Rubella at a glance: Maldives, 2018

6 regional hospitals Maldives has achieved the double victory of eliminating endemic measles and controlling rubella and congenital rubella syndrome (CRS). As the country continues this celebration, adequate care must be taken to maintain high immunization coverage, strengthen reporting and surveillance, expand private sector’s participation, improve lab capacity, monitor vaccine hesitancy issues and sustain funding to attain rubella elimination. The re-emergence of these diseases must be avoided at all costs. Coverage of routine MR vaccine at subnational level* Immunization service delivery What made Maldives successful in controlling rubella?  Strong leadership  Strong health system and sustained government funding  Introducti on of MR vaccine during SIAs from 2005 and more than 98% coverage of MMR vaccine during the last decade  A passionate workforce that took ownership of the programme  Community parti cipati on  Verifi cati on of completi on of childhood vaccinati on at school entry  Regular monitoring of progress to target  Programme driven by public demand  Backed by a dedicated Maldives Technical Advisory Group on Immunizati on (MTAGI) Rubella at a Glance Maldives, 2018 Coverage of 1st dose (%) Coverage of 2nd dose (%) Haa Alif Haa Dhaal Shaviyani Noonu Raa Baa Lhaviyani Kaaf Alif Alif Alif Dhaal Vaavu Meemu Faafu Dhaal Thaa Laam Gaaf Alif Gaaf Dhaal Gnaviyani Seenu Male’ 0 20 40 60 80 100 Ministry of Health Health Protecti on Agency (HPA)  Indira Gandhi Memorial Hospital  Private hospitals  Dhamana Veshi  Police and army hospitals  Hulhumale and Vilingili hospitals 172 primary health care centres VaccinaƟ on centres at the central level VaccinaƟ on centres in atolls/islands *2nd administrati ve level or equivalent to district 14 atoll hospitals Coverage of MRCV2 and SIA, and no. of rubella cases (2007-2017) Health situation in Maldives Routine immunization schedule for measles and rubella Significant events 2018 Verifi cati on that Maldives has adequately controlled rubella and CRS 2013 WHO South-East Asia Regional Committ ee resoluti on on measles eliminati on and rubella/CRS control by 2020 2017 MR vaccine campaign (target 8–25-year-olds); 2nd dose of rubella- containing vaccine introduced in routi ne immunizati on; measles eliminati on validated 2014 Case-based surveillance for rubella started; mandatory reporti ng of measles and rubella 2007 MMR introduced in routi ne immunizati on following mass vaccinati on of children aged 18 months–6 years 2005-2006 MR mass vaccinati on campaign held targeti ng 6–25-year-old males and 6–35-year-old females 1985 Expanded programme on immunizati on (EPI) launched 1981 MCV1 introduced 2015 Nati onal Verifi cati on Committ ee established Maldives: An overview 2nd dose (MMR): 18 months 1st dose (MR): 9 months 340 000 Total populati on 298 sq.km. total land area 20 administrati ve atolls 1192 islands 187 inhabited islands 128 industrial islands 109 designated tourist islands 4 3 2 1 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 100 90 80 70 60 50 40 30 20 10 0 Rubella cases SIA CoverageRouti ne Coverage MRCV2 77 With numerou s acti viti es und ertaken to elim inate measles, the f oundati on wa s also laid for Maldives to inch closer to its goal of c ontrolling rub ella and CRS by 2020. T he introducti o n of RCV1 and RCV2 in 2007 and 2 017 was a forc e multi plier ag ainst the rubella vir us. Supplemen tary immuniza ti on acti viti es (SIAs ) and routi ne i mmunizati on were organized, wit h extra push g iven by the su pporti ve politi cal leade rship, coopera ti ve communi ty, diligent health workers and p arti cipati ve partnering org anizati ons. 45 Maternal mortality rati o (per 100, 000) 4.9 Neonatal mortality rate (per 1000 live births) 100% Births att ended by skilled health professionals >98% Coverage of all routi ne vaccines >98% Populati on using improved drinking water source 1994 Verifi cati on of all childhood vaccinati ons completi on at school entry CRS: Congenital rubella syndrome MCV: Measles-containing vaccine MR: Measles–rubella MMR: Measles–mumps–rubella 6 regional hospitals Maldives has achieved the double victory of eliminating endemic measles and controlling rubella and congenital rubella syndrome (CRS). As the country continues this celebration, adequate care must be taken to maintain high immunization coverage, strengthen reporting and surveillance, expand private sector’s participation, improve lab capacity, monitor vaccine hesitancy issues and sustain funding to attain rubella elimination. The re-emergence of these diseases must be avoided at all costs. Coverage of routine MR vaccine at subnational level* Immunization service delivery What made Maldives successful in controlling rubella?  Strong leadership  Strong health system and sustained government funding  Introducti on of MR vaccine during SIAs from 2005 and more than 98% coverage of MMR vaccine during the last decade  A passionate workforce that took ownership of the programme  Community parti cipati on  Verifi cati on of completi on of childhood vaccinati on at school entry  Regular monitoring of progress to target  Programme driven by public demand  Backed by a dedicated Maldives Technical Advisory Group on Immunizati on (MTAGI) Rubella at a Glance Maldives, 2018 Coverage of 1st dose (%) Coverage of 2nd dose (%) Haa Alif Haa Dhaal Shaviyani Noonu Raa Baa Lhaviyani Kaaf Alif Alif Alif Dhaal Vaavu Meemu Faafu Dhaal Thaa Laam Gaaf Alif Gaaf Dhaal Gnaviyani Seenu Male’ 0 20 40 60 80 100 Ministry of Health Health Protecti on Agency (HPA)  Indira Gandhi Memorial Hospital  Private hospitals  Dhamana Veshi  Police and army hospitals  Hulhumale and Vilingili hospitals 172 primary health care centres VaccinaƟ on centres at the central level VaccinaƟ on centres in atolls/islands *2nd administrati ve level or equivalent to district 14 atoll hospitals