1. Measles outbreak investigation & Response Jordan DR MOHAMAD RATIB SUROUR NATIONAL EPI MANAGER INTER-COUNTRY MEETING ON MEASLES AND RUBELLA CONTROL AND ELIMINATION AMMAN, JORDAN, 17-20 NOVEMBER 2013

2. History 1982 measles vaccine introduced in the national EPI at age of 9 months as single dose. 1995 a second dose of measles was introduced at age of 18 months. 2000,second dose of measles at 18 months of age was replaced by MMR vaccine. 2008 a second dose of MMR was introduced at age of 12 months. Jordan was embarked on measles elimination in October 1997( after last major measles outbreak 1997) Rubella elimination with prevention of congenital rubella syndrome is jointed with measles elimination and mumps control 2002.

3. Vaccination schedule preschool -Jordan VaccineAge BCG1 st contact D a PT1 IPV1+Hib+1HepB12 months D a PT2 IPV2+Hib2+HepB2+OPV3 months D a PT3 IPV3+Hib3+HepB3+OPV4 months Measles + OPV9 months MMR112 months DPT booster1 +OPV booster1 +MMR218 months

4. Routine Measles Vaccines in Jordan VaccineAge of vaccination Type of VaccineYear introduced MCV19 MMeasles1982 MCV212 M, 18 MMMR2000,2008

5. Jordan - EPI and vaccine preventable diseases All children in Jordan are being immunized against 10 dreadful diseases. Routine EPI coverage is sustained at 95% for different antigens. Jordan is measles free for 3 years before 2013. In Feb. 2013 2 cases of measles (Syrian15 months & 14 months Iraqui ) were reported. As of now 120 measles cases reported

6. Measles cases and coverage rates,Jordan 1979 -2013

8. Measles cases by districts & nationality

9. Incidence rate of measles by districts

10. Measles cases by age group & nationality

11. Measles cases by gender & nationality

12. Measles cases by vaccination status & nationality

13. Measles outbreak response : Rapid Response Team Line list of suspected measles cases with follow up the contacts Detecting the index case Lab: Sampling ( Blood sample and throat swab) Map for area with cases distribution Control measures (case isolation, treatment, Health education and outreach activities) immediate reporting of newly cases Epidemic curve Report Documentation

14. Outbreak response Emergency measles outbreak response: – Vaccination around the case – April- May 2013: Measles/Polio/vitamin A campaign at Zaatari and EJC camps (covering 71,000 individuals up to 30 y). – June-July 2013: out of camp Measles/Vitamin A campaign in 2 Governorates bordering Syria and Iraq (covering 622,000 children up to 15 y). – November 2013: Measles/Rubella/Polio/Vitamin A campaign is going on:

15. Campaign results – administrative data *Note: Higher reported coverage among the Syrian population may be due to less accurate population target estimates - population change due to their mobility (i.e. some may be registered in Amman, but reside in Irbid or Mafraq), or they may be un-registered.

16. Results of PCES Overall 898 houses were visited Data from one child per age group were used in the analysis 1,669 children – Irbid (819 children) – Mafraq (850 children)

17. PCES – Nationality and Age Group * In Irbid, coverage was significantly lower among children 10–14 years of age than in children 6–59 months or 5–9 years Coverage among Syrian children was lower compared to Jordanian children, but the difference was not statistically significant.

18. MR-P Campaign / 2-21 Nov.2013 MR Age group targeted = 6 M – 20 years OPV Age group targeted = 0 – 59 M Vit.A Age group targeted = 6 M – 59 M Campaign strategy : - through fixed teams at health centers - outreach teams in the Universities, schools, NGOs,Malls.. Etc. - mobile teams to hard to reach and mobile populations

19. Due to polio situation in Syria we have now competing priorities regarding the measles & Polio which implicate to combine the improvement of AFP & measles surveillance and all other activities related

20. Lessons learned - 1 Frequent advocacy meetings and coordination among all partners allowed for good communication and improvements throughout the campaign Close collaboration with UNHCR and NGOs resulted in high coverage among Syrians during the campaign – Specialized strategies for reaching Syrian children needed Intensified supervision structure allowed for careful monitoring and correction of any issues that arose – Also allowed for immediate action to be taken by the campaign teams Daily supervisory tour plans and checklists provided transparency and accountability

21. Lessons learned - 2 The Measles Control Rooms were critical to the success of the campaign – Managed vaccine distribution – Daily contact with the supervisors – Identified problems in the field and took immediate action

22. Lessons learned - 3 RCA is an important tool to find pockets of missed children and guide social mobilization efforts throughout the campaign

23. Challenges Intensifying measles rubella surveillance ( combined with AFP surveillance,surveillance officers for AFP and Measles –Rubella surveillance. Negative media ( communication group ) for preparing bilingual messages ) Reaching the older age groups of universities and schools students( meetings with students unions leaders, sending messages through the SMS, through media youth radios..) Competing priorities ( combining both activities for AFP & measles ) Reaching the un registered Syrians ( through the IOM and other NGOs dealing with Syrian refugees ).

24. Acknowledgment WHO UNICEF CDC UNHCR IOM NITAG

25. Thank you