1. 2015 Measles & Rubella Initiative Annual Partners Meeting, Human & Financial Costs of Measles and Rubella, 15 September 2015, Washington, DC Achieving Success in Rubella Elimination: Examples from the Field Jon Kim Andrus, MD Executive Vice President Sabin Vaccine Institute

2. Take Home Messages Effective planning supported with adequate human resources will result in field success Regional leadership and coordination is critical Nothing replaces country ownership and political commitment, linked to community engagement Strengthening health systems is fundamental to achieving success

4. 4 PAHO Immunization Newsletter

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17. Title of the Presentation17 Strengthening surveillance systems Site visits to 9 Health Departments in Chile, to address weaknesses previously identified in their surveillance systems. Emphasis was given to increase notification rate and strengthen coordination with Laboratory.

20. Measles & Rubella Elimination in Bhutan and Maldives Bhutan –>95% routine coverage for several years –MR vaccination campaign 2006 (all children aged 9 months – 14 years, and all women 15-45 years) –No recent measles, 1 lab confirmed rubella case 2015 (4 in 2014) –Surveillance case based but needs strengthening Maldives –High routine coverage –Surveillance case based and greatly improved in 2015 compared to 2014 –No recent measles, 2 lab confirmed rubella cases imported, 1 in 35 y/o non-pregnant women

21. NCC/NVCs NCC/NVCs established in both countries TORs complete SEAR TAG for immunization – June 2015, Delhi –All countries agreed to form their NCC/NVCs within the next 6 months Polio legacy – critical role to be played in SEA and other regions

22. Take Home Messages Effective planning supported with adequate human resources will result in field success Regional leadership and coordination is critical Nothing replaces country ownership and political commitment, linked to community engagement Strengthening health systems is fundamental to achieving success

23. www.sabin.org

24. July 23 to 28 June 12-July13, 2014 August 5-21,2016September 7-18th, 2016 July-August, 2013 Preparation of health alerts to mitigate impact of importations

25. Estimated costs of containing measles outbreaks in selected LAC countries Country# of cases Scope of outbreak control activities Cost (USD)* Chile (2009) 1Limited to 1 municipality 12,400 Peru (2009) 11 municipality in Peru and 1 in Ecuador 20,300 Ecuador (2011-12) 328Nationwide8.5 million *Estimated costs include outbreak investigation, follow-up of contacts and vaccination activities Source: Country reports to FCH/IM

26. –Virus importations and risk of possible resurgence of endemic viruses due to sustained outbreaks exist as long as there is ongoing circulation of rubella and measles elsewhere in the world. – Heterogeneous coverage and pockets of susceptible populations in high risk areas (how to identify high-risk areas); under-vaccinated present an ongoing challenge for sustained disease elimination. –Maintaining specific and high sensitive surveillance in the post-elimination setting (with low incidence); especially surveillance of rubella and CRS and sporadic cases. –Role of private sector participation in case detection and laboratory analysis. –High cost of maintaining the disease elimination. –Molecular analysis in the Region: technical capacity, availability of kits, collecting specimens from the sporadic cases, specimen transport, lack of genotyping information of rubella cases –Fundraising for WHO/AMRO, and particularly for activities to maintain the measles and rubella elimination (i.e. Emergency Plan of Action to maintain the Regional Elimination in severely under funded ~ $1.5 million). Key challenges PAHO/AMRO