Measles and Rubella Elimination Country Situation for Lao PDR Lao PDR Measles and Rubella Elimination Launching Ceremony Vientiane Capital, 15 February 2019

Measles incidence, epidemiologic characteristics Year Suspected measles cases Confirmed cases Discarded as non-measles Measles incidence (per 1 M) Deaths due to measles Detected Genotypes D9|H1 Lab Epi-linked Total 2014 491 69 1 70 266 10.6 2015 631 13 43 56 570 8.4 2016 512 2 6 8 504 1.2 2017 497 3 490 0.4 2018 500 5 7 348 1.7

Measles cases and immunization coverage Year Immunization coverage Measles cases 1995 68% 3.200 1998 71% 4.500 2002 45% 2.500 2007 35% 1.600 2014 87% 70 2015 88% 56 2016 76% 8 2017 82% 3 2018 78% 7

Supplementary immunization coverage Year Age Vaccine type No vaccinated Coverage Area 2000-2001 9m-59m M 603 838 86% National 2007 9m-14y 2 086 190 96% 2011 9m-19y MR 2 614 002 97% 2012 9m-<15y 2 014 105% Subnational 2014 9m-10y 1 569 224 100% 2017 9m-5y 703 924

Confirmed rubella cases Year Confirmed rubella cases Confirmed cases Discarded as rubella Rubella incidence Lab Epi-linked Total 2014 2 13 32 45 488 6.8 2015 15 9 24 603 3.6 2016 40 7 33 472 5.9 2017 10 12 479 1.7 2018 Not available 1 8 346 2.0

Rubella cases and immunization coverage Year Immunization coverage Measles cases 2012 82% 78 2013 72% 83 2014 86% 2 2015 88% 42 2016 76% 40 2017 10

Measles and Rubella Targets Global: World Health Assembly, 2010 By 2015: MCV1 coverage ≥ 90% national and ≥ 80% in every district Measles reported incidence <5 cases/million Measles mortality reduction of 95% vs. 2000 Regional: GVAP Elimination Goals, 2012 By 2015: Elimination of measles in 4 WHO Regions Elimination of rubella in 2 WHO Regions By 2020: Elimination of measles & rubella in 5 WHO Regions

Milestone #1: 90% MCV1 Vaccination Coverage in Every Country World Health Organization Milestone #1: 90% MCV1 Vaccination Coverage in Every Country 16 June, 2019 123 (63%) countries have >90% coverage with 1st dose of measles containing vaccines <50% (7 countries or 4%) 50-79% (32 countries or 16%) 80-89% (32 countries or 16%) 90-94% (43 countries or 22%) The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2017. All rights reserved Source: WHO/UNICEF coverage estimates 2016 revision, July 2017. Map production: Immunization Vaccines and Biologicals (IVB), World Health Organization. 194 WHO Member States. Date of slide: 19 July 2017 >=95% (80 countries or 41%) Not available Not applicable Immunization coverage with 1st dose of measles containing vaccines in infants, 2016

Coverage not high enough to prevent outbreaks Measles Incidence Rate per Million (12M period) Country Cases Rate India 55344 41.80 Nigeria 9817 52.78 Pakistan 7800 40.37 China 7215 5.14 DR Congo* 6232 79.15 Indonesia 5618 21.52 Romania 5064 256.04 Italy 4544 76.46 Bangladesh 3751 23.02 Thailand 2111 30.65 Measles cases from countries with known discrepancies between case-based and aggregate surveillance, as reported by country Country Year Cases Data Source DR Congo 2016 22162 SITUATION EPIDEMIOLOGIQUE DE LA ROUGEOLE EN RDC, Week of 05/09/2017 2017 30790 Somalia 5657 Somali EPI/POL Weekly Update Week 35 16314 Based on data received 2017-09 and covering the period between 2016-08 and 2017-07 - Incidence: Number of cases / population* x 100,000 - * World population prospects, 2017 revision - ** Countries with the highest number of cases for the period

WPRO Measles and Rubella Initiative In 2005, the Regional Committee for the Western Pacific established 2012 as the target year for measles elimination (WPR/RC56.R8). At its 63rd session in 2012, the Regional Committee urged Member States to accelerate progress towards measles elimination and establish national verification committees (NVCs) to develop regular progress reports for submission to the Regional Verification Commission (RVC) (WPR/RC63.R5). In October 2014, a regional rubella elimination goal was endorsed by the Regional Committee.

World Health Organization RVC membership 16 June, 2019 Professor Michael George BAKER Professor Department of Public Health University of Otago New Zealand Dr Dukhyoung LEE Director of Disease Prevention Center Korea Centers for Disease Control and Prevention Republic of Korea Dr Paul ROTA Lead Scientist, Measles Team Division of Viral Diseases Centers for Disease Control and Prevention United States of America Dr Maria Rosario CAPEDING Head, Department of Microbiology Research Institute for Tropical Medicine Philippines Dr Wilina Wei Ling LIM Honorary Consultant Department of Health, Hong Kong Government Hong Kong Dr Thian Lian SOO Senior Consultant Paediatrician and Head of Department Paediatric Department Sabah Women and Children's Hospital Malaysia Professor David DURRHEIM Professor of Public Health Medicine University of Newcastle Australia Dr Mark James PAPANIA Medical Epidemiologist Centers for Disease Control and Prevention United States of America Dr Aiqiang XU Deputy Director Shandong Center for Disease Prevention and Control People's Republic of China Dr Kee Tai GOH Senior Consultant Office of the Director of Medical Services Ministry of Health, College of Medicine Building Republic of Singapore Dr Bounpheng PHILAVONG Director General, Department of Hygiene and Health Promotion Ministry of Health Lao People's Democratic Republic Dr Hiroshi YOSHIKURA Adviser, Department of Food Safety Ministry of Health, Labour and Welfare Japan

