Regional update of the Eastern Mediterranean Region

http://www.emro.who.int/entity/vpi/

Regional update of the Eastern Mediterranean Region

12th Annual Meeting of The Measles & Rubella InitiativeAmerican Red Cross, Washington, DC -10-11 September , 2013

Dr Nadia Teleb, Regional Adviser, Vaccine Preventable Diseases and Immunization

WHO/EMRO


Regional Measles and Rubella Goals

•Measles elimination from all countries by

2015

– Resolution EM/RC44/R.6 – 1997 (elimination by 2010),

revised by Resolution EM/RC58/R.5 – 2011 (elimination

by 2015)

• No regional target for rubella/CRS elimination2


90% Reduction in Reported Measles CasesReported measles cases and MCV1 coverage, Eastern Mediterranean Region, 1980-2012

3

19801982

19841986

19881990

19921994

19961998

20002002

20042006

20082010

20120

50000

100000

150000

200000

250000

300000

350000

400000

450000

500000

0

10

20

30

40

50

60

70

80

90

100

Measles cases Measles coverage (WHO-UNICEF estimate)


Palestine

Bahrain

MCV2 introduction into routine EPI in Countries of the EMR 2012

MCV2 introduction into routine EPI in Countries of the EMR 2012

Routine MCV2 introduced

No plan for routine MCV2 introduction


0

10

20

30

40

50

60

70

80

90

100

Co

vera

ge

%

MCV1 MCV2Source: MCV1: WHO UNICEF estimates MCV2: reported JRF 5

Routine measles vaccination, 2012


Palestine

Bahrain

Nation-wide Measles-rubella Case-based surveillance (20)

Moving to Nation-wide measles surveillance (1)

Measles Case-Based Surveillance in EMR, 2012

Sentinel site measles surveillance (2)


Jan-

06Fe

b-06

Mar

-06

Apr-

06M

ay-0

6Ju

n-06

Jul-0

6Au

g-06

Sep-

06O

ct-0

6N

ov-0

6D

ec-0

6Ja

n-07

Feb-

07M

ar-0

7Ap

r-07

May

-07

Jun-

07Ju

l-07

Aug-

07Se

p-07

Oct

-07

Nov

-07

Dec

-07

Jan-

08Fe

b-08

Mar

-08

Apr-

08M

ay-0

8Ju

n-08

Jul-0

8Au

g-08

Sep-

08O

ct-0

8N

ov-0

8D

ec-0

8Ja

n-09

Feb-

09M

ar-0

9Ap

r-09

May

-09

Jun-

09Ju

l-09

Aug-

09Se

p-09

Oct

-09

Nov

-09

Dec

-09

Jan-

10Fe

b-10

Mar

-10

Apr-

10M

ay-1

0Ju

n-10

Jul-1

0Au

g-10

Sep-

10O

ct-1

0N

ov-1

0D

ec-1

0Ja

n-11

Feb-

11M

ar-1

1Ap

r-11

May

-11

Jun-

11Ju

l-11

Aug-

11Se

p-11

Oct

-11

Nov

-11

Dec

-11

Jan-

12Fe

b-12

Mar

-12

Apr-

12M

ay-1

2Ju

n-12

Jul-1

2Au

g-12

Sep-

12O

ct-1

2N

ov-1

2D

ec-1

2Ja

n-13

Feb-

13M

ar-1

3Ap

r-13

May

-13

Jun-

13

2006 2007 2008 2009 2010 2011 2012 2013

0

500

1000

1500

2000

2500

3000

3500

4000

Monthly distribution of confirmed Measles cases in the EMR 2006-June 2013

South SudanSyriaSomaliaQatarPalestinePakistanMoroccoKuwaitJordanBahrain

Confi

rmed

mea

sles

cas

es

11,183

6,4596,079

3,0814,983

13,348

12,347

23,451


Situation of Rubella


Palestine

Bahrain

Rubella vaccine planned 2015-2016 (Djibouti)

Rubella vaccine use in countries of the EMR, 2013

9

Rubella vaccine planned 2014 (Yemen)Rubella vaccine in use (16 country)

