10th Annual Measles Initiative Meeting
Update on Measles Elimination
in the Western Pacific Region
Washington, DC
September 13, 2011
Dr David H. Sniadack, Medical Officer, EPI
WHO Region
for Western Pacific
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Regional Committee Resolution, 2010
WPR/RC61.R7
Reaffirmed the 2012 measles elimination goal!
Accelerate rubella control and CRS prevention!
Urged member states
– to commit human and financial
resources
– to develop and implement work plans
– to regularly report surveillance data
to WPRO
– to establish independent national
verification process following the
establishment of standardized
regional verification mechanisms by
WPRO
– to accelerate control of rubella and
the prevention of congenital rubella
syndrome
Requested the RD
– to establish regional verification
mechanism
– to strengthen technical
cooperation with Member States
to achieve regional immunization
goals
– to seek additional resources to
achieve regional goals utilizing
frequent ICC meetings and other
mechanisms
– to report progress periodically to
the Regional committee
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Reported Measles Cases and MCV1 Coverage
Western Pacific Region 2000 – 2012
97%
200,000
180,000
90
160,000
80
71,093
88,962
70
120,000
60
100,000
50
80,000
40
131,441
58,341
109,023
71,879
60,000
124,219
30
70,549
106,172
99,602
97,577
40,000
20
52,461
38,159
50,227
20,000
10
29,975
21,345
21,247
0
2000
2001
2002
2003
2004
3,742
3,662
2005
2006
2007
9,599
14,508
2008
8,831
10,325
6,951
2009
2010
2011
3,000
500
0
2012
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
WPR cases w/o CHN
China cases
Coverage (WHO estimate)
MCV coverage (%)
140,000
Measles cases
100
Measles Incidence*
Western Pacific Region 2008
* per million population
LEGEND:
< 1.0 (22)
1.0 – 4.9 (4)
5.0 – 9.9 (3)
(29 <10/mill)
10.0 – 19.9 (4)
20.0 – 29.9 (0)
30.0 – 39.9 (0)
40.0 – 49.9 (0)
Incidence
82 per million
≥ 50.0 (3)
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Source: WPRO measles-rubella monthly country reports and WHO-UNICEF Joint Reporting Form (data for 2008)
Percent of Districts at Different Levels of MCV1 Coverage
in Five Priority Countries,* WPR 2007 – 2010
100%
5%
90%
80%
% of Districts
70%
60%
56%
(≥ 90%)
67%
70%
67%
78%
77%
74%
50%
40%
13%
30%
20%
21%
10%
7%
4%
9%
10%
5%
8%
6%
10%
10%
6%
11%
8%
8%
2007
2008
2009
0%
2010
Year
Level of MCV1 Coverage
< 50%
50-79%
80-89%
90-94%
95% Regional
Not Office
reporting
* KHM,LAO,MNG,PNG,VNM
World Health
Organization
• Western≥Pacific
• Expanded
Programme on Immunization
Reported Routine Measles Vaccination Coverage,
by Operational District, Cambodia 2007, 2010
2010: 93%
2007: 79%
<50%:
5% (n=4)
50-79%: 55% (n=42)
80-89%: 25% (n=19)
≥ 90%:
15% (n=11)
<50%
50-79%
80-89%
≥ 90%
<50%
1% (n= 1)
50-79%: 14% (n=11)
80-89%
40% (n=31)
≥ 90%
44% (n=34)
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Reported Routine Measles Vaccination Coverage,
by District, Lao PDR 2007 and 2010
2007: 40%
2010: 64%
<50%
58% (n=81)
