Beruflich Dokumente
Kultur Dokumente
Measles elimination-2015
Rubella elimination-2015
Measles elimination-2012
Measles elimination-2000 Measles elimination-2015
Rubella elimination-2010
Measles elimination-2020
Measles elimination goal for all six WHO regions in the world
Rubella elimination goal for two (Americas, Europe) regions
Key strategic objectives to achieve: MR elimination
1. Immunization:
Achieve and maintain at least 95% vaccination coverage with two doses of
measles and rubella containing vaccines within every district
A strong routine immunization system delivery mechanism in every
district critical for achieving this goal
2. Surveillance:
Develop and sustain a sensitive and timely case-based measles and
rubella surveillance system and CRS surveillance that fulfils recommended
surveillance performance indicators
3. Laboratory:
Develop, sustain and expand an accredited measles and rubella laboratory
network that supports case based MR surveillance across the country
4. Support & Linkages:
Case-outbreak investigation, management and response
Develop linkages with other child health interventions and programs
Global Measles and Rubella midterm-Targets
Global targets by 2015:
Measles vaccination coverage 90% national and 80% district
Measles reported incidence <5 cases per million
Measles mortality reduction of 95% vs. 2000
Regional targets:
Measles Elimination goals:
2000 AMRO
2012 WPRO
2015 EURO, EMRO
2020 AFRO, SEARO
Rubella Elimination goals:
2010 AMRO, 2015 EURO
Global Vaccine Action Plan (GVAP):
2020 - Measles and rubella elimination in 5 WHO regions
Progress Report at the end of 2015
5
Annual reported measles cases and MCV1 and MCV2**
coverage*, 1980-2015
4.5 100
4 90
3.5 80
3 70
60
2.5
Millions
50
2
40
1.5 30
1 20
0.5 10
0 0
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
2014
Number of cases MCV1 Coverage* MCV2 Coverage*
1,000.0
Measles incidence per million population
Projected
146 trend GOAL
100.0 AFR
39 AMR
(log scale)
EMR
10.0
EUR
5.0
SEAR
1.0 2015 Goal Trend to WPR
reach 5/ GLOBAL
million
projected
0.1 2012 needed
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2013
2014
2015
2016
2017
2018
2019
2020
Reported Measles Incidence Rate*
Aug 2015 to Jul 2016 (12M period)
0
AMR EUR AFR EMR SEAR SEAR India WPR Global
10 Including Excluding
India India
20 51%
30 66%
% Reduction
12
Estimates of the median incidence of CRS per 100,000
live births by country in 2010
Vynnycky E et al. (2016) Using Seroprevalence and Immunisation Coverage Data to Estimate the Global Burden of Congenital Rubella Syndrome, 1996-2010: A
Systematic Review. PLoS ONE 11(3): e0149160.
Countries with Rubella containing vaccine in the
national immunization program; by 2017
The boundaries and names shown and the designations used on this map do not imply the
Data source: WHO/IVB Database, as of 16 December 2016 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
Map production Immunization Vaccines and Biologicals (IVB), concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent
World Health Organization approximate border lines for which there may not yet be full agreement. WHO 2016. All
rights reserved.
Annual Reported Rubella Cases, 2000-2015
2000 2015
900,000 Incidence Incidence
Number of Reported Rubella Cases
2015
2000
2001
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Year
Source: JRF, as of July 15, 2016
Rubella containing vaccine coverage by WHO region,
1980-2014
100
RCV* coverage (%)
80
46%
60
40 43 44 46
39 41 41 41
20 22 23 23 23
25 24 26 26
16 18
4 4 5 5 6 6 6 6 7 7 8 9 9 10 10 12 12 13
0
1987
1989
1998
2007
2009
1980
1981
1982
1983
1984
1985
1986
1988
1990
1991
1992
1993
1994
1995
1996
1997
1999
2000
2001
2002
2003
2004
2005
2006
2008
2010
2011
2012
2013
2014
Global AFR AMR EMR EUR SEAR WPR
Source: WHO/UNICEF coverage estimates 2014 revision. July 2015
* MCV1 was used as a proxy in the Member States that have introduced rubella Immunization Vaccines and Biologicals, (IVB), World Health Organization.
