light of continuous virus importations;

2. Strengthen national ownership and capacity within the framework of the Regional Immunization Action Plan (RIAP) for increasing immunization coverage among vulnerable and hard-to-reach populations with at least 95% at national and district level;

22

Measles and Rubella elimination sustainability challenges in the Americas (2)

3. Ensure a high quality measles and rubella surveillance and a rapid response facing imported cases;

4. Ensure high herd immunity in the population through high quality follow-up campaigns;

5. Advocate with other WHO Regions and strategic partners (M&RI) to step up our efforts with a view to achieving a global measles and rubella elimination toward the global eradication of both viruses.

23http://www.paho.org/hq/index.php?option=com_content&view=article&id=7022&Itemid=39541&lang=en

1994 2009 2020…

The Region of the Americas

certified as polio-free

Last case of endemic measles

virus in theAmericas

Last case of endemic rubella

virus and congenital rubella syndrome (CRS) in

the Americas

Elimination and Erradication of Vaccine-preventableDiseases in the Americas

Declaration of theelimination of measles

in the Americas

2015

Elimination of Hepatitis B??

20021991 2016

Declaration of theelimination of rubella in the

Americas

Global switch fromtOPV al bOPV

Last case of wild

poliovirus in the Americas

Thank you!