50-79% 35% (n=49)
<50%
23% (n=33)
50-79% 59% (n=84)
80-89%
3% (n= 4)
80-89%
8% (n=12)
≥ 90%
4% (n= 6)
≥ 90%
10% (n=14)
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
CHN
102.3 million
5 provinces: 8m-14y
3 provinces: 8m-6y
23 provinces: 8m-4y
Measles SIAs in 2010-2012,
Western Pacific Region
LAO (9m-19y)
3.0 million
PHL (9-95m)
KHM
18.5 million
9-59 m: 1.5 million VNM (9-71m)
FSM (12m-8y, Chuuk)
(100%)
7.0 million (97%)
6,800 (90%)
5-9 y: 433,000
PNG (6-35m)
KIR (9-47m): 8,400
500,000
SOL (9-47m) TUV (12-71m)
1,100 (79%)
48,500
SMA (12-47m):11,500
VAN (9-47m)
22,600
LEGEND
2010 (CHN, FSM, PNG, TUV, VNM)
2011 (KHM, LAO, PHL)
2012 (KIR, PNG, SMA, SOL, VAN)
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Measles Incidence*
Western Pacific Region 2011
* per million population
LEGEND:
< 1.0 (24)
1.0 – 4.9 (4)
5.0 – 9.9 (3)
(31 <10/mill)
10.0 – 19.9 (1)
20.0 – 29.9 (1)
30.0 – 39.9 (1)
40.0 – 49.9 (1)
Incidence
16 per million
≥ 50.0 (1)
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Source: WPRO measles-rubella monthly country reports, data through June 2011
Indicators of Progress Towards Measles Elimination
Western Pacific Region 2007-2011¹
Category
Target
2007
2008
2009
2010
2011²
73.7
81.6
34.0
27.0
15.8
Incidence (per million population)
Confirmed measles cases (confirmed by lab,
epidemiologic linkage or clinically)
High Quality Surveillance
National reporting of discarded measles cases
> 2 per
100 000
2.5
1.6
2.8
1.7
2.9
% of districts reporting ≥ 1/100 000 discarded measles
cases
> 80%
31%
27%
43%
38%
41%
% of suspected cases with adequate investigation
> 80%
27%
47%
36%
76%
67%
% of suspected cases with adequate blood specimens
> 80%
65%
62%
72%
71%
78%
Proportion of clinically confirmed measles cases
<10%
83%
48%
25%
35%
28%
National MCV1 coverage
> 95%
92%
93%
96%
97%
NA
National MCV2 coverage
> 95%
86%
88%
94%
91%
NA
High Population Immunity
¹ Data as of July 2011
² Annualized numbers
Source: WPRO surveillance database
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Confirmed Measles Cases, by Month of Onset
China 2007—2011*
30,000
Confirmed measles cases
25,000
20,000
National SIA
15,000
10,000
75% decrease
in 2011 cases
5,000
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
0
2007
2008
2009
2010
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through July 2011
2011
Confirmed Measles Cases, by Month of Onset
Japan 2008—2011*
2,500
Confirmed measles cases
2,000
Rolling SIA for 13 & 18 year olds each year from 2008-12;
Improving routine MVCV1 and MCV2 coverage
1,500
1,000
500
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
0
2008
Lab-confirmed + Epi-linked = 6709
Clinically = 4230
2009
2010
Lab-confirmed + Epi-linked = 424
Clinically = 281
Lab-confirmed
Epi-linked
Lab-confirmed + Epi-linked = 309
Clinically = 123
2011
Lab + Epi = 282
Clinically = 74
Clinically
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through July 2011
1,600
Confirmed Measles Cases, by Month of Onset
SIA
Philippines 2003—2011*
9m - 7y
SIA
9m - 7y
1,400
SIA
9- 48 m
