1. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Measles Elimination in the Western Pacific Region 2007 Partners Meeting Wayne A. Antkowiak, PMO-WHO/WPRO Ernest Smith, MO-EPI (Measles)-WHO/WPRO David H. Sniadack, CDC/Atlanta

2. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Presentation Outline Introduction Status of Measles Elimination in WPR Plan for 2007-2008 Partner Contributions Unmet Needs

3. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization WHO Region for the Western Pacific Population: 1.7 billion Countries/areas: 37 (including 20 PICs)

4. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization WHO/WPRO Indicators for Measles Elimination Low Incidence –Confirmed measles cases < 1/1,000,000 population Excellent Surveillance –Suspected cases > 1 per 100,000 in 80% of districts –>80% of samples adequate serum for IgM –virus isolation in select outbreaks Maintaining high population immunity to measles –>95% coverage with 2 doses of MMR –Outbreaks <100 cases <3 month duration

5. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Measles Incidence Rate, 2005 (per 1 Million Population) < 1.0 (21) 1.0 – 9.9 (5) 10.0 – 99.9 (6) LEGEND: ≥ 100 (1) No data (4) * 2005 data, from 2006 JRF

6. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Countries Reporting Surveillance Data to WPRO, 2006 Case based (10) Aggregate data (2) Hospital-Based Active Surveillance (20) Not yet reporting regularly (5)

7. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Indicators for Measles Elimination in WPR, 2005 & 2006 IndicatorTarget PNG 5.9 LAO 5.9 CAM 13.3 VTN 83.3 MOG 2.6 PHL 84.8 CHN 1303.7 Low Incidence - confirmed case rate < 1/1,000,000 207.648.8 15.3 6.89.71.381.2 Excellent Surveillance - suspected case rate > 1/100,000 ND5.03.5 16.7 0.970.34ND - % districts with >1/100,000 suspected cases > 80% ND 32% 82%ND10%ND - % cases with sera > 80% ND 63% 31%100%31%ND - % transmission chains with virus isolates 100% ND MDND Maintaining high immunity - MCV2 coverage > 95% 49% NO MCV2 NO MCV2 NO MCV2 98% NO MCV2 98% - # cases/outbreak <100 ND - duration of outbreaks <3 months ND 2006 case based or aggregate data2005 case based or aggregate data

8. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization MCV1 Coverage, WPR, 2005* 85 – 94% (4) ≥ 95% (14) 75 – 84% (7) 50 – 74% (5) LEGEND: < 50% (2) No data (5) * 2005 data, from 2006 JRF

9. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization MCV2 Coverage, WPR, 2005* 85 – 94% (0) ≥ 95% (9) 75 – 84% (6) 50 – 74% (3) LEGEND: < 50% (1) No Data (9) No MCV2 (9) * 2005 data, from 2006 JRF

10. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Priority Countries, WPR I.GAVI eligible 1.Papua New Guinea 2.Lao People’s Democratic Republic 3.Cambodia 4.Viet Nam 5.Mongolia II.Not GAVI-eligible 1.The Philippines 2.China

11. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Reported Measles Cases and MCV1 Coverage Papua New Guinea, 1974 to 2005

12. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Reported Measles Cases and MCV1 Coverage Lao PDR, 1974 to 2005

13. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization

16. Reported Measles Cases and MCV1 Coverage Philippines, 1974 to 2005 SIA

17. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Priorities for 2007-08: SIAs SIAs are needed in high risk countries/areas to interrupt measles virus circulation 1.Complete cMYPs for non-GAVI countries VTN, CAM, LAO, MOG, PNG completed 2.Identify adequate financing for planned SIAs IFFIm for GAVI-eligible countries Other financing mechanisms for countries that are not GAVI-eligible 3.Ensure adequate technical assistance for high quality operational planning, preparation and implementation for campaigns

18. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Papua New Guinea 4 th Quarter 2008 Target age: 6m-10yrs Target number: 1,800,000 Lao PDR Oct/Nov 2007 Target age: 9m-15 years Target number: 2,262,000 Viet Nam 3 rd Quarter 2007 Target age: high risk 7-20 yrs Target number: 3,537,194 2008 Target age: high risk 7-20 yrs Target number: 1,073,050 Cambodia Feb/Mar 2007 Target age: 9-59 months Target number: 1,500,000 Planned SIAs, WPR, 2007-2008 Mongolia Oct/Nov 2007 Target age: 1-9 years Target number:431,521 Philippines 4 th Quarter 2007 Target age: 9-48 months Target number: 8,600,000

19. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization

20. Priorities for 2007-08: Surveillance Surveillance is needed to identify high risk areas and monitor progress 1.Provide technical assistance to establish case-based reporting of measles throughout the region, integrated with AFP surveillance 2.Work with countries to strengthen national monthly reporting to WPRO 3.Publish monthly EPI bulletin based on data supplied from countries

21. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Priorities for 2007- 08: Routine Immunization Strengthened routine immunization is needed to sustain interrupted measles transmission 1.Assist GAVI-eligible countries to complete ISS, HSS plans and applications (e.g., LAO, CAM, MOG) 2.Encourage all countries on RED a.Microplanning (including vaccine management and logistics) b.Outreach c.Supportive Supervision d.Data collection and use e.Community participation 3.Focus on urban poor as high risk group 4.Introduce routine MCV2 where feasible 5.School entry checks

22. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization UNF Support to WPRO/UNICEF for SIAs in 2007-2008  Viet Nam $4,458,000  Papua New Guinea$1,788,000  Lao PDR$1,208,000  Cambodia$ 959,000  Mongolia$ 302,000  China$1,000,000  Philippines$ -  Consultants$ 78,000 TOTAL $ 9,793,000

23. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Additional Partner Support for Measles Elimination in WPR GAVI – MCV2 for –VTN: $2,500,000 for 5 years - conditionally approved –CAM: $600,000 - denied because MCV1=79% CDC –$200,000/year to WPRO for measles support –$500,000/year for measles SIA and other activities in Sichuan Province, China JICA –$15 million to WPR for EPI $525,000 for Cambodia SIAs in 2007 –Feasibility study for project to strengthen measles and polio surveillance for provinces in Western China CIDA - $200,000/year to WPRO for EPI and surveillance AUSAID - $900,000/year to WPRO for EPI and surveillance

24. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Unmet SIA Needs in WPR, 2007- 08  Lao PDR$ 986,000  Philippines$ 7,334,000  China$19,412,000 * TOTAL $27,732,000 * For 2007-2012

25. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Philippines SIA 4 th Quarter 2007 Target Population – 8.6 million (9 - 48 months)  Operational Costs$3,420,000  Vaccine/Syringe/SB$3,580,500  Surveillance$ 870,000  Advocacy$ 60,000 Total Requirement$7,930,500 Government Contribution$ 600,000 Shortfall$7,333,500

26. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization China SIAs (2007 – 2012) Requirement supported by Govt. funds  Vaccine$ 9,907,000  Vaccinators$ 2,810,000  AEFI$ 133,000 Total Government Contribution$ 12,852,000 Unfunded requirement  Syringe/needle$ 3,820,000  Cold Chain/Transport/Disposal$ 7,444,000  Social Mobilization$ 8,147,000 Total Shortfall$19,412,000

27. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Thank You The moment one definitely commits oneself, then Providence moves too - Goethe

28. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Indicators for Measles Elimination in PNG WHO’s indicatorsPapua New Guinea Low Incidence –Less than one confirmed measles case reported per million population – 207.57 cases / million * Excellent Surveillance –incidence of suspected case per 100,000 in 80% of all district –>80% of adequate serum for IgM –virus isolation –No data Maintaining high immunity to measles –>95% coverage with 2 doses –<100 case in outbreak <3 month duration – 49% MCV1; 48.9% MCV2 * – No data * 2005 data, from 2006 JRF

29. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Indicators for Measles Elimination in Lao PDR WHO’s indicatorsLao PDR Low Incidence –Less than one confirmed measles case reported per million population – 48.78 cases / million * Excellent Surveillance –incidence of suspected case per 100,000 in 80% of all district –>80% of adequate serum for IgM –virus isolation –4.98/100,000 (nationwide) * –No data Maintaining high immunity to measles –>95% coverage with 2 doses –<100 case in outbreak <3 month duration – 41% MCV1 (no MCV2) ** – No data * from 2005 aggregate data ** 2005 data, from 2006 JRF

30. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Indicators for Measles Elimination in Cambodia WHO’s indicatorsCambodia Low Incidence –Less than one confirmed measles case reported per million population – 15.26 cases / million * Excellent Surveillance –incidence of suspected case per 100,000 in 80% of all district –>80% of adequate serum for IgM –virus isolation –3.54/100,000 (nationwide) * –31.87% (58/182 districts) * –63.39% (322/508 cases) * –No data Maintaining high immunity to measles –>95% coverage with 2 doses –<100 case in outbreak <3 month duration – 79% MCV1 (no MCV2) ** – No data * from 2006 case-based data ** 2005 data, from 2006 JRF

31. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Indicators for Measles Elimination in Viet Nam WHO’s indicatorsViet Nam Low Incidence –Less than one confirmed measles case reported per million population – 6.81 cases / million * Excellent Surveillance –incidence of suspected case per 100,000 in 80% of all district –>80% of adequate serum for IgM –virus isolation –16.65/100,000 (nationwide) * –82% (50/61 provinces) * –31% (4341/14024 cases) * –No data Maintaining 95% immunity to measles –>95% coverage with 2 doses –<100 cases in outbreak <3 month duration – 95% MCV1 (no MCV2) ** – No data * from 2005 case-based data ** 2005 data, from 2006 JRF

32. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Indicators for Measles Elimination in Mongolia WHO’s indicatorsMongolia Low Incidence –Less than one confirmed measles case reported per million population – 9.71 cases / million * Excellent Surveillance –incidence of suspected case per 100,000 in 80% of all district –>80% of adequate serum for IgM –virus isolation –0.97/100,000 (nationwide) * –No data –100% (26/26 cases) * –No data Maintaining high immunity to measles –>95% coverage with 2 doses –<100 imported case <3 month duration – MCV1 >97%, MCV2 98.3% ** – No data * from 2006 case-based data ** 2005 data, from 2006 JRF

33. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Indicators for Measles Elimination in the Philippines WHO’s indicatorsPhilippines Low Incidence –Less than one confirmed measles case reported per million population – 1.25 cases / million * Excellent Surveillance –incidence of suspected case per 100,000 in 80% of all district –>80% of adequate serum for IgM –virus isolation –0.34/100,000 (nationwide) * –10.10% (10/99 provinces) * –31.34% (89/284 cases) * –No data Maintaining high immunity to measles –>95% coverage with 2 doses –<100 case in outbreak <3 month duration – 82% MCV1 (no MCV2) ** – No data * from 2006 case-based data ** 2005 data, from 2006 JRF

34. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization Indicators for Measles Elimination in China WHO’s indicatorsChina Low Incidence –Less than one confirmed measles case reported per million population – 81.24 cases / million * Excellent Surveillance –incidence of suspected case per 100,000 in 80% of all district –>80% of adequate serum for IgM –virus isolation –No data Maintaining high immunity to measles –>95% coverage with 2 doses –<100 case in outbreak <3 month duration – 98.6% MCV1; 97.9% MCV2 ** – No data * from 2006 aggregate data ** 2005 data, from 2006 JRF

35. World Health Organization Western Pacific Regional Office Expanded Programme on Immunization SIA Budget Breakdown, Western China, 2007-2012 Province GovernmentRequest for possible donor support TOTAL Vaccines, Vaccinators, Adverse Events Sub-total Syringe+ Needle Cost of cold chain and transportation Cost of social promotion, training, supervising, etc Waste Disposal Sub-total Guizhou1,029,482306,935261,665451,913306,9351,327,4482,356,930 Tibet95,84928,30524,130242,92828,305323,668419,517 Shaanxi2,181,577661,947564,3171,737,677661,9473,625,8885,807,465 Gansu1,924,559580,539494,9151,614,328580,5393,270,3215,194,879 Qinghai141,48843,11936,759137,85643,119260,853402,341 Ningxia142,02643,23636,859101,04343,236224,375366,401 Xinjiang479,606145,103123,702313,145145,103727,0531,206,659 Guangxi2,578,963785,948670,029757,097785,9482,999,0225,577,985 Chongqing1,499,055453,911386,964672,093453,9111,966,8783,465,933 Sichuan4,213,4061,272,4791,084,8012,565,6631,272,4796,195,42110,408,827 Yunnan2,980,751901,323768,387856,633901,3233,427,6666,408,417 Neimeng235,48871,76661,181259,30271,766464,015699,503 Hunan3,048,439884,090941,9651,618,654884,0904,328,8007,377,239 Hebei2,883,299836,583891,3482,160,208836,5834,724,7217,608,020 Total 23,433,9887,015,2836,347,02213,488,5407,015,28333,866,12857,300,117 Provinces proposed for donor support19,412,766