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Global Overview of Measles & RubellaGlobal Overview of Measles & Rubella
11th Annual Meeting The Measles Initiative
Washington, DC18-19th September, 2012
Major causes of annual under 5yrs child mortality: 1990-2010
2000 : 9.6 million
2010 : 7.6 million
Source: Li, Liu, at all The Lancet 379, June 9, 2012):
1990: 12.1 million
2008: 8.8 million
Source: Van den Ent et al, J Infect Dis Suppl July 2011
020
040
060
080
010
00E
stim
ated
dea
ths,
thou
sand
s
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Year
Estimated mortality 95% confidence interval
Estimated measles deaths down by three - quarters, 2000 - 2010 Estimated measles deaths down by three - quarters, 2000 - 2010
2015 Target
74%
4 |
Trends in 1st and 2nd dose Measles delivery various strategies
Trends in 1st and 2nd dose Measles delivery various strategies
Number of doses of measles vaccine administered, by delivery strategy, 2000-2010
Measles Initiative
1st routine dose: WHO/UNICEF coverage estimates, The World Population Prospects New York, 2011. 2nd routine dose: WHO/UNICEF Joint reporting form, (not all countries report 2nd dose). SIA dose;: WHO SIA database, July 2011 (Provisional data)
0
50
100
150
200
250
300
350
400
450
500
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Num
ber o
f MC
V d
oses
(in
mill
ions
)
1st routine dose 2nd routine dose SIA
1 billion vaccinated as of July 2011
Measles and other interventions supplementary activities, 2011Legend
maskline_general
COUNTRY
Abyei border
Abyei border1
Bline_Kosovo
Bline_Sudan
Cont_ja_ka
Fline
Gaza
South_sud
Wline
Measles_SIAs<all other values>
Measles_2011_2012.ImpStatus
<Null>
MR
OPVMeasles
OPVVitAMeasles
VitADewormingMeasles
VitAMeasles
all*
measles
maskpoly_general
AREA
Abyei
Jammu and Kashmir
Lakes
ISO_3_CODE
ESH
<all other values>
Vitamin A – 12De-worming – 10Bed nets – 2OPV – 16Other interventions -5
WHO;August 2012
*OPV+VitA+Deworming+Mealses
0 3,250 6,5001,625 Kilometers
6 |
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
4,000,000
4,500,000
5,000,0001
98
0
19
81
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
num
ber
of
cases
0
10
20
30
40
50
60
70
80
90
100
imm
uniz
ation c
overa
ge (
%)
Number of cases WHO/UNICEF estimates
84%2015 Target
Annual Number of Reported Measles Cases and 1st Dose Measles Vaccination Coverage, Worldwide, 1980-2011
7 |
Reduction in Estimated Measles Deaths by WHO Region 2000 to 2010
Reduction in Estimated Measles Deaths by WHO Region 2000 to 2010
74%76%79% 85%
2010 reduction goal (90%)
78%
Source: WHO/IVB, November 2009
87%100%
26%
8 |
Pareto-Juran principlePareto-Juran principle
20% of the work (the first 10% and the last 10%) consume 80% of your time and resources
9 |
IndiaIndia
RAJASTHAN
ORISSA
GUJARAT
MAHARASHTRA
MADHYA PRADESH
BIHAR
KARNATAKA
UTTAR PRADESH
ANDHRA PRADESH
JAMMU & KASHMIR
ASSAM
TAMIL NADU
CHHATTISGARH
PUNJAB
JHARKHAND
WEST BENGAL
ARUNACHAL PR.
HARYANA
KERALA
UTTARAKHAND
HIMACHAL PRADESH
MANIPUR
MIZORAM
MEGHALAYANAGALAND
TRIPURA
SIKKIM
GOA
A&N ISLANDS
D&N HAVELI
PONDICHERRY
LAKSHADWEEP
DELHI
CHANDIGARH
DAMAN & DIU
Phase 2 (157 districts)
Phase 1 (45 districts covered)
Remaining (159 districts)
Source: Based on target population available with GoI
Target pop
(millions)
Vaccinated (millions)
Coverage
Phase-1 13.8 12.1 88%
Phase-2 42.9 28.6 67%*
Phase-3 72.7 Planned --
Total 129.4 40.7* --
* Phase-2 campaigns ongoing; data as on 23 Jan 2012.
17 states with MCV1 coverage ≥ 80% introduced a routine second dose by August 2011.
14 states with MCV1 < 80% are implementing measles SIAs
10 |
Measles and Rubella Elimination Goalsby WHO Region, February 2012
Measles and Rubella Elimination Goalsby WHO Region, February 2012
20152015 20152015
2015201520122012
SEAR: 95% Mortality Reduction by 2015
Americas, Europe, E. Mediterranean, W. Pacific, Africa have measles elimination goalsAmericas and Europe have rubella elimination goals
20202020
2000 2000 20102010
Political advocacy, mobilizing decision makers Branding,
advertising & ‘edu-tainment’ with national, provincial and community mass media
Community engagement Meetings, forums, film showings and events
Targeted sellingVolunteer Social Mobilization Networks
Point of service promotion Inter-personal communication
Researched & Evidenced multi-
pronged communication: Experience from
GPEI
COMBI Star adapted for polio eradication
Challenges 1: Communication
12 |
Challenges 2: Weak Immunization Systems Challenges 2: Weak Immunization Systems
1st dose:– 67 Countries have
MCV1 coverage < 90%
2nd dose ( routine ):– 54 countries do not
have routine 2nd dose
Campaigns:– Variable quality
Measles 1st dose coverage among infants, 2010
80-89% (24 countries or 12 %)
50-79% (41 countries or 21%)
>=90% (126 countries or 66%)
<50% (2 countries or 1%)
13 |
Challenges 3: Some set backs in AfricaChallenges 3: Some set backs in Africa
4-fold increase since 2008
Large outbreaks in Burkina Faso (2009), S. Africa (2010), and DRC (2011)
Outbreaks in drought affected Horn of Africa
– High case-fatality
0
100,000
200,000
300,000
400,000
500,000
600,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010‡
Year
No.
of c
ases
(in
thou
sand
s)
0
10
20
30
40
50
60
70
80
90
100
MCV1 coverage (%
)
Number of cases
WHO/UNICEF estimates
Administrative coverage
Weekly Epidemiological Record(2011) 86:129-135
14 |
Historical procurement of Measles and MR vaccine through UNICEF in 2000-2012 and forecasts for 2013-2016 (in doses)Historical procurement of Measles and MR vaccine through
UNICEF in 2000-2012 and forecasts for 2013-2016 (in doses)
15 |
SummarySummarySummarySummary
Achievements– 1st dose coverage up to 85%– 1 billion doses delivered in campaigns– 2 / 3 reduction in cases– 3 / 4 reduction in deaths
Challenges– Catch - up in India; Outbreaks in Africa; Weak systems
New Strategic Plan, 2012 – 2020– Addressing rubella together with Measles– Taking the Initiative towards achieving regional goals
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