Confirmed measles cases
1,200
1,000
800
600
400
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
200
2003
Lab + Epi = 120
Clinically = 5487
2004
Lab + Epi = 58
Clinically = 1240
2005
Lab + Epi = 0
Clinically = 124
2006
2007
Lab + Epi = 6
Clinically = 162
Lab + Epi = 195
Clinically = 302
2008
Lab + Epi = 278
Clinically = 560
2009
Lab + Epi = 588
Clinically = 763
2010
Lab + Epi = 3004
Clinically = 3355
Epi-linked
Clinically Programme on Immunization
World Health Organization Lab-confirmed
• Western Pacific Regional
Office • Expanded
* Source: WPRO measles-rubella monthly country reports, data through July 2011
2011
Lab + Epi
= 2768
Clinically =
3120
Confirmed Measles Cases, by Month of Onset
Viet Nam 2008—2011*
2500
50
40
2000
30
5
44
15
Number of cases
20
17
10
1500
0
14
1
4
Jan
20
10
0
2
3
F eb
M ar
Apr
6
01
M ay
Jun
1000
SIA
500
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
0
2008 (N= 260)
2009 (N= 7500)
laboratory
epi-linked
2010 (N= 1830)
2011 (N= 142)
clinically
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through June 2011
Lab-confirmed & Epi-linked Measles Cases, by Province
Viet Nam 2010—2011*
2010
2011
1 dot = 1 case
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through June 2011
Confirmed Measles Cases, by Month of Onset
Malaysia 2008—2011*
90
80
2004 SIA: 7-14 y; 93%
Confirmed measles cases
70
60
50
40
30
20
10
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
0
2008
Lab-confirmed + Epi-linked = 110
Clinically confirmed = 222
2009
2010
Lab-confirmed + Epi-linked = 55
Clinically confirmed = 1
Lab-confirmed
Epi-linked
Lab-confirmed + Epi-linked = 71
Clinically confirmed = 4
2011
Lab + Epi-linked = 398
Clinically = 60
Clinically
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through July 2011
2010
Confirmed Measles Cases, by State
Malaysia 2010—2011*
1 dot = 1 case
2011
Discarded measles per 100K population:
≥2
1.0 - 1.9
<1
No suspected measles cases
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through June 2011
Confirmed Measles Cases, by Year of Age,
Malaysia 2011*
Confirmed measles cases
100
90
90
80
Routine schedule: MCV1 at 12-24m; MCV2 at 7y
70
56
60
50
40
30
30
18
20
16
21
21
23
12
10
6
6
7
6
1
2
1
2
1
2
0
1
9 10 11 12
Age (in years)
13
14
15
16
17
18
19
2
0
<1
1
2
3
4
5
6
7
8
20 >20
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through June 2011
Confirmed Measles Cases, by Month of Onset
Australia 2007—2011*
30
1998 SIA: 5-12 y; 75%
Confirmed measles cases
25
20
15
10
5
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
0
2007
Lab-confirmed + Epi-linked = 11
Clinically confirmed = 0
2008
Lab-confirmed + Epi-linked = 65
Clinically confirmed = 0
Lab-confirmed
2009
2010
Lab-confirmed + Epi-linked = 104
Clinically confirmed = 0
Epi-linked
Clinically
Lab-confirmed + Epi-linked = 70
Clinically confirmed = 0
2011
Lab + Epi-linked =
117
Clinically = 0
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through July 2011
Imported Measles Genotypes, by Territory,
Australia 2011
Singapore
India
Indonesia – D9
Singapore – D9