194 WHO Member States. Date of slide: 17 July 2015.
vaccine
Rubella incidence rate per million population by
country in 2013
Source: WHO/IVB Database as at 28 June 2014. 194 WHO The boundaries and names shown and the designations used on this map do
Member States. not imply the expression of any opinion whatsoever on the part of the World
Health Organization concerning the legal status of any country, territory,
Map production: Immunization Vaccines and Biologicals, city or area or of its authorities, or concerning the delimitation of its
(IVB). World Health Organization frontiers or boundaries. Dotted lines on maps represent approximate
border lines for which there may not yet be full agreement. WHO 2014.
Date of slide: 16 July 2014 All rights reserved
Verification of MR Elimination in countries and regions
Measles Elimination Status
Rubella Elimination Status
Situation in the South-East Asia Region
Immunization - Progress
All 11 countries in the region provide 2 doses of measles
containing vaccine through routine immunization
9/11 countries have introduced rubella vaccine
Most recent introduction has been in India phased
introduction
Indonesia to introduce in August 2017 phased
introduction
DPR Korea yet to introduce rubella containing vaccine
Periodic supplementary immunization activities
conducted in SEAR countries to close immunity gaps
MCV1 and MCV2 coverage & measles cases SEAR
2003-2016
120000 100
90
100000
80
70
Number of measles cases
80000
60
Coverage (%)
60000 50
40
40000
30
20
20000
10
0 0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
MCV1 coverage MCV2 coverage
Source:
Case numbers: Joint Reporting form submissions by Member States to SEARO
Coverage data: WHO and UNICEF estimates (provisional for 2016)
However, only 5/11 countries in SEAR have achieved > 95%
coverage of first dose of measles containing vaccine (MCV1)
100
90
80
70
60
Percent
50
40
30
20
10
0
Bangladesh
Myanmar
Maldives
Sri Lanka
DPR Korea
Bhutan
India
Indonesia
Thailand
Nepal
Timor-Leste
2014 2015 2016
Indonesia
24%
India
67%
90
80
70
60
Percent
50
40
30
20
10
0
Bangladesh
Maldives
Sri Lanka
India
Nepal
Timor-Leste
DPR Korea
Thailand
Indonesia
Bhutan
Myanmar
2014 2015 2016
Nepal introduced MCV2 in Sept 2015 and Timor Leste in Feb 2016
Source 2014, 2015: WHO/UNICEF coverage estimates, July 2016 revision and 2016: Country official estimates, JRF 2016
Reported Measles Incidence Rate
SEAR, 2000-2013
80
71
70 70
60 59 59
56 56
52
Incidence per million
50
48
46
42
40
38
30 31
26
20
17
10
2015 target: 5 cases per million
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
27
Measles Elimination and Rubella/CRS control
South East Asia Regional Goal
~ 36 % in
2015
0
100
97
GOA
96
CHANDIGARH
95
PONDICHERRY
94
CHHATTISGARH 93
SIKKIM
93
PUNJAB
93
WEST BENGAL
93
LAKSHADWEEP
91
TELANGANA
91
DELHI
89
ANDHRA PRADESH
89
KERALA
88
ODISHA
88
HIMACHAL PRADESH
TAMIL NADU
83
MAHARASHTRA
83
JHARKHAND
82
KARNATAKA
82
D&N HAVELI
81
UTTARAKHAND
80
MADHYA PRADESH
79
BIHAR
79
HARYANA
78
RAJASTHAN
76
A&N ISLANDS
75
GUJARAT
74
12-23 months, Survey data*, India
MANIPUR
72
MEGHALAYA
22 out of 36 (61% of the states having > 80% evaluated MCV-1 coverage
71
ASSAM
71
UTTAR PRADESH
70
TRIPURA
Percent Measles first dose evaluated-coverage,
61
India 81.1%
MIZORAM
55
ARUNACHAL PRADESH
50
NAGALAND
NTAGI Recommendation on MCV-2 & MR
.
