Regional Measles and Rubella Goals
• Measles elimination from all countries by 2015
– Resolution EM/RC44/R.6 – 1997 (elimination by 2010), revised by
Resolution EM/RC58/R.5 – 2011 (elimination by 2015)
• No regional target for rubella/CRS elimination
– RTAG meeting November 2013: recommended developing
regional rubella/CRS elimination target by 2020
– Elimination target established in 15 countries
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Me
asle
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Reported Measles cases and MCV1 coverage in the EMR, 1980- June 2014
Measles cases Measles coverage (WHO-UNICEF estimate)
Source: WHO UNICEF estimates, JRF reported dataCases 2013: country reports to EMRO
Catch up campaigns in all countries Follow up SIAs in several countries
81% reduction in reported measles cases 1998-2014 June with improved
surveillance
MCV1 coverage WHO UNICEF estimates, and number of countries reaching > 90% coverage. 2001 – 2013. (N=22)
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02468
1012141618202224
2001200220032004200520062007200820092010201120122013
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No
. Co
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No. countries with ≥90% MCV1 coverage Regional MCV1 WHO-UNICEF MCV1 Est.
Palestine
Bahrain
MCV2 introduction into routine EPI in Countries of the EMR 2013
MCV2 already in EPI schedule (21)
No MCV2 introduction plans currently (1)
AFR countries
SIAs done in 2013 in the EMRCountry Vaccine Target Age
AdminCov
Survey Cov
Independent Review
Other Intervention
Afghanistan M 9 - 59 M 85% Penta, BCG
Lebanon M 9 M - 18 Y 85%
Lebanon M 9 M - 14 Y 90%
Jordan MR 6 M - 19 Y 102% 97% OPV, Vit A
Pakistan/Sindh M120-119 M -9Y
110% 85%
Pakistan/Punjab M 6 M - 9 Y 102% 95% OPV/Vit A
Pakistan/Baluch. M 9 M - 9 Y 106 89%
Morocco MR 9 M - 19 Y 91%
Somalia M 6-59M 85% Penta & ORS
Sudan M 9 - 14 Y 98% 97%
Syria MMR 6 - 10 Y 72%
Syria MMR 12 - 15 Y 92%
Yemen, Sa’da M 6 - 59 M 93% OPV, Vit A
64 Million people reached through SIAS in 2013 thanks to international , local partners and Gov support
Local funding raisedfor measles SIAs, 2013
CountryTotal Budget
(USD)Amount Raised Locally (USD)
% locally raised
Afghanistan 1,381,449 1,381,449 100%
Lebanon NA NA 100%
Jordan 4,285,065 4,285,065 100%
Pakistan 12,877,360 12,428,480 97%
Morocco 8,377,419 8,377,419 100%
Somalia 3,100,000 2,080,000 67%
Sudan 9,666,928 1,101,838 11%
Syria 5,025,000 5,025,000 100%
Yemen 116,279 9,302 8%
EMR 44,829,500 34,688,553 77%
86.7 Million people reached through SIAS in 2013 Thanks to our international , local Partners and Gov support
Resource Gaps 2014-2015
•*All figure are for 2014 except for AFG SIAS 2015•**MRI fund allocated: include amount committed/transferred to WHO & UNICEF•PAK received addition 4 M Locally from JICA•SOM received 701,000$ locally from OCHA for outbreak response & US$ 146,000 is expected
Country
Requirement* (USD) Available/Committed* (USD)
Funding gap*
Total Requirement SIAs, Surv, RI
GAVI Support Local MRI**
Total Committed (GAVI, MRI, Local
AFG 2014 2,029,375 0 0 1,489,375 1,489,375 540,000
AFG 2015 7,023,056 6,123,056 300,000 0 6,423,056 600,000
PAK 2014 65,693,669 34,983,274 25,282,519 2,740,000 63,005,792 0
SOM 2014 2,193,959 0 500,000 1,148,800 1,648,000 545,959
SUD 2014 150,000 0 0 150,000 150,000 0
YEM 2014 22,902,915 17,591,500 4,943,415 368,000 22,902,915 0
Total 99,992,974 58,697,830 31,025,934 5,896,175 95,619,138 1,685,959
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2006 2007 2008 2009 2010 2011 2012 2013 2014
Co
nfi
rme
d m
eas
les
case
sMonthly distribution of confirmed Measles cases in the EMR 2006-June 2014
South SudanYemenUAETunisiaSyriaSudanSomaliaSaudi ArabiaQatarPalestinePakistanOmanMoroccoLibyaLebanonKuwaitEgyptJordanIraqIranDjiboutiBahrainAfghanistan
3,081
6,079
6,459
12,347
4,983
11,721
23,464
17,166
5,988
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2006 2007 2008 2009 2010 2011 2012 2013 2014
Iraq Measles outbreak Monthly distribution of confirmed
measles cases in the 2006-June 2014
Measles outbreak age distribution 2013-June 2014
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Jan-June 2014
• The SIAs campaign to be conducted in 2 Phases:• Phase 1 for children 9-59 months once the vaccine arrives
(tentative date November 2014 but according to schedule of vaccine arrival it will not take place before Februay 2015)
• Phase 2 for children 15-19 yrs• The intention is to use MR vaccine if available for Phase
one need 5 million doses and another 5 for Phase 2 but UNICEF is already started the procurement for measles vaccine since MR is not available.
