Measles and Rubella Regional Progress Updates 1 Contents 1 AFRICAN Region ................................................................................................................ 4 1.1 Regional control and/or elimination targets ............................................................. 4 1.2 Summary of progress towards regional targets ........................................................ 4 1.3 Summary of implementation of each of the 5 key strategies ................................... 5 1.4 Status of the measles Elimination in the African Region ........................................ 10 1.5 Country Case Studies .............................................................................................. 14 2 AMRO Region .................................................................................................................. 23 2.1 Objectives: .............................................................................................................. 23 2.2 Regional control and/or elimination targets ........................................................... 23 2.3 Summary of progress towards regional targets: ..................................................... 23 2.4 Summary of implementation of each of the five key strategies ............................. 26 2.5 Successes and failures in applying the four basic principles ................................... 32 2.7 Country Studies ....................................................................................................... 42 Analysis of vaccination coverage, by cohort (national level): ............................................. 44 3 Eastern Mediterranean Regional Status ......................................................................... 52 3.1 Regional control and/or elimination targets ........................................................... 52 3.2 Summary of progress towards regional targets (Table 1) ....................................... 52 3.3 Summary on progress towards regional targets ..................................................... 54 3.4 Summary of implementation of each of the five key strategies ............................. 55 3.5 Successes and failures in applying the four basic principles ................................... 59 3.6 Success factors enabling progress .......................................................................... 60 3.7 Barriers to achieving the targets ............................................................................. 60 3.8 Conclusion ............................................................................................................... 60 3.9 Country Case Studies - Egypt .................................................................................. 61 4 European Region ............................................................................................................. 76 4.1 Regional control and/or elimination targets ........................................................... 76 4.2 Summary of progress towards regional targets ...................................................... 76 4.3 Summary of implementation of each of the 5 key strategies ................................. 80 4.4 Successes and failures in applying the 4 basic principles (see country case studies) 85 4.5 Conclusions ............................................................................................................. 85 4.6 Country Case Studies .............................................................................................. 86 5 SEAR Regional Status .................................................................................................... 102 2 5.1 Regional control and/or elimination targets ......................................................... 102 5.2 Summary of progress towards regional targets (Table 1) ..................................... 102 5.3 Summary on progress towards regional targets ................................................... 104 5.4 Summary of implementation of each of the 5 key strategies ............................... 105 5.5 Success factors enabling progress ........................................................................ 108 5.6 Barriers to achieving the targets ........................................................................... 108 5.7 Conclusion ............................................................................................................. 109 5.8 Country Case Studies ............................................................................................ 110 6 WPRO Regional Status .................................................................................................. 133 6.1 Regional control and/or elimination targets ......................................................... 133 6.2 Summary of progress towards regional targets (Table 1) ..................................... 133 6.3 Summary on progress towards regional measles elimination .............................. 133 6.4 Summary of implementation of each of the 5 key strategies ............................... 138 6.5 Successes and failures in applying the 4 "Guiding Principles" .............................. 145 6.6 Success factors enabling progress ........................................................................ 147 6.7 Barriers to achieving the targets ........................................................................... 147 6.8 Conclusions ........................................................................................................... 148 6.9 Country Case Studies ............................................................................................ 151 3 1 AFRICAN Region 1.1 Regional control and/or elimination targets a) Measles elimination target 2020 b) Rubella target : No regional target set Comment In 2001 the region launched mortality reduction activities. Subsequently, in 2011, Resolution AFR/RC61/4/(2011).was adopted for measles elimination for 2020. Although there was no target date set for rubella elimination, countries are introducing rubella containing vaccines in their programs and conducting surveillance for rubella and congenital rubella syndrome. 1.2 Summary of progress towards regional targets 1. In 2014, only 14 countries maintained the indicator of MCV1 of 90% or more coverage. The number of countries achieving coverage of 90% or more increased from 4 in 2000 to 16 in 2009. This period also showed a significant increase in MCV1 coverage between 2001 and 2009 (53% to 74%) This has however stagnated around 73-76% since 2009. 2. There has been a more than 90% decline of reported cases of measles case reports since 2000 (from over 500,000 to under 50,000 in 2008). However, a sharp increase occurred between 2010 and 2011 due to outbreaks , especially in Southern African countries mainly due to spread among susceptible order age groups. 3. The increases in case reports in 2013 represent large outbreaks that occurred in DR Congo (88,381 cases) and Nigeria (52,852 cases) which represented 83% of the 171,178 cases reported in this year. Figure 1. African Region measles vaccination coverage (WUENIC) and official case reports, 2000 – 2014 4 1.3 Summary of implementation of each of the 5 key strategies a) AcHieve and maintain HigH levels of population immunity witH two doses of measles and rubella containing vaccines : 1. As of December 2015, 23 countries had introduced MCV2 in their routine programs (with 4 of these in 2015). Coverage data was available from 16 countries in 2014. 2. Only 9 of 47 (19%) have introduced RCV in their routine immunization program. 3. Three of 31 (9.7%) countries conducting SIAs ( 2013-2015) achieved coverage (administrative) greater than 95% in every district, and all countries doing SIAs include AEFI and routine immunization strengthening in the training of staff. Figure 2. African Region MCV1 coverage (WUENIC) and number of countries witH >90% coverage, 2000 – 2014 b) Monitoring disease using effective surveillance (Table 2) 1. The proportion of countries with measles incidence of less than 5 per million population was, 23 of 44 (52%) in 2013, 21 of 44 (48%) in 2014 and 25 of 44 (57%) in 2015. 2. Overall, the average incidence (2012-2014) was less than 1 per million in 11 countries, between 1 and 5 million in another 11, between 5 and 9 in 6 countries, between 10 and 49 in 12. Four countries (Ethiopia, Nigeria, Angola, and Namibia) had an average incidence above 50. 3. Fourth-four (44) countries are currently implementing case-based surveillance for measles, which is done alongside laboratory confirmation for both measles and rubella. Field activities are integrated with AFP surveillance. 4. The number of specimens received in the Laboratory Network (2012 -2015) was 29,797, 44,998, 43377 and 41,382. 5 5. The percentage of suspected cases with adequate blood specimens for the for the years 2011 to 2015 were 91%, 78%, 85% and 82% respectively. The receipt of serology results within 7 days was 79%, 54%,75% and 79%. Table 1: African Region Measles case-based surveillance performance indicators, 2012- 2015 Indicator 2012 2013 2014 2015 Comments Discarded non-measles rate 3.4% 2.9% 3.0% 2.5% % second level units witH ≥ N/A N/A N/A N/A Indicator is not 2 discarded cases monitored % Districts witH at least one 84.0% 78.0% 77.0% 82.0% case witH blood specimen % suspected cases witH N/A N/A N/A N/A Indicator not adequate investigation monitored % suspected cases witH 91.0% 78.0% 85.0% 82.0% adequate blood specimens % serology lab results