Thailand – D4, D8
Indonesia – D9
Philippines
Thailand
Bangladesh
France – D4
Italy – D4
Philippines – D9
France – D4
Kenya/Tanzania
Cambodia – D8
France
Malaysia – D4
Singapore – D9
England – D4
India – D4, D8
New Zealand – D4
Thailand – D8
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through July 2011
UT-10 A-2
D8-1
Korea
China
D4
D8
A-1
D9-2
D9
H1-106
B3
G3-1
KOR
A
A
Japan
A
D4
D8
A
D4
D4
D8
D8
D9
G3
D4-51
H1
UT
D9-38
D9
D9
G3
D11
H1
G3
G3
UT
Hong
Kong
UT
H1
HOK
D9-1
MAC
Macao
D8-1
D4
D8
D8-1
H1
D8-5
A
D9
G3
H1
UT
UT
A
D4
D8
D9
PHL
G3
H1
UT
MAA
Philippines
A
Malaysia
G3-2 A-2
D4
D9 - 12
D8
D9
G3
H1
UT
A
D4
SIN
D8
D9
Singapore D8-1
D4-1
D8-1
D9-4
G3
D9-18
H1
UT
A
D4
D8
D9
G3
H1
UT
AUS
A-4
H1-1
D4-13
A
D9-29
D4
D8
Australia
D9
G3
D8-19
New Zealand
NEZ
H1
UT
D9-11 D4-9
Genotype Distribution of
D8-3
World Health
Organization
• Western Pacific Regional Office • Expanded Programme on Immunization
Measles Virus,
WPR
2011
* Data up to July 2011
Rubella Incidence, Western Pacific Region, 2010
LEGEND (per million population)
<= 10 (25)
11 – 25 (1)
15% of regional population
26 – 49 (3)
>= 50 (0)
No data (7)
Common rubella genotypes: 1E and 2B
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Data source: JRFs and surveillance data
Rubella Protection and Plans in
the Western Pacific Region
Legend
F & M ≥ 20 yrs protected (16)
F ≥ 20 yrs protected (5)
F & M ≥ 15 & < 20yrs protected (4)
Recent introduction of RCV (5)
RCV not yet introduced (6)
LAO: introduction late 2011
KHM, VNM: under discussion
Data source: JRFs
PNG, SOL, VAN:
considering
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Priority Activities for Measles Elimination & Rubella
Control, Western Pacific Region, 2011-2012
• Conducting quality SIAs, incorporating RCV when feasible
⁻ 2011: CHN (Xinjiang, others?), KHM (Oct/Nov), LAO (Nov)
⁻ 2012: PNG, 4 PICs – KIR, SOL, SMA, VAN; also ORI
• Improving routine MCV1, MCV2 and RCV coverage and
schedules
• Strategies for immunizing adults (if needed)
• Strengthening surveillance
– Sub-national sensitivity
– Contact tracing; epidemiologic linkages
– Measles virus detection
• Verification
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Measles Elimination Funding Needs (in thousands),
Western Pacific Region 2011-2012
KHM
SIAs
CHN
500
400
ORI
Surveillance
75
Lab
45
Tech Asst
25
50
LAO
MNG
600
100
48
24
60
100
19
16
75
PHL
PNG
VNM
350
812
PICs*
Others
WPRO
425
1,875
64
522
7
1,877
100
180
20
535
46
19
66
16
25
50
80
80
Verification
Rubella &
CRS
Total
Total
60
100
60
10
10
20
115
680
550
862
150
822
603
883
Funding currently available: US$ 1,717,000
Expected funding in 2012:
US$ 570,000
Total 2011-12 funding:
US$ 2,387,000
311
200
405
350
350
375
548
80
550
Total Need: $5,728,000
SHORTFALL: $3,341,000
All funds are in US$
WorldVAN
Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* PICs: KIR, SMA, SOL,
5,728
With malice toward none, with charity for all,
with firmness in the right, as God gives us to see the right,
let us strive on to finish the work we are in.