• Some of the funds are secured but not all. WHO will be requested to cover training and meetings, supervisors etc. around USD 6.2 M
Outbreak response and to move Measles elimination
Palestine
Bahrain
Rubella vaccine planned 2015-2016 (3 countries)
Rubella vaccine use in countries of the EMR, 2014
15
Rubella vaccine planned 2014 (Yemen)
Rubella vaccine in RI (16 country)
• A total of 4 countries are expected to introduce RCV by end 2018.
Rubella vaccine introduction not decided (Somalia and Pakistan)
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2006 2007 2008 2009 2010 2011 2012 2013 2014
Monthly distribution of confirmed Rubella cases in the EMR 2006-June 2014
South Sudan
Yemen
UAE
Tunisia
Syria
Sudan
Somalia
Saudi Arabia
Qatar
Palestine
Pakistan
Oman
Morocco
Libya
Lebanon
Kuwait
Egypt
Jordan
Iraq
Iran
Djibouti
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2006 2007 2008 2009 2010 2011 2012 2013 2014
Yemen Rubella outbreak Monthly distribution Rubella cases in Yemen 2006 - June 2014
Yemen Rubella Age distribution, 2013 & 2014
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Yemen Rubella confirmed cases by age Year 2013
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Yemen Rubella confirmed cases by age Year June 2014
MR SIAS
• MR routine introduction 6 Nov 2014
• GAVI application approved MR SIAs and will be conducted 19 Oct
• Target age group 9M to 14 Yrs
• Establishment of CRS surveillance
Yemen Rubella Plan 2014
2014-2016 Rubella introduction plans16/22 countries have introduced rubella vaccine in RI
• Yemen: – Routine introduction; July
2014– MR SIAs: September 2014
• Djibouti: – will apply in connection to
next follow up SIAs (2016?)
• Afghanistan: – UNICEF committed to support
routine introduction – low routine coverage? SIAs
quality and delays?
• Pakistan: – no discussion
• Sudan: – Discussion with UNICEF for
routine introduction is ongoing
– NITAG decision is pending– CRS establishment:
ongoing– Probable application with
next FU SIAs (2016?)
• Somalia: – Low routine coverage – RTAG recommended
holding on advocating for rubella vaccine introduction due to low
2014-2015 GAVI application and introduction plans for M, MR
CountryVaccine(MSD, MR, M)
Year of Intro (or MR SIA)
MCV1coverage (2013)
Year of planned GAVIapplication
Total Budget (GAVIapproved)
Pakistan M SIAs Roll-out startedMay 2014
61 Approved $ 65,593,669 (34,983,274)
Yemen MR routine
6 Nov 2014
78 Approved $ 965,581($ 767,500)
Yemen MR SIAs 19 Oct 2014
78 Approved $ 21,569,334($ 17,591,500)
Afghanistan M SIAs May-June 2015
82 Approved $ 6,723,056($ 6,123,056)
Challenges and constraints to achieving the target
• Security situation: rapidly deteriorating in the EMR
– Sustainability of achieved MCV coverage: decreased routine coverage: Syria, Yemen
– Delayed implementation of planned activities– Spread of outbreaks to previously free countries
• Higher priorities/Emerging priorities, low visibility of measles target
– Polio endemic countries
– Polio outbreak in Syria
• Pockets of susceptible populations/groups
– Hard to reach populations in low income countries
– Expatriate population in GCC States
• Vaccine availability
- MMR shortage for Egypt, Syria and Iraq
• Funding: Follow-up SIAs, Measles surveillance
Planned activities 2014-2015• Implementation of Measles/MR SIAs
– Afghanistan: Mop up SIAs in 2014 and FU SIAs in 2015
– Pakistan: roll-out SIAs
– Somalia: CHDs specially in the newly reachable areas
– Yemen: RI of MR and MR SIAs, 2014
– Morocco: Phase 2 of MR SIAs
– Syria and Iraq: SIAs
• Strengthening routine immunization and data quality
– RED in low coverage districts in Pakistan, AFG, Iraq
– Using PEI assets to strengthen RI: Pakistan, AFG and Somalia
– Vaccination weeks
• Reviews and assessments & Strengthen Cases base surveillance
– Review of the situation and preparation for verification of elimination: Bahrain, Palestine, Oman, Iran and Tunisia
– Sustain the strength and capacity of M&R Lab Net
• Measles risk assessment and Establishing CRS surveillance
– Sudan and Yemen
• Meetings
– Regional Technical Advisory Group (RTAG) and Regional Measles Verification Commission (RMVC), Meeting November 2014
– Inter-country meeting on Measles and Rubella control/elimination Nov 2014
Anne Ray Charitable Trust