Measles elimination in the African
Region- Regional updates
Dr Balcha MASRESHA
IVD/AFRO
Annual MRI Partners’ Meeting
Washington DC
10 – 11 September 2013
Regional measles elimination
targets for 2020
• > 95% measles immunization coverage at national level and in all
districts;
• > 95% SIAs coverage in all scheduled measles SIAs, and in outbreak
response immunization activities;
• measles incidence of <1: 1,000,000 population at national level;
• > 80% of districts investigating > 1 suspected measles cases within a
year, and a non measles febrile rash illness rate of > 2 per 100000
population at national level.
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
Routine Immunisation
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
MCV1 coverage WHO UNICEF estimates. AFR.
2000 – 2012.
MCV1 coverage estimates (percentage)
80
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75
70
65
60
55
50
45
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
Number of countries
MCV1 coverage WHO UNICEF estimates in
AFR countries. 2008 – 2012.
50
45
40
35
30
25
20
15
10
5
0
90 plus
80 - 89
70 - 79
60 - 69
<60
2008
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2009
2010
Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
2011
2012
MCV2 introduction in AFR
(as of August 2013)
• MCV2 in routine
services in 20
countries by end 2014
• MCV2 in ~ 25
countries by the end
of 2015.
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
Supplemental Immunisation
activities
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
Measles SIAs in 2013
• 16 countries doing SIAs
• MR SIAs in 4 countries
• A total of 88.9 million
targeted
• 16,118,351 reached in 3
countries,
• awaiting results from 2 more
countries
• 11 countries doing SIAs in the
last quarter
• MR used in 4 of the 16 SIAs
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
Measles SIAs national and district level
coverage. 2012 – August 2013. AFR.
100%
National admin coverage
90%
100%
80%
70%
80%
60%
60%
50%
40%
40%
30%
20%
20%
10%
0%
0%
ERI GUB GUI SWZ KEN ETH UGA NIE
SIL CAE BUR RWA ZIM STP NAM CHA ZAM
National coverage
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
Districts >=95%
% districts with >/=95% coverage
120%
Case based surveillance
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
Key Measles Surveillance Performance
Indicators, African Region 2010 – end July 2013.
PERFORMANCE INDICATORS
2010
2011
2012
2013
Number of suspected measles cases
163,575
reported
74,896
55,717
58,657
Number of confirmed measles cases
127,422
32,323
20,935
35,558
3.7
4.4
3.7
2.9
% districts reporting at least 1 case with
blood sample (target >80%)
84%
81%
84%
77%
Incidence of confirmed measles per
million population
165
42
27
41
Non-measles febrile rash illness
(target >2/ 100,000 population )
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
Measles case based surveillance
performance. AFR. 2012.
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
Measles Incidence rate per million
population. AFR. 2012
Measles case reports & MCV1 coverage (WHOUNICEF estimates). AFR. 1980 - 2012
1,400,000
100%
Follow up SIAs
Measles case reports
MCV1 coverage estimates
90%
80%
Measles case reports
1,200,000
Catch up SIAs
1,000,000
70%
60%
800,000
50%
40%
600,000
30%
400,000
20%
200,000
10%
0%
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
year
• 64% of case reports in 2010 = from Malawi
• 69% and 68% of case reports in 2011 and 2012= from DR Congo
WHO-UNICEF
MCV1 coverage estimates
1,600,000
Performance against the 2020 measles
elimination targets (as of Dec 2012)
• > 90% MCV1 coverage nationally (WHO UNICEF estimates)
• 15 countries (2012)
• > 95% coverage during measles SIAs in every district.
• 3/12 countries (2012)
• incidence < 1 confirmed measles /1,000,000 pop’n /year
• 16 countries
• NMFRI rate of > 2:100,000
• 25 countries
• > 80% districts reporting per year
• 25 countries
Weekly trends of measles reporting in DR
Congo by province. 2010 – week 33, 2013
Measles Resurgence in AFR; Key factors
• Gaps in routine coverage
• Delays and gaps in SIAs coverage
• Resistant groups
• Shift in epidemiological susceptibility
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
Confirmed measles. Case based surveillance
data. AFR. 2003 – July 2011
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
Age breakdown of confirmed measles
cases. Ethiopia. 2005 – 2012.
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
Attempts to address the resurgence:
Routine immunisation program
• Ongoing efforts to strengthen immunisation systems
• The opportunity of new vaccine introduction
• “RED approach”
• Ministerial conference on implementing GVAP – early 2014
• MCV2 introduction and Post introduction evaluations
• Linking GAVI HSS support to immunisation outcomes
• Using SIAs as an opportunity to support strengthening
routine immunisation
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
Attempts to address the resurgence: SIAs
• Planning and budgeting for SIAs in the context of national
strategic plans & cMYPs
• Timely mobilisation of local and partner resources for SIAs
• Timely conduct of scheduled SIAs
• Emphasising on high quality SIAs ( > 95% coverage in every
district)
• SIAs targeting age groups as determined by the epi. picture:
• Zambia, Niger in 2012
• Togo, 2 provinces in DRC in 2013
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
100
100
90
90
80
80
70
unknown
60
15 yrs and above
50
10 - 14 yrs
40
5 - 9 yrs
30
9 - 59 months
< 9 months
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Percentage of cases
Percentage of cases
Age breakdown of measles cases in selected
provinces in DRC. 2005 – 2012.
70
60
50
40
30
20
10
10
0
0
2005
2006
2007
2008
2009
2010
2011
2012
Equateur province, DRC.
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
2005
2006
2007
2008
2009
2010
2011
Orientale province, DRC.
2012
Measles SIAs in 2014
• 14 countries (incl. S Sudan)*
• A total of 78.6 million to be
targeted
– MR SIAs in 2 countries
– GAVI support for CHA, DRC, BUR,
TAN
– 3 non GAVI eligible
• MRI support = 5 countries
with 11.6 million to target:
– ~ USD 13.1 million for BV, ½ ops
costs, surveillance and TA
* CAR and MOZ = SIAs in 2013???
Technical support needs in 2014
• SIAs:
• Mostly francophone countries
• Angola
• S Sudan!
• Areas for MRI support:
• SIAs:
• Logistics
• Planning and coordination of coverage survey
• Advocacy with non-GAVI eligible countries
• MCV-2 Post-Introduction Evaluation
• Surveillance reviews:
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013
Thank you
Anne Ray Charitable Trust
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Annual MRI Partners’ Meeting, Washington DC 10 - 11 Sept 2013