Update on Progress toward Measles Situation in EMR September 2008 Dr B. Naouri VPI/DCD/EMRO

Overview Current situation Status of implementation of measles elimination strategies Challenges Future Plans

Regional Committee Resolution, 1997 Eliminate measles in all member states of the Eastern Mediterranean region by 2010 Measles Elimination in EMRO

Current situation

Measles Mortality in EMR target: 50% reduction compared to target (GIVS): 90% reduction 103, ,000 93,600 68,700 70,000 47,600 39,000 34, ,000 40,000 60,000 80, , , Year Deaths EMR target: elimination, 2010

Status of implementation of measles elimination strategies

Strengthening routine infant immunization 95% coverage MCV1 in all districts

Palestine Bahrain Less than 50% (1 country & S. Sudan) 50% to 79% (5 countries) More than 90% (14 countries) MCV1 Coverage in countries of the EMR % is not achieved in all districts MCV1: 67% in % in % to 90% (2 countries)

Palestine Bahrain 2nd opportunity of Measles Immunization 18 countries with routine second dose 4 countries with one dose and follow-up SIAs

Distribution of the 2.7 million children who did not receive measles vaccine, in 2007, EMRO

Supplemental Immunization activities

Catch-up campaigns All countries have conducted catch-up campaign : 220 M children were immunized through catch-up campaigns Repeated campaigns 2008  Pakistan, Morocco, Lebanon  Planned: Egypt

Reported Measles/Rubella Cases in Egypt (1996 – mid 2008) MMR Lab Rubella outbreak

MR Campaign Phase 1, 2008 Budget Short Fall (21%) Egypt (74%) Vaccine and Logistics Budget short fall 21% ($ 4.3 million) SIA’s Training SM MP CM UNICEF 5%

Planned SIA, EMRO,

Measles Case-Base Surveillance

Palestine Bahrain Nationwide case-based measles surveillance with laboratory investigation (18) Case-based needs to be strengthened (4 & South Sudan) Case-based Measles Surveillance 2008

Countries with serology plus virus isolation (12) Utilizing Polio infrastructure Capacity of Measles/Rubella Laboratory Network in the EMR, 2008 Palestine Bahrain All Countries have NML serology Regional Reference Laboratories (22) Sub-Regional Reference Laboratories

Challenges

Measles outbreaks EMR August 2008 Iraq: 3322 cases 74% non-immunized Afghanistan: 20 outbreaks, 5-30 cases/outbreak South Sudan: 147 cases, 9 deaths

Challenges (cont.) Repeated catch-up campaigns (Egypt) Support to non GAVI countries Implementation of an Integrated Disease Surveillance System Weakness of routine immunization programs

Future Plans (2009) Achieve and maintain a high routine measles vaccination coverage Implementation of RED strategy Ensure high quality of follow-up SIAs Strengthening of measles surveillance in all EMR countries by end of 2009 Regional Guidelines Guidelines for validation of measles elimination Assistance to Somalia and South Sudan Special efforts are needed

Thank you!