Updates in measles control in the African Region

1
Updates in measles control in the African Region

• Measles Partnership Annual Meeting
• September 2008
• Dr Balcha G Masresha
• WHO AFRO

2
Outline of presentation

• Regional measles control goal and current status
• Routine immunisation
• Supplemental immunisation activities
• Measles case-based surveillance
• Programmatic challenges
• The pre-elimination goal for the African Region

3
Estimated reduction in measles mortality (all
ages) in the African Region, 2000-2006
91 reduction
4
Reported coverage vs WHO UNICEF estimates. AFR.
2001 - 2007
5
Measles vaccination administrative coverage by
category. AFR. 1981 - 2007
6
DPT1 measles drop out rates.(WHO UNICEF
estimates. 2006)

• 33 of 46 countries with drop-out rates gt10
• 11 countries with drop out rates 20
• 3 countries with DTP1 90 with drop out rates
  20

7
Stagnating coverage / high drop out rates WHY?

• Infrastructure, financial and human resource
  limitations
• Limited geographic access and utilisation access
  for routine services
• Gaps in implementing the RED strategy
• Outreach, community linkages, use of data for
  action, appropriate management of resources
• Logistics gaps including vaccine stock outs,
  aging cold chain and EPI vehicle fleet
• Inaccuracy of denominators
• Improved quality of coverage reporting (e.g.,
  administrative coverage data from CHWs / IPDs)

8
MP support for focused routine immunisation
strengthening

• In 2008, 9 countries were supported financially
• A total of USD 1,050,000
• Support focused to avert measles outbreaks,
  de-linked from the SIAs (i.e., these 9 countries
  were not scheduled for SIAs in 2008)

9
TAG 2008. Criteria for considering MCV2

• MCV1 coverage gt80, for gt 3 consecutive years
  (using WHO/UNICEF coverage estimates)
• and
• Attainment of one of the two primary measles
  surveillance performance indicators for at least
  two consecutive years.
• i.e.,
• Non-measles febrile rash illness rate of gt 2.0
  cases per 100,000 population per year
• At least 1 suspected measles case investigated
  with blood specimens in gt 80 of districts per
  year.

10
Second Opportunity for measles vaccination (SIAs)
11
Children reached in measles SIAs, 2001 2007,
and target plans for 2008 - 2010. AFR
12
Measles SIAs results

• 97 SIAs in 43 countries reaching 329.9 million
  children from 2001 end of 2007
• 12 rounds with admin coverage 90 94
• 20 rounds with admin coverage lt 90
• By end of 2008, a further 63.4 million children
  will be targeted in 9 countries

13
Measles SIAssome examples of coverage gaps
Guinea Bissau, 2006 85 MCV
Ghana, 2006 79 MCV
Gabon, Nov 2007 83 MCV 98 ITN
Nigeria, 2006 83 MCV
14
Measles Follow up SIAs Coverage by Region,
Ethiopia. April - May 2008
15
Integrated delivery of interventions in measles
SIAs. 2006 - 2008
Intervention 2006 2007 2008
Measles 15 countries 14 countries 10 countries
Vit A 12 13 8
Deworming 7 11 6
ITNs 7 7 6
OPV 5 2 5
16
Integration in measles SIAs AFR. 2007
17
Integrated delivery of multiple interventions is
it always synergistic?

• Integration may be seen as being partner-led
• room for advocacy and local consensus building
• Weakness of central coordination
• Need for stronger involvement of all programs
• Delays in program level decisions/ resources/
  logistics
• Stock-out of commodities disrupting acceptance
  of antigens
• appropriate and detailed logistic planning
• Need for further operational research on the
  factors conducive to the synergy

18
Measles case based surveillance
19
The Regional measles surveillance network

• 40 countries (749.4 million population) under
  case based surveillance
• with a network of National / Regional Referral
  measles laboratories
• Heavily dependent on the Polio infrastructure
• Staffing, vehicles, funding for activities

20
Measles surveillance performance results. AFR.
2006 July 2008
Indicator/ parameter 2006 2007 2008
suspected cases reported 21580 25111 25688
investigated with blood specimens (target gt80) 93 92 96
districts reporting at least 1 suspected case (target gt80) 54 71 68
lab confirmed cases (targetlt10) 30 22 25
total confirmed measles cases 7707 7869 13410
Incidence of confirmed measles per 100,000 population 1.2 1.1 1.8
Annualised non measles febrile rash illness rate (target gt2100,000) - 2.1 2.3
21
Measles incidence. 2007

• Regional incidence gt 10 cases per million
  for the last 3 years
• Country incidence levels ranging from 0 60
  cases per million

22
Measles incidence. AFR. 2007
Incidence per 100,000 population of countries of total regional population
lt0.1 17 26
0.1 0.49 8 8
0.5 0.99 5 19
1.0 1.99 4 37
gt/ 2.0 4 10
23
Incidence of confirmed measles. Jan June 2008.
AFR
24
Trends of measles case reports. Nigeria. 2005 -
2008
Measles catch up campaign in Northern states
Measles catch up campaign in Southern states
2007
2008
2005
2006
25
Measles case reports by final classification,
Nigeria. 2007 vs 2008
Jan Mar 2007
Jan Mar 2008
26
Age vaccination status of confirmed measles
cases, Nigeria. Jan Dec 2007 (n2,297)
27
LGAs with reported measles outbreaks.Jan July
2008, Nigeria
28
Age vaccination status of confirmed measles
cases. Nigeria, Jan Jul 2008 (n8,887)
29
Challenges for measles control in AFR

• Limitations in SIAs operational funding
• Currency exchange rates, Rising costs of fuel,
  Rising staff costs,
• Limited local mobilization of resources for
  operational component of SIAs
• Complacency following significant reduction of
  measles case burden
• Gaps in SIAs coverage, surveillance performance
• System-wide constraints preventing sustained
  increase of routine immunization coverage beyond
  80
• New Regional measles targets pre-elimination

30
Plans for Measles SIAs in 2009

• 18 countries 39.7 million children
• Total cost of 49.7 million
• including
• surveillance support to 40 countries
• Focused support to close routine immunization
  program gaps and avert outbreaks in countries
  scheduled for SIAs in 2010
• Expected MP portion of 37.8 million
• Local sources expected to raise 11.9 million
• MP role in advocacy!!!

31
Pre-elimination regional goal to be achieved by
end-2012

• Targets
• gt98 mortality reduction by 2012 as compared to
  estimates for 2000
• Measles incidence lt5 cases/106 population/year at
  national level in all countries
• gt90 routine MCV1 coverage at national level, and
  gt80 in all districts
• gt95 SIAs coverage in all districts
• AND

32
Pre-elimination regional goal to be achieved by
end-2012 (contd)

• continued
• Measles surveillance performance
• Non-measles febrile rash illness rate of gt2.0
  cases per 100,000 population per year
• 1 suspected measles case investigated with blood
  specimens in at least 80 of districts per year
  and
• Routine district reporting from 100 of
  districts.

33
Working towards the pre-elimination targets
anticipated challenges

• Overcoming the complacency and maintaining the
  political will to scale up measles control
  activities to pre-elimination levels esp. while
  polio eradication still poses a challenge
• Raising the required resources (at
  international and local levels)
• Maintaining the surveillance infrastructure
• Attaining the ambitious routine immunization
  goals of gt90 MCV at national level and gt80 in
  all districts

34
The Measles Partnership