Measles elimination

Dr. As’ad RamlawiPalestine .

• Measles vaccination coverage in the last 15 years is more than 95%.

• Two doses , at 9th month ( measles ) & at 15th month ( MMR ) .

Measles incidence rate in the last 6 years:

Year Measles

2000 0.17

2001 0.10

2002 0.09

2003 0.00

2004 0.00

2005 0.00

2006 0.00

Measles Reporting1. Clinical picture2. IgM confirmation3. Daily notification4. Case investigation

Measles out Break

In 1990 , 1994 , 1999 , in small clusters

From 1999 till now , NO Measles Out Break.

Measles Seroservey1990 – 1995 ========= 95-98 %

immune response

Measles immune response during Al

Aqsa IntifadaVaccine Negative

W.B Gaza Total

Equivocal

W.B Gaza Total

Positive

W.B Gaza Total

Measles 12.7% 31.6% 20.3% 13.5% 12.1% 13.0% 73.8% 56.3% 66.7%

Rubella 2.5% 1.5% 2.1% 0.0% 0.5% 0.2% 97.5% 98.0% 97.7%

Hep.B 5.5% 7.9% 6.5% 1.4% 1.5% 1.4% 93.1% 90.6% 92.1%

WHY Low immune response

1. Measles vaccine ??

2. Screening Kits ??

3. Cold chain ??

Cold chain affected By:

1. Electricity

2. Transportation

3. Political instability, Siege, Closure , Curfew

Measles National Plan

WHO Goal Measles elimination

Taking into consideration:1. Measles vaccination low

response2. Measles high infectivity rate 3. Measles vaccine sensitivity

Micronutrient deficiencies

•Anemia•Vitamin A for: - Children under 5 years

old 22 % Vit. A deficiency 54 % Border line

Recommendation of the serosurvey

1. Carry out a measles vaccination campaign for all children between 9 months & 5 years of age

2. A sero-survey with a small sample should be carried out after three months after the end of the campaign . This will serve as an indicator for the sero-response

Recommendation Cont.3. More attention should be paid to the

cold chain.4. The sero-survey results should be

widely disseminated to all the health providers.

5. Training for all health personnel in the expanded program on immunization (EPI ) in general & cold chain in particular should be carried out.

Campaign carried out in 2004 for children between 9months – 60 months

1. Measles Vaccine

2. Vitamin A capsules

100,000 IU 9m – 12 m.

200,000 IU 12m – 60 m.

Mumps Outbreak 2004-2005

Age affected 5 years – 25 years.

Thousands of cases with some complication.

• MMR campaign was conducted in 2005 6 years – 25 years.

the number of vaccinated children

were 650,000

• The second serosurvey is in 2006 for the same targeted group of the first Measles campaign with 98 %immune response.

Polio

Estimated of Palestinian

population for 2006 Total

Population <1 year < 5 years < 15 years

3,512,822 129,974 625,282 1,626,437

Vaccination Coverage

OPV3 coverage is more than 90 % in the last 10 years.

OPV coverage 1995-2004 in Palestine

Year Coverage Year Coverage

1995 96.0 % 2000 93.4 %

1996 96.7 % 2001 96.7 %

1997 95.92 % 2002 96.5 %

1998 97.96 % 2003 98.5 %

1999 89.4 % 2004 98.3 %

Polio cases

Last case was detected in 1988 .

One case wild polio virus

One vaccine associated virus

Last wild poliovirus isolate in 2002 ( Feb. August ) : Rafah, Gaza ( imported ).

NIDs

Implemented since 1995 up to 1999.

Two rounds yearly for children under 5 years old with > 95 % coverage.

Mopping up

Is implemented since 2000 up to 2005 targeted for children under 5 years for certain areas selected by preventive medicine dept.

AFP surveillance

Started in 1996 & performance indicators were achieved up to 2000.

2000 – 2004 indicators were not achieved due to Intifada ( invasions , closures , & restrictions).

2005 indicators were achieved again.Virus isolation not done in PNA areas.

Improving AFP Surveillance in

2005• Certificates of appreciation

• Increase sensitization among pediatrician.

• Meeting Frb. 2005.

• Increasing zero-reporting sites to include major pediatricians from 22 to 32.

Environmental Surveillance

• Collect on monthly bases.

• Last wild poliovirus isolation was from : Rafah, Gaza,2002:imported, Egyptian strain.

• 2005 total 190 samples:

- West Bank 164

- Gaza 26.

Lessons learned

1. Additional activities for good surveillance is very important in planning & prevention ( serosurvey, environmental screening).

2. Better coordination ( UNICEF , MoH , WHO )

3. Good preparation before starting

Lessons learned cont.

4. Media involvement

5. Community participation

6. Target groups should based on the really number of newborns in Palestine .

THANK YOU