- Abraham Lincoln
2nd Inaugural Address
March 4, 1865
Thank You
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Geographic Distribution of Reported Measles Cases, by Province,
China, January-June 2011
1 dot =2 cases
27
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Confirmed Measles Cases, by Month of Onset,
Cambodia 2007—2011*
400
350
Number of measles cases
300
250
200
SIA
SIA
150
100
50
0
J F M A M J J A S O N D J F M A M J J A S ON D J F M A M J J A S O N D J F M A M J J A S ON D J F M A M J J
Year
2007
Lab + Epi = 8
Clinically = 386
2008
Lab + Epi = 5
Clinically = 1760
2009 (N= 865 )
Lab + Epi = 115
Clinically = 750
2010 (N= 1162 )
Lab + Epi = 457
Clinically = 705
2011 (N= 356 )
Lab + Epi = 275
Clinically = 81
Lab-confirmed
Epi-linked
Clinically
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through June 2011
Laboratory Confirmed Measles Cases,
by Year of Age, Cambodia 2010
45
SIA Target
40
35
30
number of cases
25
20
15
10
5
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 3940+
N = 457
World Health Organization • Western Pacific
Regional
Office • Expanded Programme on Immunization
age
in years
Laboratory Confirmed Measles Cases with Rash
Onset from May-July, by Year of Age and Vaccination
Status, Cambodia 2011*
12
10
SIA Target
Number of cases
8
6
4
2
0
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 >=30
Age in years
N = 108
0 dose
1 dose
>=2
unknown
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly laboratory reports
Discarded Measles Rate and Measles IgM Positive
Cases, by District and Age Group, Cambodia 2011*
2010
2011: May - July
Age of MIgM pos cases
≥ 15yr
10 - 14yr
5 - 9yr
1 - 4yr
< 1yr
Discarded measles per 100K pop:
≥2
1.0 - 1.9
<1
No suspected measles cases
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly surveillance reports, data through June 2011
Lab-Confirmed Measles Cases, by Operational
District and Age Group, Cambodia May–July 2011*
Age of MIgM(+) cases
≥ 15yr
10 - 14yr
5 - 9yr
1 - 4yr
< 1yr
Annualized discarded measles
per 100K pop:
≥2
1.0 - 1.9
<1
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly surveillance reports, data through July 2011
Confirmed Measles Cases, by Month of Onset
Lao PDR 2008—2011*
70
Confirmed measles cases
60
50
40
30
20
10
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
0
2008
Lab-confirmed + Epi-linked = 2
Clinically = 111
2009
2010
Lab-confirmed + Epi-linked = 72
Clinically = 0
Lab-confirmed
Epi-linked
Lab-confirmed + Epi-linked = 6
Clinically = 147
2011
Lab + Epi = 10
Clinically = 3
Clinically
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source:
WPRO
measles-rubella
country reports, data through June 2011
* Source: WPRO measles-rubella monthly
country
reports,
data throughmonthly
July 2011
Confirmed Measles Cases, by Province
Lao PDR 2010—2011*
2010
2011
1 dot = 1 case
Discarded measles per 100K population:
≥2
1.0 - 1.9
<1
No suspected measles cases
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella* Source:
monthly WPRO
surveillance
measles-rubella
reports, data
monthly
throughcountry
July 2011
reports, data through June 2011
Confirmed Measles Cases, by Age Group & Vaccination Status
Kuala Lumpur and Sabah (Malaysia) 2011*
Kuala Lumpur
Sabah
35
Confirmed measles cases
Confirmed measles cases
35
30
25
20
15
10
5
0
30
25
20
15
10
5
0
<1 yr
1-4
yrs
0 dose
5-9
yrs
10-14 15-19 20-24 25-29 30-34 35-39 ≥40
yrs
yrs
yrs
yrs
yrs
yrs
yrs
1 dose
≥2 doses
Unknown
<1 yr
1-4
yrs
0 dose
5-9
yrs
10-14 15-19 20-24 25-29 30-34 35-39 ≥40
yrs
yrs
yrs
yrs
yrs
yrs
yrs
1 dose
≥2 doses
Unknown
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through June 2011
Confirmed Measles Cases, by Month of Onset
Singapore 2007—2011*
20
Confirmed measles cases
15
10
5
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
