1. Measles elimination Dr. As’ad Ramlawi Palestine.

2. Measles vaccination coverage in the last 15 years is more than 95%. Two doses, at 9 th month ( measles ) & at 15 th month ( MMR ).

3. Measles incidence rate in the last 6 years : YearMeasles 20000.17 20010.10 20020.09 20030.00 20040.00 20050.00 20060.00

4. Measles Reporting 1.Clinical picture 2.IgM confirmation 3.Daily notification 4.Case investigation

5. Measles out Break In 1990, 1994, 1999, in small clusters From 1999 till now, NO Measles Out Break.

6. Measles Seroservey 1990 – 1995 ========= 95-98 % immune response

7. Measles immune response during Al Aqsa Intifada Vaccine Negative W.B Gaza Total Equivocal W.B Gaza Total Positive W.B Gaza Total Measles 12.7% 31.6% 20.3%13.5% 12.1% 13.0%73.8% 56.3% 66.7% Rubella 2.5% 1.5% 2.1%0.0% 0.5% 0.2%97.5% 98.0% 97.7% Hep.B 5.5% 7.9% 6.5%1.4% 1.5% 1.4%93.1% 90.6% 92.1%

8. WHY Low immune response 1.Measles vaccine ?? 2.Screening Kits ?? 3.Cold chain ??

9. Cold chain affected By: 1.Electricity 2.Transportation 3.Political instability, Siege, Closure, Curfew

10. Measles National Plan WHO Goal Measles elimination Taking into consideration: 1.Measles vaccination low response 2.Measles high infectivity rate 3.Measles vaccine sensitivity

11. Micronutrient deficiencies Anemia Vitamin A for: - Children under 5 years old 22 % Vit. A deficiency 54 % Border line

12. Recommendation of the serosurvey 1.Carry out a measles vaccination campaign for all children between 9 months & 5 years of age 2.A sero-survey with a small sample should be carried out after three months after the end of the campaign. This will serve as an indicator for the sero-response

13. Recommendation Cont. 3. More attention should be paid to the cold chain. 4. The sero-survey results should be widely disseminated to all the health providers. 5. Training for all health personnel in the expanded program on immunization (EPI ) in general & cold chain in particular should be carried out.

14. Campaign carried out in 2004 for children between 9months – 60 months 1.Measles Vaccine 2.Vitamin A capsules 100,000 IU 9m – 12 m. 200,000 IU 12m – 60 m.

15. Mumps Outbreak 2004-2005 Age affected 5 years – 25 years. Thousands of cases with some complication.

16. MMR campaign was conducted in 2005 6 years – 25 years. the number of vaccinated children were 650,000

17. The second serosurvey is in 2006 for the same targeted group of the first Measles campaign with 98 %immune response.

18. Polio

19. Estimated of Palestinian population for 2006 Total Population <1 year < 5 years < 15 years 3,512,822129,974 625,282 1,626,437

20. Vaccination Coverage OPV3 coverage is more than 90 % in the last 10 years.

21. OPV coverage 1995-2004 in Palestine YearCoverageYearCoverage 199596.0 %200093.4 % 199696.7 %200196.7 % 199795.92 %200296.5 % 199897.96 %200398.5 % 199989.4 %200498.3 %

22. Polio cases Last case was detected in 1988. One case wild polio virus One vaccine associated virus Last wild poliovirus isolate in 2002 ( Feb. August ) : Rafah, Gaza ( imported ).

23. NIDs Implemented since 1995 up to 1999. Two rounds yearly for children under 5 years old with > 95 % coverage.

24. Mopping up Is implemented since 2000 up to 2005 targeted for children under 5 years for certain areas selected by preventive medicine dept.

25. AFP surveillance Started in 1996 & performance indicators were achieved up to 2000. 2000 – 2004 indicators were not achieved due to Intifada ( invasions, closures, & restrictions). 2005 indicators were achieved again. Virus isolation not done in PNA areas.

26. Improving AFP Surveillance in 2005 Certificates of appreciation Increase sensitization among pediatrician. Meeting Frb. 2005. Increasing zero-reporting sites to include major pediatricians from 22 to 32.

27. Environmental Surveillance Collect on monthly bases. Last wild poliovirus isolation was from : Rafah, Gaza,2002:imported, Egyptian strain. 2005 total 190 samples: - West Bank 164 - Gaza 26.

28. Lessons learned 1.Additional activities for good surveillance is very important in planning & prevention ( serosurvey, environmental screening). 2.Better coordination ( UNICEF, MoH, WHO ) 3.Good preparation before starting

29. Lessons learned cont. 4. Media involvement 5. Community participation 6. Target groups should based on the really number of newborns in Palestine.

30. THANK YOU