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

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

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

4. Current situation

6. Measles Mortality in EMR 1999 - 2006 2005 target: 50% reduction compared to1999 2010 target (GIVS): 90% reduction 103,800 106,000 93,600 68,700 70,000 47,600 39,000 34,000 0 20,000 40,000 60,000 80,000 100,000 120,000 19992000200120022003200420052006 Year Deaths EMR target: elimination, 2010

9. Status of implementation of measles elimination strategies

10. Strengthening routine infant immunization 95% coverage MCV1 in all districts

11. 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 2007 90% is not achieved in all districts MCV1: 67% in 1990 85% in 2007 80% to 90% (2 countries)

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

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

14. Supplemental Immunization activities

15. Catch-up campaigns All countries have conducted catch-up campaign 1994-2008: 220 M children were immunized through catch-up campaigns Repeated campaigns 2008  Pakistan, Morocco, Lebanon  Planned: Egypt

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

17. 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%

18. Planned SIA, EMRO, 2008-2009

19. Measles Case-Base Surveillance

20. 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

21. 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

22. Challenges

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

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

25. 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

26. Thank you!