0
2007
Lab-confirmed + Epi-linked = 15
Clinically confirmed = 0
2008
Lab-confirmed + Epi-linked = 18
Clinically confirmed = 0
Lab-confirmed
2009
2010
Lab-confirmed + Epi-linked = 16
Clinically confirmed = 0
Epi-linked
Lab-confirmed + Epi-linked = 54
Clinically confirmed = 0
2011
Lab + Epi-linked =
70
Clinically = 0
Clinically
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through July 2011
Confirmed Measles Cases, by Age
Singapore 2011*
16
15
14
12
12
Confirmed measles cases
11
10
Routine schedule: MCV1 at 12-24m; MCV2 at 6-7y
8
6
4
3
2
2
2
2
2
1
1
0
0
0
0
0
0
0
0
0
0
0
9
10
11
12
13
14
15
16
17
18
0
0
<1
1
2
3
4
5
6
7
8
19
Age in years
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through June 2011
20
>20
Confirmed Measles Cases, by Age Group & Vaccination Status
Australia 2010—2011*
25
Confirmed measles cases
20
15
10
5
0
<1 yr
1-4
yrs
5-9
yrs
10-14 15-19 20-24 25-29 30-34 35-39 ≥40 <1 yr
yrs
yrs
yrs
yrs
yrs
yrs
yrs
1-4
yrs
5-9
yrs
10-14 15-19 20-24 25-29 30-34 35-39 ≥40
yrs
yrs
yrs
yrs
yrs
yrs
yrs
2010
2011*
0 dose
1 dose
≥2 doses
Unknown
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through June 2011
Lab-confirmed & Epi-linked Measles Cases, by Province
Australia 2010 & 2011*
2010
2011
1 dot = 1 case
Measles incidence per 1M population:
≥ 50
20.0 - 49.9
10.0 - 19.9
5.0 – 9.9
1.0 – 4.9
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
<1
* Source: WPRO measles-rubella monthly country reports, data through July 2011
Genotypes and Countries of Imported Measles
Cases, Australia 2011*
12
10
Thailand
8
Thailand
Thailand
Singapore
New Zealand
Philippine
New Zeala
6
Singapore
Malaysia
Malaysia
Italy
Indonesia
India
Italy
4
India
Philippines
France
England
Indonesia
Cambodia
0
D4
Total: 10
England
Cambodia
India
2
France
D8
Total: 10
D9
Total: 8
Total genotypes in 2011: D4=19; D8=22; D9=30
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through July 2011
Confirmed Measles Cases, by Month of Onset
New Zealand 2007—2011*
90
80
Confirmed measles cases
70
60
50
40
30
20
10
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
0
2007
Lab-confirmed + Epi-linked = 7
Clinically confirmed = 18
2008
Lab-confirmed + Epi-linked = 8
Clinically confirmed = 7
Lab-confirmed
2009
2010
Lab-confirmed + Epi-linked = 190
Clinically confirmed = 63
Epi-linked
Lab-confirmed + Epi-linked = 36
Clinically confirmed = 12
2011
Lab + Epi-linked =
150
Clinically = 1
Clinically
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through July 2011
Confirmed Measles Cases, by Region
New Zealand 2010—2011*
2010
2011
1 dot = 1 case
Measles incidence per 1M population:
≥ 50
20.0 - 49.9
10.0 - 19.9
5.0 – 9.9
1.0 – 4.9
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
<1
* Source: WPRO measles-rubella monthly country reports, data through June 2011
Confirmed Measles Cases, by Age Group & Vaccination Status,
New Zealand 2010—2011*
35
30
Confirmed measles cases
25
20
15
10
5
0
<1 yr
1-4
yrs
5-9
yrs
10-14 15-19 20-24 25-29 30-34 35-39 ≥40
yrs
yrs
yrs
yrs
yrs
yrs
yrs
<1 yr
1-4
yrs
5-9
yrs
10-14 15-19 20-24 25-29 30-34 35-39 ≥40
yrs
yrs
yrs
yrs
yrs
yrs
yrs
2010
2011*
0 dose
1 dose
≥2 doses
Unknown
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
* Source: WPRO measles-rubella monthly country reports, data through June 2011
Reported Rubella Cases, Western Pacific Region
1993-2010
No. cases
140,000
Number of cases
127,305
120,000
100,000
80,000
85,236
Reporting from China
60,000
42,947
45,962
27,124 28,713
40,000
20,000
73,655
4,006 3,496 5,770 3,540 6,738 965 3,911 7,854 6,866 4,564 5,076
0
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
World Health
• Western
Pacific Regional
Office rubella
• Expanded
Programme
Data source: WHO/UNICEF
Joint Organization
Reporting Forms
