12th Annual MeetingThe Measles & Rubella Initiative

Western Pacific Regional Update: The Final Push

1

10-11 September 2013American Red Cross National HeadquartersWashington, DC

• 2003: Measles elimination to be used to strengthen routine immunization

• Sept 2005: By 2012, the Region should aim to eliminate measles;

• Oct 2010: Reaffirms the 2012 measles elimination goal and calls to accelerate control of rubella and the prevention of congenital rubella syndrome;

• Sept 2012: Reaffirms the commitment to eliminate measles and accelerate rubella control;

Regional Measles and Rubella Goals

• Measles– The TAG urges countries to make intensified efforts to

accelerate progress towards achieving and sustaining measles elimination.

• Rubella– The TAG recommends establishing a regional goal of

eliminating rubella, with a target date to be determined

Technical Advisory Group on Immunization Recommendations, June 2013

Measles and rubella reported cases and coverage of MCV1 and MCV2, 1980-2012

4

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

200

400

600

800

1000

1200

1400

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Measles cases Rubella Cases

Source: WHO-UNICEF Joint Reporting Form (data for 2012)

Measles Cases by Month and Year, Region, 2008-Jul 2013

Data as of 20 August 2013 Source: National measles and rubella monthly report

Jan

Feb

Mar Apr

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Apr

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Apr

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Apr

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Apr

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Apr

May Jun Jul

2008 2009 2010 2011 2012 2013

0

5 000

10 000

15 000

20 000

25 000

30 000

China Japan Philippines Viet Nam Others

Num

ber

of m

easl

es c

ases

Measles incidence per million population by country/area, WPR, 2013*

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BRN KHM MNG PNG PIC NEZ JPN VNM AUS KOR HOK SGP MAC PHL MYS LAO CHN0

2

4

6

8

10

12

14

16

18

20

22

24

26

28

30

Inci

denc

e ra

te

Source: National measles and rubella month reports as of 20 August 2013*Annualized as of July 2013

2013年麻疹疫情回升The resurgence of measles in 2013

Reported incidence and confirmed Measles Cases, by Province, China, 2013*

2013年 1～ 5月全国麻疹病例按区县分布（ 1点 =1病例）measles distribution by county in 2013 from JAN to MAY (1dot equals 1case)

* Source: National Notifiable Disease Reporting System , data through May

2013年 1～ 5月全国各省麻疹发病率measles incidence by province in 2013 from JAN to MAY

数据截至 2013年 5月

Measles cases by age group and vaccination status, China, January - May 2013

Source: National surveillance report as of May 2013 数据截至 2013年 5月

Select Recommendations from National / International Consultation on Measles, China, June 2013

• Provincial (or smaller) SIAs needed to fill immunity gap

• Survey population coverage among young children at national and subnational levels

• Develop stronger immunization practice standards to reduce missed opportunities

• Reduce nosocomial transmission of measles by reducing admissions, isolating cases, and vaccinating health workers

Source: National measles and rubella report as of 20 August 2013

1 dot = 1 case

Cases with onset in 2012

Cases with onset in 2013

Legend:

Confirmed Measles Cases, Lao PDR and Viet Nam, 2013

Confirmed measles cases by month of rash onset, Philippines, 2013

*National measles and rubella monthly reports as of 20 August 2013

Jan

Feb

Mar

Apr

May

Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun Jul

2009 (N=1490)Lab & Epi=668Clinically=822

2010 (N=6388)Lab & Epi=3020Clinically=3368

2011 (N=6555)Lab & Epi=3411Clinically=3144

2012 (N=1441)Lab & Epi=601Clinically=840

2013 (N=410)Lab & Epi=410

0

200

400

600

800

1000

1200

1400

1600

1800

Laboratory Epi-Linked Clinically

Num

ber

of m

easl

es c

ases

Laboratory and epi-linked confirmed measles cases by province, Philippines, 2012 and 20131

1National measles and rubella monthly reports from January to July 2013

1 dot = 1 case

Dots are placed at random within the corresponding province, and might not reflect the exact location of the case.

 

2012 2013

Laboratory and epi-linked confirmed measles cases by age group and vaccination status, Philippines, 2013 (N=410)

*National measles and rubella monthly reports as of 20 August 2013

<1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs ≥40 yrs0

50

100

150

200

250

0 dose 1 dose ≥2 doses Unknown

Mea

sles c

ases

Confirmed measles cases by month of onset, Malaysia, 2008–2013

Jan

Feb

Mar

Apr

May

Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun Jul

2009 (N=56)Lab & Epi=55Clinically=1

2010 (N=74)Lab & Epi=70Clinically=4

2011 (N=1603)Lab & Epi=1556

Clinically=47

2012 (N=1868)Lab & Epi=1712Clinically=156

2013 (N=140)Lab & Epi=140

0

50

100

150

200

250

300

Laboratory Epi-Linked Clinically

Num

ber

of m

easl

es c

ases

*National measles and rubella monthly reports as of 20 August 2013

Laboratory and epi-linked confirmed measles cases, Malaysia, 2012–20131

Source: National measles and rubella monthly country reports1 Reports received for January to July 2013

*Dots are placed at random within the country, and might not reflect the exact location of the case.