Rubella vaccine introduction not decided (5 countries)

http://www.emro.who.int/entity/vpi/10

Tunisia

Qatar

Sudan

Yemen

Pakist

an

Kuwait

Afghan

istan

Bahrai

n

South Su

dan UAEOman Ira

q

Saudi A

rabia

Egyp

tIra

n

Jordan

Palesti

ne

Leban

onLib

ya

Morocco Sy

ria

Djibouti

Somali

a0.0

10.0

20.0

30.0

40.0

50.0

60.0

50.9

15.6

9.56.9

3.7 3.6 3.5 3.2 2.1 1.90.6 0.6 0.6 0.4 0.4 0.3 0.2 0.2 0.2 0.1 0.0 0.0 0.0

Incidence of Rubella /million in EMR 2012


Measles in Syria and the surrounding countries

Syrian camp in Lebanon


0

20

40

60

80

100

120Ja

n-07

Apr-

07Ju

l-07

Oct

-07

Jan-

08Ap

r-08

Jul-0

8O

ct-0

8Ja

n-09

Apr-

09Ju

l-09

Oct

-09

Jan-

10Ap

r-10

Jul-1

0O

ct-1

0Ja

n-11

Apr-

11Ju

l-11

Oct

-11

Jan-

12Ap

r-12

Jul-1

2O

ct-1

2Ja

n-13

Apr-

13

2007 2008 2009 2010 2011 2012 2013

Monthly distribution of total measles cases, Syria 2007-2013

0

5

10

15

20

25

30

Jan-

07Ap

r-07

Jul-0

7O

ct-0

7Ja

n-08

Apr-

08Ju

l-08

Oct

-08

Jan-

09Ap

r-09

Jul-0

9O

ct-0

9Ja

n-10

Apr-

10Ju

l-10

Oct

-10

Jan-

11Ap

r-11

Jul-1

1O

ct-1

1Ja

n-12

Apr-

12Ju

l-12

Oct

-12

Jan-

13Ap

r-13

Jul-1

3

2007 2008 2009 2010 2011 2012 2013

Monthly distribution of total measles cases, Jordan 2007-2013

0

500

1000

1500

2000

2500

3000

Jan-

07

Apr-

07

Jul-0

7

Oct

-07

Jan-

08

Apr-

08

Jul-0

8

Oct

-08

Jan-

09

Apr-

09

Jul-0

9

Oct

-09

Jan-

10

Apr-

10

Jul-1

0

Oct

-10

Jan-

11

Apr-

11

Jul-1

1

Oct

-11

Jan-

12

Apr-

12

Jul-1

2

Oct

-12

Jan-

13

Apr-

13

2007 2008 2009 2010 2011 2012 2013

Monthly distribution of total measles cases, Iraq 2007-2013

0

100

200

300

400

500

600

700

Jan-

06Ap

r-06

Jul-0

6O

ct-0

6Ja

n-07

Apr-

07Ju

l-07

Oct

-07

Jan-

08Ap

r-08

Jul-0

8O

ct-0

8Ja

n-09

Apr-

09Ju

l-09

Oct

-09

Jan-

10Ap

r-10

Jul-1

0O

ct-1

0Ja

n-11

Apr-

11Ju

l-11

Oct

-11

Jan-

12Ap

r-12

Jul-1

2O

ct-1

2Ja

n-13

Apr-

13

2006 2007 2008 2009 2010 2011 2012 2013

Monthly distribution of total measles cases, Lebanon 2006-2013


Efforts are ongoing to coordinate synchronized MCV SIAs in Syria

and surrounding countries


SyriaActivities Completed Activities Planned

• March 2013– MMR SIAs for IDP

shelters (6 m - 15 y) – MMR SIAs for school

children 1st- 4th grade

• April 2013– MMR SIAs during the

regional vaccination week (1-5 y)

• 10-21 November 2013– MMR SIAs– 1-5y not reached in

previous SIAs

• MMR SIAs– School students– 6th – 9th grade

• Negotiation to implement SIAs for higher age group


Jordan Activities Completed Activities Planned

• April 2013– M SIAs in Syrian refugee

camps– 6 m-30y– Coverage was not very high.

