MEASLES Introduction Welcome to the first edition of Measles Bulletin, a publication of the EPI Unit of the WHO Regional Office for the Western Pacific Pacific. This bulletin is designed to communicate the progress towards measles elimination in the Region by incorporating information shared by the Member States. In September 2003, the WHO Regional Committee for the Western Pacific adopted resolution WPR/RC54.R3. The resolution noted that 95% population immunity is essential to achieve measles elimination and recognized that some countries have made significant progress towards achieving this level of immunity. The Regional Committee decided that, in the Western Pacific Region, measles elimination should be one of two new pillars to strengthen the Expanded Programme on Immunization (EPI). The Regional Committee confirmed that
BULLETIN
World Health Organization Regional Office for the Western Pacific Expanded Programme on Immunization
World Health Organization, Western Pacific Regional Office, Manila, Philippines Issue 1 January 2004
elimination as part of the overall plans for immunization services; (2) to use measles elimination to strengthen EPI and other public health programmes, such as prevention of congenital rubella syndrome; (3) to offer, in principle, all children two doses of measles vaccine, taking into account local situations, so that the 95% population immunity of each birth cohort can be achieved and maintained in every district; and (4) to develop or strengthen measles surveillance systems and laboratory confirmation of cases. The Regional Committee also requested the Regional Director to further strengthen technical cooperation with Member States, in particular the improvement of immunization coverage and surveillance and to strengthen laboratory capacity in the Region to achieve measles elimination. It also requested regular reports on progress and a proposed target date for regional measles elimination. To share information and keep abreast of the progress towards measles elimination, WHO Western Pacific Regional Office requests National Immunization Programmes of Member States to send its case-based measles data on a regular basis. The data shared can only be as good as the data received.
measles elimination should be a regional goal and that the establishment of a target date should be made at the earliest opportunity and should be based on an annual review of progress. It also endorsed the Western Pacific Regional Plan of Action for Measles Elimination. The Regional Committee urged Member States: (1) to develop or strengthen national plans for measles
Figure 1. Reported measles cases, Western Pacific Region (1974-2002) 3,500 Cases (in thousands)
3,000
2,500
2,000
1,500
1,000
500
74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02
Year
MEASLES BULLETIN The leopard can’t get rid of its spots but our kids can! Measles remains the leading cause of vaccine-preventable death among children. In the Western Pacific Region, it is estimated that over 32 000 children die each year of this disease. Despite major progress during the past few years, it is estimated that 30-40 million cases of measles still occur worldwide every year, leading to over 770 000 deaths per year. Yet controlling measles is well within our power. Measles is totally preventable. We have a highly effective, safe and inexpensive vaccine that can halt the transmission of the virus when individuals receive two doses. We have not yet achieved the necessary levels of measles immunization coverage to interrupt transmission throughout the Region. Most countries and areas of the Region have developed national plans of action for measles control and elimination. Australia and New Zealand have targeted measles for elimination and have probably succeeded, although this has not been formally certified. It is likely that many Pacific island countries and areas have also interrupted the transmission of the virus. Other countries that have set target dates for measles elimination include the Republic of Korea - 2005, Malaysia - 2005, the Philippines - 2008 and Viet Nam - 2010. To work towards the regional measles elimination goal, many countries are offering two doses measles vaccine to attain 95% population immunity. The method generally adopted for implementing the second dose is supplementary measles immunization activities (SIAs). In 2004 and 2005, countries such as Cambodia, China, Lao People’s Democratic Republic, Malaysia, Papua New Guinea and the Philippines are planning SIAs (nationally and/or sub-nationally). It is now up to us to make it happen - a Region free of measles!
Figure 2. Measles incidence in the Western Pacific Region (average 1998-2002)
MEASLES BULLETIN Table 1. Reported measles cases, vaccination status and deaths (2003) Total Vaccination status Incidence Lab Number number of Date of last Unknown per 100,000 confirmed of reported report Immunized Unimmunized Immunization population cases deaths cases Status
Country/area Australia Brunei Darussalam Cambodia China Hong Kong (China) Japan Lao People's Democratic Republic Macao (China) Malaysia Mongolia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Viet Nam Western Pacific Region
364
2.81
144
220
0
74
0
23/01/2004
811
21.72
149
657
5
73
10
02/12/2003
86
4.41
…
…
…
6
…
25/11/2003
8440*
14.07
1547
5149
1744
82
230
27/11/2003
788 10 489
1.43 5.71
433 2273
366 6392
19 1768
243 478
0 240
10/11/2003
* 11% tested for laboratory confirmation, of that 89% was positive.
Regional Measles Laboratory Network Considerable progress has been made on the Regional Measles Laboratory Network. - Most of the countries in the Region have identified National Measles Laboratories (NML). - A laboratory network covering Pacific island countries (LABNET) and another covering surveillance (EPINET) has been established with four laboratories (Fiji, French Polynesia, Guam and New Caledonia). - Three Regional Reference Laboratories in Australia, Japan and China have been proposed. - An on-site review for accreditation of the Regional Reference Laboratory in China was carried out in November. - Since April 2003, the Lao People’s Democratic Republic, Mongolia, the Philippines and Viet Nam have started sending case-based reports to the EPI Informatics Assistant at bersondad@wpro.who.int. Accreditation procedures of NMLs, including provision of proficiency test panels and first accreditation visits, will be in place in due course. A training course mainly for national laboratories in need of assistance is being planned.
MEASLES BULLETIN Table 2. Reported measles cases in countries and areas in the Western Pacific Region (1990 - 2002). Country/area American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Federated St. of Micronesia Fiji French Polynesia Guam Hong Kong (China) Japan Kiribati Lao People's Democratic Republic Macao (China) Malaysia Marshall Islands Mongolia Nauru New Caledonia New Zealand Niue Northern Mariana Islands Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna Western Pacific Region 1990 1991 1992 1993 1994 1995 498 19 0 0 0 0 880 1380 1425 4536 4895 1198 12 51 50 2473 2186 2759 1262 946 2038 85 705 123 428 140 048 117 851 76 204 53 232 36 61 9 3 0 7 1 0 46 0 930 0 32 969 425 39 414 30 31 22 21 95 7 1 62 4 25 228 0 48 278 329 29 210 33 3259 5452 2002 30 8 4357 114 292 4 2168 1400 520 1083 984 3174 19 1 35 21 52 3 563 345 363 542 346 654 14 19 10 9 0 296 656 1069 71 177 558 300 0 18 5 3 6 6 2 9239 69 33 121 0 0 2 0 35 7 116 29 0 0 0 0 93 0 0 4575 2740 6634 8212 6821 3578 42 938 29 037 39 304 7541 3006 4051 3415 7883 71 0 0 4 7 0 0 143 216 606 0 159 185 343 45 86 1527 640 4 0 0 0 0 0 65 18 16 0 0 0 1 0 0 1 67 541 171 91 27 27 8175 9874 11 830 12 015 11 853 6171 0 9 9 13 156 139 187 162 210 678 157 730 115 866 75 425 1996 0 498 2814 68 404 9 39 387 0 110 1640 13 917 1997 12 853 13 3826 82 687 194 0 828 518 0 318 1998 2 327 12 1993 53 030 9 0 0 0 56 899 355 4613 0 483 0 8 1999 0 235 23 13827 61 840 0 0 20 13 1 32 2 2302 1 2576 0 10 1 1 106 0 0 0 6304 2981 2000 1 108 42 12327 71 093 2 0 0 0 60 22 497 0 332 5 6187 0 925 0 65 0 0 0 7135 7120 32 088 NA 141 2001 0 141 11 3761 88 962 0 0 17 3 0 179 22 552 0 94 3 2198 0 10 677 0 0 65 0 0 0 4023 7360 23 044 ND 408 0 0 4 0 7 12 058 2002 0 32 1361 58 341 0 0 304 3 9 61 33 812 0 2070 3 408 0 1205 0
25 671 3 460 627 0 0 128 4 58 0 2041 164 0 0 0 1 0 0 1 2879 2717 1148 36 465 1984 71 2 4 87 0 8 1413 114 0 0 0 336 287 0 0 1081 36 51 14 0 4 113 5156 6507 11 690 0 0 84 003 141 278 76 936
21 0 0 0 17 620 7003 41 ND 0 65 211 ND 0 0 0 0 6 0 0 0 ND 0 12 52 101 14 134 16 512 6755 0 0 0 104 492 176 692 175 567 129 361
* Source: Reported number of cases for 2002 in Cambodia, Mongolia, Philippines and Viet Nam from WHO/WPRO Regional Measles Database. All other countries from the WHO/UNICEF Joint Reporting Form data.
Comments may be sent to Dr. Ernest Smith smithe@wpro.who.int or Ms. Margaret Hercules herculesm@wpro.who.int Please send quarterly data to Mr. Dexter Bersonda at bersondad@wpro.who.int WORLD HEALTH ORGANIZATION Regional Office for the Western Pacific United Nations Avenue P.O. Box 2932 1000 Manila, Philippines Fax No. (632) 5211036, 5260279, 5260362 Tel. No. (632) 5288001