1 dot = 1 case

2012

2013

Laboratory and epi-linked confirmed measles cases by age group and vaccination status, Malaysia, 2013 (N=140)

<1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs ≥40 yrs0

10

20

30

40

50

60

0 dose 1 dose ≥2 doses Unknown

Mea

sles c

ases

*National measles and rubella monthly reports as of 20 August 2013

Verification of Measles Elimination• Guidelines for verification finalized in March

2013• First annual progress reports due 1 October

2013– 5/16 National Verification Committees may

request verification of elimination: Australia, Japan, Korea, Macao, Mongolia

• Training for the Subregional Verification Committee for the Pacific islands in September 2013

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World Immunization Week: No more measles, for anyone

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WIW launching at Western Pacific Regional Office by the Regional Director, Dr Shin Young-soo

WIW launching in Brunei Darussalam

A US

CHN

HO K

KHM

L AO

MA C

MN G

MY S

N EZ

P HL

PNG

SG P

VNM

LAO PDR

PNG

PHL

KHM

MYS

VNM

NEZ

MACAUS

MNG

KOR

3040

5060

7080

9010

0

natio

nal_

cove

rage

30 40 50 60 70 80 90 100

district_coverage

CHN

National MCV1 coverage and percentage of district with >=80% MCV1 coverage in non-pacific countries, WPR 2012

Source: WHO-UNICEF Joint reporting Forms

MCV2 introduction into routine EPI in (region) 2013

Only 5 countries or areas have not yet introduced MCV2:

• Kiribati • Lao People’s Democratic Republic • Papua New Guinea: 2013 GAVI application • Solomon Islands• Vanuatu

With MCV2

With no MCV2

LEGEND

2013 (KHM, FSM (Chuuk State) & VUT)

Measles SIAs in 2013, Western Pacific Region

2013-2015 SIA plans and budget

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Country Vaccine Target Age Dates Geographic

ExtentOther

interventionFunding source

Micronesia MR 9-59 m Jul 2013 Chuuk State CDC/MoH

Vanuatu MR 9-59m Aug 2013 Nationwide MRI/MoH

Cambodia MR 9m-15y Q4 2013 Nationwide OPV, Vit A GAVI

Viet Nam MR 9m-15y Q2 2014-Q4 2014 Nationwide GAVI

Philippines MR 9-59 m Aug 2014 Nationwide OPV MoH

Lao PDR MR 9-59 m Q4 2014 Nationwide MRI

2014: FSM (Pohnpei State); Vanuatu (5-15 years);2015: Papua New Guinea; Solomon Islands

Category Target 2013 2012 2011 2010 2009 2008

Low measles incidence

Incidence (% countries < 5 per million population)  

71%  59%  41% 59% 47% 53%

Incidence of confirmed measles per million population2 21.7 5.9 11.7 27.0 34.0 81.6

High quality surveillance

National reporting of discarded measles cases

> 2 per 100,000

4.3 2.4 2.8 1.7 2.8 1.6

% of 2nd level admin units reporting ≥ 2/100 000 discarded measles cases > 80%

38% 35% 40% 28% 23% 22%

% of suspected cases with adequate blood specimens > 80%

96% 91% 73% 70% 71% 80%

High population immunity

% countries with MCV1 ≥90% 76% 70% 66% 57% 71%

% countries with MCV1 ≥80% in all dist 63% 41% 46% 46% 58%

Indicators of Progress Towards Measles Elimination and Rubella Control, Western Pacific Region 2008-2013¹

Source: WPRO surveillance database and WHO-UNICEF JRF¹ Data as of August 20132 Only lab and epi linked cases for 2013

Rubella-containing vaccine introduction in (region) 2013

Only 4 countries and areas have not introduced RCV in RI in 2013: • Cambodia: 2013 MR SIA (9 mos to <15 years)• Papua New Guinea: 2013 GAVI application• Vanuatu: 2013 MR SIA (9 to 59 months)• Viet Nam: 2014 MR SIA

With RCV

With no RCV

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MRI Support Needed

• Achieving measles elimination goal– China, Malaysia, Philippines

• Regional rubella elimination goal• SIAs

– Lao follow up campaign– Vanuatu (6-15 years) – Kiribati, Samoa, Tuvalu

• Surveillance sensitivity– Pacific islands countries, Papua New Guinea, Viet Nam

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Acknowledgements

• China CDC (slides 7-9)• NIID, Japan (slide 26)

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29

Thank you

Number of countries with MCV1 coverage of at least 90%, WPR, 2008-2012

Source: WHO-UNICEF Joint reporting Forms

2008 2009 2010 2011 20120

5

10

15

20

25

30

35

Year

Num

ber

of c

ount

ries