• On going M vaccination of new Syrian refugees – 6 m-30y

• July 2013– M SIAs in Irbid and Mafrak,

including the camps– almost 100% coverage

• 2-21 November 2013– Nationwide MR SIAs– 6m-20y


Lebanon Activities Completed Activities Planned

• March 2013:– National M SIAs– including Syrian refugees– 9m-18y

• MMR vaccination of Syrian new comers

• Outbreak is still ongoing• EMRO recommendation

for elimination:– MR SIAs (9m-30y) – synchronized with

Jordan

• Under negotiation with MOH


Iraq Activities Completed Activities Planned

• Refugee camps:– Vaccination with MMR

for age 6m-18y for refugee camps and surrounding community

– Vaccination of all new comers (6m-18y)

• Nation-wide preferable– or at least in most

affected provinces

• EMRO recommended– MR/MMR SIAs (6m-30y)

• Under discussion with MOH


Challenges and barriers to achieving the target

• Security situation, refugees and displaced populations• Susceptible hard to reach populations groups

– Gypsy, resistant population, expatriate work forces• Measles among older age group

in almost all countries• Human Resources

- Inadequate technical and managerial capacity of national EPI programme - Rapid turn over of staff

• Inadequate data quality- High incidence of measles despite reported high coverage of routine and/or SIAs

coverage • Funding: specially for the follow-up campaigns

– FU campaigns needed in 7 countries– Measles surveillance


Facing the challenges: 1. Routine strengthening and improving data quality

• Conduct EPI/measles programme reviews:– Afghanistan, Bahrain, Egypt, Jordan, Oman, Qatar, Kuwait, Pakistan, Saudi

Arabia, Sudan, Yemen, UAE• Strengthening implementation of RED approach

– Afghanistan, Iraq, Pakistan, Somalia, South Sudan, Sudan and Yemen• Training workshop on measles surveillance and monitoring and

evaluation of EPI with emphasis on data quality to improve routine immunization, January 2013

• Annual measles/rubella elimination meeting: reviewing performance and developing annual plans

• EPI-PEI collaboration in Pakistan: Using PEI assets to strengthen routine immunization

• WHO-CDC collaboration for strengthening routine immunization and data quality in Afghanistan, started August 2013


Facing the challenges: 2. Advocacy and Communication

• Regional Director highlighting progress towards measles elimination at the Regional Committee

• Regional vaccination week 2013: Theme “Stop Measles Now” celebrated by all countries

• NITAG chairpersons attend annual measles/ rubella meeting

• Advocacy for allocation of national resources and targeting older age group– Pakistan, Morocco, Jordan, Lebanon SIAs in 2013


SIAs and Fund requirement for SIAs 2013-2014

21

Country SIAs Surveillance

Funding gapVaccine Target age Target number Total cost in

US$

Afghanistan 2014

M 9-59M high risk dist.

1,500,0001,275,000 $154,375

$1,429,375

Somalia 2013M 9-59M

CHDs1,287,935 (accessible

areas)

2,610,000$91,000

None (if committed money is provided

Somalia 2014 M 9-59M 1,779,095 4,600,000 $148,000 $4,748,000Pakistan 2013 M 6M to 9Y 14,000,000 14,760,601 $100,000 $2,200,000Pakistan 2014 M 6M to 9Y 48,500,000 50,833,067 $100,000 $17,122,067Sudan 2013 M 9M-15Y 15,203,664 16,700,000 $150,000 $1,660,000Sudan 2014 M 0 0 0 $150,000 $150,000Yemen 2013 M

6M-10Y 304,527 (Sa'adah) 120,023 $260,000 $105,000

Yemen 2014 MR 6M-20Y 14,379,556 11,503,645 $368,000 $3,902,434Total 93,224,710 103,323,590 1,521,375 31,316,876


Technical assistance needs in 2013-2014

22

• For all countries planning SIAs: strong consultants are needed to support planning, implementation and evaluation of the SIAs


Thank You

23


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Documents

Regional update of the Eastern Mediterranean Region