1. 1 |1 | Measles pre-elimination and resurgence in the African region Balcha Masresha IVD AFRO Global Measles Management Meeting Geneva 15 - 17 March 2011

2. Global measles management meeting.15 - 17 March 2011 2 | OutlineOutline Regional goal Routine immunization Second opportunity immunization through SIAs Measles case-based surveillance Measles resurgence in AFR Challenges Opportunities

3. Global measles management meeting.15 - 17 March 2011 3 | 98% mortality reduction by 2012 compared to estimates for 2000 Measles incidence <5 cases/10 6 per year in all countries; >90% MCV1 national level coverage in all countries, and >80% in all districts; >95% SIAs coverage in all districts; All countries meeting the 2 main surveillance performance indicator targets 80% districts reporting > 1 suspected measles case with a specimen per year Non measles febrile rash illness rate of > 2:100,000 per year Regional measles pre-elimination goal; targets to be met by end 2012.

4. Global measles management meeting.15 - 17 March 2011 4 | Routine immunisation

5. Global measles management meeting.15 - 17 March 2011 5 | MCV1 coverage (WHO UNICEF estimates) and reported measles cases: AFR. 1980 - 2009

6. Global measles management meeting.15 - 17 March 2011 6 | Countries in AFR by MCV1 coverage category. (WHO-UNICEF estimates). 2001 - 2009

7. Global measles management meeting.15 - 17 March 2011 7 | MCV1 coverage > 80% (WHO UNICEF estimates) for > 3 years including 2009. AFR +/- MCV2 introduction

8. Global measles management meeting.15 - 17 March 2011 8 | Second opportunity measles vaccination through SIAs

9. Global measles management meeting.15 - 17 March 2011 9 | Measles SIAs. 2010 Follow up SIAs planned in 14 countries ~ target pop. 60.2 million SIAs implemented in 9 countries targeting ~ 25 million 5 countries had to postpone to 2011 for lack of partner and local resources Outbreak response mass immunization in 5 countries Target population ~ 22.6 million 13 countries raised USD 21 million (51%) locally out of the expected USD 41 million for ops costs

10. Funds raised locally for measles SIAs (in USD per child targeted). AFR. 2010

11. Global measles management meeting.15 - 17 March 2011 11 | Proportion of districts with >95% coverage during measles SIAs. 2009 – 2010. Nationwide outbreak response

12. Global measles management meeting.15 - 17 March 2011 12 | Measles case based surveillance

13. Selected surveillance performance indicators Selected surveillance performance indicators20092010 Number of reporting countries40 Number of suspected measles cases35,984172,824 Number of confirmed measles cases14,545133,412 Incidence of confirmed measles per 100,000 population1.917.2 Non-measles febrile rash illness rate (target >2:100,000)2.14.1 % districts reporting at least 1 suspected case with blood sample (target >80%)75%86% Number of countries that met both targets14/4023/40 Measles case based surveillance Performance Indicators. AFR. 2009 - 2010

14. Global measles management meeting.15 - 17 March 2011 14 | Measles Resurgence in AFR. 2010 28 countries reported measles outbreaks > 223,000 suspected measles cases and ~ 1,200 deaths reported through the aggregate reporting system vs 37,010 suspected cases reported thru the JRF in 2008 Outbreaks started at a median of 17 months after measles follow up SIAs (range: 1 to 44 months)

15. Global measles management meeting.15 - 17 March 2011 15 | Incidence of confirmed measles per 100,000 population. AFR. 2010  Regional incidence: 17.4 per 100,000 population  10 countries (with 112.6 million total population) have measles incidence of >10 cases per 100,000

16. Global measles management meeting.15 - 17 March 2011 16 | Measles outbreaks in AFR. Surveillance data and preliminary investigations: B3 serotypes in isolates Reasons for outbreaks gaps in routine immunization coverage suboptimal coverage during recent SIAs (ZIM, NAM, ANG, BOT) Pockets of unvaccinated & resistant populations (ZIM) Critical accumulation of susceptibles in older age groups too long (> 3 yrs) interval between follow-up SIAs (ZAM, LES, SEN)

17. Global measles management meeting.15 - 17 March 2011 17 | 17 Regional measles pre-elimination goal and current status Targets to be met by end 2012:Status (2010): 98% mortality reduction by 2012 compared to estimates for 2000 92% reduction by end 2008 Measles incidence <5 cases/10 6 per year in all countries; 22 countries in 2009, and 15 countries in 2010 respectively [quality of surveillance] >90% MCV1 national level coverage in all countries, and >80% in all districts; 13 countries with >90% MCV1 coverage as of end 2009 >95% SIAs coverage in all districts; Only 5/24 countries have > 90% districts achieving > 95% coverage in 2009 - 2010 All countries meeting the 2 main surveillance performance targets 14/ 40 countries in 2009, and 23/ 40 countries in 2010 met both targets

18. Global measles management meeting.15 - 17 March 2011 18 | Planned Measles SIAs 2011 Target population: 56.7 million Total budget: USD 56.7 million Expected MI contribution thru WHO and UNICEF: USD 29.6 million

19. Global measles management meeting.15 - 17 March 2011 19 | Timing of scheduled measles SIAs. AFR. 2010 MI funding OK MI funding not yet in place

20. Age group distribution of confirmed measles. AFR. 2010.

21. Confirmed measles cases by age category and vaccination status. Nigeria. Jan – Oct 2010 (N=5938) 16.7%

22. Confirmed measles cases by age category and vaccination status. Zimbabwe. Jan – Oct 2010 (N=7870) 47% Not targeted by follow up SIAs or child health days

23. Confirmed measles cases by age category and vaccination status. Malawi. Jan – Oct 2010 (N=72,566) 59% 73% cases aged 6 – 11 months

24. Global measles management meeting.15 - 17 March 2011 24 | Age-specific measles attack rates per 100,000 population. Malawi. 2010. (N=72,566)

25. Global measles management meeting.15 - 17 March 2011 25 | ChallengesChallenges Slow pace of routine immunization coverage improvement Inadequate partner and local funding for SIAs Delayed and inadequate preparations for measles SIAs Continued measles outbreaks related to program gaps Limited capacity for high quality outbreak investigation

26. Global measles management meeting.15 - 17 March 2011 26 | OpportunitiesOpportunities Updating technical guidelines: to disseminate by end of March 2011 EPI managers’ meetings Best practices documentation: Ethiopia Measles TAG: April 28 – 29, 2011 in Accra Africa Vaccination Week RC 61 – resolution on measles elimination for 2020

27. African Vaccination Week. 2011  38 countries have been conducting CHDs, MCH days etc  RC 60 resolution “to institutionalize an annual African Vaccination Week for sustaining advocacy, expanding community participation and improving immunization service delivery"  AVW to comprise of advocacy, education & outreach activities  Expected to  Improve access to high-risk populations and hard to reach areas;  Increase media interest in immunization;  create opportunities for pooling resources and coordinating efforts,  engage partners  build on the existing implementation framework of the maternal and child health initiatives

28. Global measles management meeting.15 - 17 March 2011 28 |  AVW slogan is “Vaccinated communities, Healthy community”  AVW Theme for 2011 is "Put mothers and children first; Vaccinate and stop polio now”.  Last week of April 2011 African Vaccination Week. 2011 (2)

29. Global measles management meeting.15 - 17 March 2011 29 | Proposed recommendations Resurgence and loss of gains in mortality reduction Better mobilization of partner resources Local resource mobilization for measles SIAs Use the surveillance data and epidemiological information to determine the target age-groups for SIAs Document and disseminate lessons learnt from the best practice SIAs Economic impact of measles outbreaks

30. Global measles management meeting.15 - 17 March 2011 30 | ThanksThanks JapaneseGovernment