1. Reaching the 2010 Measles Mortality Reduction Goal-can SEARO get there? Meeting of the Partners for Measles Advocacy Washington DC, 23-24 September 2008 Dr. Pem Namgyal Regional Adviser, Vaccine Preventable Diseases Immunization and Vaccine Development Department of Family and Community Health, SEARO

2. Immunization and Vaccine Development, FCH | Regional Strategic Plan 2007-2010 Goal By 2010 reduce the number of estimated measles deaths by 90% in comparison to 2000 Specific objectives 1 st dose measles coverage >90%, nationally and >80% coverage in all districts by 2010 Provide a second opportunity for measles immunization by 2010 while achieving >90% coverage Case based measles surveillance within integrated surveillance systems in countries that completed catch- up campaigns Fully investigate all detected/reported measles outbreaks

3. Immunization and Vaccine Development, FCH | 41 million people were vaccinated in SIAs in 2007 Sources: Mortality estimate WHO/HQ MCV1 coverage: WHO/UNICEF best estimates Estimated measles mortality reduced by 26% between 2000 and 2006

4. Immunization and Vaccine Development, FCH | Measles 2 nd Opportunity through Routine Immunization Catch-up Campaigns completed Measles 2 nd Opportunity through Catch-up Campaigns Provide MR/MMR vaccine Bhutan, Maldives and Sri Lanka provided MR Follow up campaigns planned : Nepal (2008), Bangladesh (2010) 116 million people have been vaccinated from 2000-07 Provide Measles Vaccine Second Opportunity for Measles Immunization, SEAR, 2008

5. Immunization and Vaccine Development, FCH | SEAR Measles Lab Network 2008 (July) The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.  WHO 2005. All rights reserved NIV Pune BJM Ahm IoS Kol Ref lab for genotyping (India) (18) (1)

6. Immunization and Vaccine Development, FCH | Cases from Serologically Confirmed Suspected Measles Outbreaks Nepal, 2003-2008 July Source: Monthly case-based data, Jul 2008

7. Immunization and Vaccine Development, FCH | Cases from Serologically Confirmed Suspected Measles Outbreaks Bangladesh, 2004-2008 July Source: Monthly case-based data, Jul 2008

8. Immunization and Vaccine Development, FCH | Estimated Measles Mortality, India, 2006 94% deaths In 10 states ~ 150,000 Deaths

9. Immunization and Vaccine Development, FCH | Measles: routine coverage and surveillance in India Measles routine coverage in India is low, but showing progressive improvement Surveillance in general is poor; in six southern states WHO SMO network is supporting the state government to carry out measles surveillance Surveillance needs to be established in other states as well, but who is to do it is the current debate

10. Immunization and Vaccine Development, FCH | Total cases- 678 Total cases- 1044 Total cases-1132 Andhra PradeshGujarat Tamil Nadu Total cases- 314 Kerala Total cases-1838 West Bengal Total cases- 2530 Karnataka Serologically confirmed measles outbreaks India: cases by age, 2007 Cases from serologically confirmed measles outbreaks %% %% * data as on 10 th Jul, 2008

11. Immunization and Vaccine Development, FCH | India Technical Advisory Group for Measles Control (ITAGM) In 2007 GoI formed the India Technical Advisory Group for Measles (ITAGM) comprising national and international experts to guide the government on the future steps for measles mortality reduction in India ITAGM held its 1 st meeting in September 2007 and put up its recommendations to National Technical Advisory Group on Immunization (NTAGI) NTAGI met on 16 June 2008 endorsed ITAGM recommendations

12. Immunization and Vaccine Development, FCH | ITAGM – State specific strategies Gro up 1 st dose coverage with MCV Strategy 1 Low  Improve RI  One-time catch-up SIA targeting children 9m-10 years*  Repeat SIAs targeting new birth cohorts based on RI coverage and surveillance data 2 Medium  Improve RI  One-time catch-up SIA targeting children 9m-10 years*  Repeat SIAs targeting subsequent birth cohorts and/or introduction of a routine 2nd dose 3 High (>90%)  Introduce a routine 2 nd dose of measles vaccine *Target age range for SIAs will be adjusted based on age distribution of recent cases

13. Immunization and Vaccine Development, FCH | NTAGI Recommendations for Measles control a) UIP second dose (MR): States with >=80% evaluated MCV1 b) Catch-up measles SIA campaigns (9mo-10 YR): States with <80% evaluated MCV1. c) For UP, decision on catch-up SIA after consultation with State Government. d) CFR studies: in selected high burden states. Draft proposal developed, being reviewed e) Expansion of measles surveillance will be done in UP and Bihar and other states with high mortality due to measles for SIA planning and having a baseline.

14. Immunization and Vaccine Development, FCH | Recommendations of ITAG and regional priorities Implementation of NTAGI recommendations on accelerating measles mortality reduction in India. –Most importantly, the 10 states of India that account for 90% of measles mortality need to conduct measles catch-up SIAs as soon as possible. Technical sub-group to develop SEAR regional rubella control policy and providing more comprehensive guidance on implementation of measles control and surveillance. All countries that have completed catch-up campaigns should initiate measles case-based surveillance with laboratory confirmation and fully investigation of all detected/reported outbreaks.

15. Immunization and Vaccine Development, FCH | Can SEA Region Make it? The answer is Yes if we can get India to accelerate the process The problem is neither financial nor technical The most influential partners and from the highest level need to emphasize to the highest authorities in India the importance of India’s achievement to the regional and global ability to achieve the goal for measles mortality reduction

16. Immunization and Vaccine Development, FCH | THANK YOU