WPRO-RVC history The RVC was first convened in April 2012 At the second RVC meeting in March 2013, The Guidelines on Verification of Measles Elimination in the Western Pacific Region were finalized and: Documentation was standardized 3 criteria were described 5 lines of evidence support the criteria

3 criteria and 5 lines of evidence Documentation of the interruption of endemic measles and rubella virus transmission for a period of at least 36 months from the last known endemic case; The presence of verification standard surveillance; and Genotyping evidence that supports the interruption of endemic transmission. 5 lines of evidence: Epidemiology of measles and rubella Quality of epidemiological surveillance Population immunity Programme sustainability Genotyping evidence

Main strategies   Achieving and maintaining 95% population immunity of each birth cohort in every district, ; Assessing and enhancing quality and representativeness of reported coverage; Conducting high-quality case-based measles, rubella, and CRS surveillance; Ensuring high-quality laboratory surveillance through laboratories accredited to conduct timely and accurate testing of samples to confirm or discard suspected cases and detect measles and rubella virus for genotyping and molecular analysis; Developing and maintaining outbreak preparedness with regular programme review and risk assessment; and Rapidly responding to measles and rubella outbreaks including appropriate case management and prevention of nosocomial transmission.

ການມີ ພູມຄຸ້ມກັນໃນຊຸມຊົນ ສູງ High Population Immunity Fundamental strategy to interrupt endemic measles virus transmission. To prevent re- establishment of measles virus transmission when importation occurs. ແມ່ນ ຍຸດທະສາດ ຕົ້້ນຕໍ ໃນການຢຸດຕິ ການຕິດຕໍ່ຂອງ ພະຍາດໝາກແດງນ້ອຍ ຂອງທ້ອງຖິ່ນ ຊ່ວຍປ້ອງກັນ ການກັບຄືນມາ ຕິດຕໍ່ໃໝ່ຂອງພະຍາດໝາກແດງ ໃນເວລາມີ ການນຳເຂົ້າຂອງພະຍາດ, ໝາກແດງນ້ອຍ

Indicators of Population Immunity MCV1 ≥ 95% nationally and in every district MCV2 ≥ 95% nationally and in every district SIA coverage ≥ 95% nationally and every district Additional Evidence Coverage survey data and/or serological data Descriptions of focused strategies and intensified efforts made to identify and reach high risk communities and population groups through routine and supplementary immunization.

World Health Organization Summary of progress towards elimination World Health Organization 16 June, 2019 Categories Countries, Areas, Epidemiological Blocks 1 Verified as having achieved measles elimination in 2014-2017 Australia, Brunei Darussalam, Cambodia, Hong Kong SAR, Japan, Macao SAR, Republic of Korea, New Zealand (n=8) 2 Verified as having achieved rubella elimination in 2017 New Zealand, Republic of Korea (n=2) 4 Approaching measles elimination, but with surveillance gaps Lao People’s Democratic Republic, Pacific Islands, Singapore (n=3) 5 Re-established measles transmission Mongolia (n=1) 6 Endemic measles virus transmission China, Malaysia, Papua New Guinea, the Philippines, Viet Nam (n=5) Rubella

RVC 7th Meeting in September 2018 in Kuala Lumpur, Malaysia Conclusion: The RVC notes and congratulates Lao PDR on its substantial recent effort to strengthen measles and rubella elimination programmes, including a VPD surveillance review and full EPI programme review. The RVC notes the high coverage achieved during the recent nationwide SIA. The RVC congratulates Lao PDR on the passage of an ambitious and comprehensive immunization law, and for developing a new national plan of action for measles and rubella elimination. The RVC notes the implementation of school-based immunization checks to improve coverage among young people. The RVC is pleased to see the declining case counts with sporadic outbreaks, despite improvements in surveillance; this reflects the increasing population immunity achieved through routine and supplemental immunization.

RVC 7th Meeting in September 2018 in Kuala Lumpur, Malaysia Recommendations: The RVC recommends that Lao PDR use every opportunity to vaccinate against measles and rubella with focus on reducing wastage of open multi-dose vials. The RVC urges Lao PDR to increase efforts to collects virologic specimens for genotyping from as many cases as possible. The RVC recommends that Lao PDR further strengthen capacity at the district and health center levels to detect, investigate, and responds to outbreaks. Noting the significantly declining rates of endemics cases, the RVC urges Lao PDR to conduct careful case investigations to identify the sources of importations outbreaks and sporadic cases. The RVC recommends that Lao PDR continue to implement the recommendations of the measles risk assessment conducted in 2016, and the National EPI review conducted in 2014, particularly at the sub-national level. The RVC encourages Lao PDR to collaborate with neigbouring countries to develop and implement synchronized or coordinated surveillance and immunization activities.

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