(1993-2010)
and measles
surveillance
dataon Immunization
15% of regional population
Rubella Incidence
Western Pacific Region, 2010
LEGEND (per million population)
<= 10 (25)
11 – 25 (1)
26 – 49 (3)
>= 50 (0)
No data (7)
Common rubella genotypes: 1E and 2B
Protection from RCV in WPR
Protecting F & M ≥ 20 yrs (16)
Protecting F ≥ 20 yrs (5)
Protecting F & M ≥ 15 & < 20yrs (4)
LAO: will introduce in late 2011
CAM, VTN: under discussion
Recent introduction of RCV (5)
RCV not yet introduced (6)
PNG, SOL, VAN:
considering
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Data source: JRFs and surveillance data
Susceptibility to Rubella, Vientiane, Lao PDR
%
Age group (years)
Study (2010): among 784 women of child bearing age (15-45 y):
36% were susceptible to rubella at 15-19 y;
- 78% of these are infected by rubella during CBA years
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Source: MOH, Lao PDR
Updated WHO Position
Purpose and Approaches for Rubella Vaccination
•
•
The primary purpose is to prevent
the occurrence of congenital
rubella infection including CRS
Countries should use the two
dose measles vaccine strategy to
use MR or MMR vaccine
– Preferred approach: MR or
MMR vaccine in a wide-age
range campaign followed
immediately with introduction
of routine MR or MMR vaccine
– Achieve and maintain ≥ 80%
RCV immunization coverage
delivered through routine
services and/or regular SIAs
Wkly Epid Rec,World
15Health
JulyOrganization
2011, vol
86:301-316
• Western Pacific Regional Office • Expanded Programme on Immunization
CRS Cases Hospitalized in Two Children Hospitals, Viet Nam, April 2011
PDA/ASD/PS/PH, thrombocytopenia, Cataract (bilateral)
LBW, hydrocephalus, PDA, CoA
Petechia, Cataract, PDA
Cataract, Nystagmus, PDA, ASD
Petechia, Cataract, PDA
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Credits: Dr. Kohei Toda , EPI Officer, WHO/Viet Nam
Reported Measles Cases and MCV1 Coverage
Western Pacific Region 1980 – 2011*
97%
1,400,000
100
90
1,200,000
80
70
60
800,000
50
600,000
40
30
400,000
coverage (%)
Number of cases
1,000,000
20
200,000
10
0
Year
0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11
Measles Accelerated
Measles Elimination
EPI
Measles Control
Control
WPR cases w/o CHN
* Data as of June 2011
China cases
Coverage (WHO estimate)
Source:
WPRO surveillance database
World Health Organization • Western Pacific Regional Office • Expanded Programme
on Immunization
WHO/UNICEF JRFs ,1980-2011
Measles Incidence*
Western Pacific Region 2010
* per million population
LEGEND:
< 1.0 (23)
1.0 – 4.9 (6)
5.0 – 9.9 (0)
(29 <10/mill)
10.0 – 19.9 (2)
20.0 – 29.9 (3)
30.0 – 39.9 (0)
40.0 – 49.9 (0)
Incidence
27 per million
≥ 50.0 (2)
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Source: WPRO measles-rubella monthly country reports
Measles Incidence*
Western Pacific Region 2012
* per million population
LEGEND:
< 1.0 (27)
1.0 – 4.9 (5)
5.0 – 9.9 (4)
(36 <10/mill)
10.0 – 19.9 (0)
20.0 – 29.9 (0)
30.0 – 39.9 (0)
40.0 – 49.9 (0)
Incidence
4 per million
≥ 50.0 (0)
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Expected data
Priority Activities of Measles Elimination
Western Pacific Regional Office, 2011-2012
• Publish Measles and Rubella Bulletin monthly (as of May 2011)
• Regular data analysis of countries/areas and feedback
• Update/revise guidelines for measles and incorporate rubella
control, outbreak response and verification
• Support surveillance capacity building at national and sub-national
levels
• Accreditation of all RRLs and NMLs in 2011
• Convene Regional Verification Commission
• Country visits to support immunization, surveillance, laboratory and
verification (where appropriate)
• Resource mobilization
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization