MEASLES he 15th Technical Advisory Group meeting on the Expanded Programme on Immunization and Poliomyelitis Eradication was held in Beijing, China, from 8 to 10 June 2005. The primary objectives of the meeting were to make recommendations on the programmatic strategies and set a target date for regional measles elimination. Conclusions: 1. The fifty-fourth session of the WHO Regional Committee for the Western Pacific resolved to eliminate measles, and the Region is continuing to progress towards elimination with many countries and areas at, or close to, elimination. A target date is needed to focus efforts; facilitate resource mobilization; enable the development of an appropriate implementation plan complete with timeline and milestones; and to rapidly bring to an end the unnecessary morbidity and mortality from measles in the Region. 2. Only a strong routine immunization system with high coverage of two doses of measles vaccine can achieve and sustain the 95% population immunity necessary to interrupt measles virus transmission and sustain measles elimination. However, measles coverage must not come at the expense of reduced coverage of other Expanded Programme on Immunization (EPI) vaccines. 3. In July 2004, the Measles Task Force recommended setting 2012 as the target date for measles elimination. Experience in the Region and globally continues to confirm the feasibility of elimination. 4. Well-planned and carefully targeted campaigns may be used to achieve rapid but temporary: · interruption of transmission in endemic areas;
BULLETIN · ·
World Health Organization Regional Office for the Western Pacific Expanded Programme on Immunization
World Health Organization, Western Pacific Regional Office, Manila, Philippines Issue 6 July 2005
ISSN 1814 3601
Measles elimination conclusions and recommendations from the 15th Technical Advisory Group meeting
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filling of gaps in population immunity (e.g., school-aged children); and prevention of outbreaks.
5. Measles elimination can also be used as a platform for strengthening health systems because of the continuing need for very high coverage and sensitive community-wide surveillance systems. Measles incidence is an excellent indicator of coverage because measles is so infectious and visible. Thus, coverage can be validated by surveillance data. 6. Achieving regional measles elimination requires a commitment from all countries and areas. A target date must be feasible and one that all can aspire to reach, recognizing that additional investments in health systems will be needed to achieve the goal. 7. The operational definition of measles elimination in the regional Field Guidelines for Measles Elimination remains appropriate. Recommendations: 1. TAG recommends that the Regional Director propose 2012 as the target date for regional measles elimination at the fifty-sixth session of the WHO Regional Committee in September 2005. It will be a challenge to eliminate measles in every country and area in the Region by that date, especially in China where measles elimination may require more time and effort in some provinces. 2. Political commitment, as well as financial support, for immunization is critical to the success of measles elimination and should be primarily mobilized at national and subnational levels. WHO and its partners should assist in this endeavour by establishing a regional measles partnership as part of the existing Interagency Coordinating Committee framework.
MEASLES BULLETIN China high-level consultation on strategy development for measles elimination and post-Oral Polio Vaccine (OPV) cessation immunization policies
A
high-level consultation was organized and held from 27 to 28 June in Beijing to review and discuss the current status and plans for measles elimination and post-OPV cessation immunization policies in China. The meeting was attended by Dr Wang Longde, Vice Minister of Health, experts from the National Immunization Advisory Committee, representatives from the State Food and Drug Administration, vaccine manufacturers, WHO and UNICEF. With regard to measles elimination, the issues presented and discussed included a review of the progress in measles control in China, data on this year’s measles resurgence, transmission in urban migrant populations, measles vaccine quality and efficacy in relation to the proposed changes in the measles immunization schedule and dose, the cost of achieving measles elimination, and measles
vaccine needs and domestic supply. Regarding poliomyelitis immunization policy, issues presented and discussed included a review of the global situation, WHO policies and strategies following eradication of wild poliovirus, including immunization policy, laboratory containment and the establishment of monovalent OPV stockpiles. China presented data on vaccine-derived poliovirus, rates of vaccine-associated paralytic paralysis, and the status of Sabin IPV development. The meeting was notable in its timely response and adoption of the recommendations from the 15th Technical Advisory Group meeting that reflected the situation in the country. The discussions sought to find a way to work towards the recommended target date of 2012 for the elimination of measles in the Region.
Global Measles Management Meeting, New Delhi, 18 April 2005
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his informal meeting provided an opportunity for regional measles focal points and partners to discuss progress and obstacles for substantially reducing measles deaths, eliminating measles, and controlling or eliminating rubella. The goal was to share regional experiences and to encourage interregional collaboration. Presentations were given on measles/rubella surveillance; measles/ rubella laboratory issues; forecasting supply and demand for measles/rubella vaccines; a global measles update and updates from the regional 2
measles focal points. In addition, updates were given by partner agencies such as United Nations Children’s Fund, International Federation of Red Cross, American Red Cross, and Centers for Disease Control encouraging action in coordination in all regions. The need for updates of the WHO/ UNICEF global strategy, the draft version has now been distributed, was discussed. The strategy aims for a 90% reduction in global measles deaths by 2010 when compared to the estimated deaths from 2000.
MEASLES BULLETIN Map 1: 2004 Measles incidence rate per 100 000 population (JRF 2004)
Figure 1. Countries with 2-dose measles immunization schedule (JRF 2004) 30
25
China Mongolia
2
20
16 15 Cambodia Lao PDR Papua New Guinea Philippines Viet Nam Kiribati Samoa Solomon Is Tuvalu
Priority PIC Others
10
5
5
8
4 1 No
0 Yes
3
MEASLES BULLETIN Figure 2 : Countries/Areas With Source: JRF 2004 25 6 20
15 12 10 8 5 5 7 4 0 Measles Case-Based Rubella Case-Based Surveillance System Surveillance System 100% of Total Measles Case-Based Measles Cases Data Sent to WHO Having Case-Based Data 4 4 1 2 Priority PIC Others
Map 2: Countries setting national target dates for measles elimination (JRF 2004)
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MEASLES BULLETIN Table 1. Regional Measles Monitoring of Country Surveillance Data (January-June 2005)* Reported Confirmed cases suspected Laboratory Epi-linked Clinical cases confirmed
Classification Incidence rateF Discarded (Total confirmed) Pending
Indicators Suspected cases immunized O
Deaths
Latest date reported by country
Type of report
Australia Brunei Darussalam Cambodia China Hong Kong (China) X Japan Lao People's Democratic Republic Macao (China) Malaysia Mongolia New Zealand Papua New Guinea X Philippines Republic of Korea Singapore Viet Nam Pacific Island Countries: American Samoa Cook Islands Fiji French Polynesia Guam Kiribati Marshall Islands Micronesia, Federated States of Nauru New Caledonia Niue Northern Mariana Islands Palau Samoa Solomon Islands Tokelau Tonga Tuvalu Vanuatu Wallis and Futuna Western Pacific Region
8 43 42 309 264 2 879 4 7 62 35 18 4300 0
8
†
0 0 0 73 0 0 0 0 0 0 4 0
0 24 14 178 0 879 0 40 0 0 2 0
0.04 (8) 0.30 (43) 0.55 (39) 0.24 (309) 4.56 (258) 0.00 (0) 3.60 (879) 0.00 (0) 0.18 (7) 0.05 (40) 0.00 (0) 0.42 (18) 0.02 (19) 0.00 (0)
0 0 3 8 2 0 4 22 35 0 3971 -
0 0 0 0 0 0 0 0 0 0 310 -
38% (3) 26% (11) 26% (11) 35% (92) 100% (2) 75% (3) 52% (32) 80% (28) 54% (2340) -
0 0 0 0 0 0 0 0 0 0 0
12-Jul-05 11-Jul-05 15-Jul-05 14-Jul-05 18-Jul-05 07-Jul-05 07-Jul-05 18-Jul-05 30-Jun-05 18-Jul-05 15-Jul-05 13-Jul-05 18-Jul-05 07-Apr-05
case data case data case data aggregate aggregate aggregate aggregate case data aggregate case data case data case data case data zero-reporting
19 25 7 0 0 0 0 0 18 13 0
0
0
0
0
0.00 (0)
0
0
-
0
07-Jul-05
zero-reporting
0
0
0
0
0.00 (0)
0
0
-
0
07-Jul-05
zero-reporting
5973
90 F
0.39 (1620) 4045 310 0 * Data are based on country reports and other sources available to EPI/Western Pacific Regional Office. Incidence rate per 100 000 population (World Population Prospects: The 2002 Revision, New York, United Nations, 2002). O Suspected cases immunized does not distinguish between 1 or 2 doses. † Lab confirmed or epidemiologically linked to a laboratory confirmed case X Sentinel surveillance system
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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 5