2000
1000
0
2010 2011 2012 2013 2014 2015 2016
A&N ISLANDS
Target : 25.9 million children Target : 26.3 million children Target : 26.6 million children
< 50%
50% to 60%
60% to 70%
70% to 80%
> = 80%
Data not available
*HMIS data as on March 2017
Phased Measles-Rubella vaccination campaign - India
MR vaccine doses
Target pop 9m -
Phase-2 states <15 yrs. in 2016
required for Campaigns
(WMF-1.11)
39
Surveillance reporting network in the country
Quack Other
14% 1%
Govt.Allopathi
ISM* c
Practitioner 34%
8%
Pvt.Allopathic
44%
12 - National laboratories
2 - National reference laboratories
1 Proposed laboratory
PGI, Chandigarh
SGPGI, Lucknow
PMC, Patna
NCDC, Delhi
SMS, Jaipur
GMC, Bhopal
BJMC, Ahmedabad
NIV, Bangalore
IPM, Hyderabad
KIPM, Chennai
IOS, Kolkata
MCG, Guwahati
ERC, Mumbai
NIV, Pune
# # #
# #
# #
# #
# #
# # # #
# # #
# ### ### # # ### # #
##
# #
# # # ##
#
# #####
# #
# ##
## # ### # # ## ## ## #
###
#
#
# # # ## # ## ## # ## # ## #
# # ## ## ## ##### # #
# # ######
# #### ##### ### # ##
# # # #
### # # #######
# # #####
#
#
####
# # # # #
## ######## ### ####
####### # # # # # # ## ############## # # ###
### # ######## ## ## ## ## # ## # # # # ###
# ####
# # # # # #### ##### # # # #### ### # #
### ## # # # # ##
#
# ### ## # #
# # # ## ### # # ###### # #### # # # #
## # # ##
#
## # ## # # # # #
# # # # # #
## # # ### ###### ## # # ##### #### # ##### ## # ## # # ### # # ## # #
# # #
## # # # ### # # ## #
# # #
#
# # ## ##
#
# ####
## # # # ### #
## ##
### # ##
# # ## # # # # #
#
##
# #
## # # ## ## ## # ######## # # # #### #
# # # ## # # ## ############ #
#
##
# ## ## #
# ## #
# ### #
# #
# # # ## # # # ###
##### ####### # ## # # # ## ###
# ### #
### # ## # ### ##
# # ### # # ##
# ## # # # ## # # # ## ##
# # # # # # #
## # # # #### # # #
# # # # # # # # #
# ## # # # # # ## ## #
# # ## # #
# ### # # ## ## ## # ## #
## #### # # ## # # # # ## # ## ## ## ## ##
# ## #
# ### #
# # # #### # # ## #
#### ## ## #
## #### ## # ## # ##
# # ## # # # #
#
# # # # # # # # # #
# ### # # ## # # ##
### # #
# # # ## # #
# ##
## ## ##
# # # # # # ####
# ##
#
#
# # # ## # # # ##
## ## # ## # # #
# ## ## ## # #
# # # ## ## #
#### ## #### ## # #
## # # ## # # ## # # ## # ## #
# ## # #
# # #
### ###
#
# # # ##
#
## # ### # #
###
##
###
#
# ##### # #
# ### #
## # #
### ### # # ### ## # #
## # #
# #
# #
# #
# # #
# #
# ## # #
#
#
## #
###
## #
# #
### # # ##
## # #
#
#
#
Confirmed Measles outbreaks 798 outbreaks Confirmed Measles outbreaks 371 outbreaks
Confirmed Mixed outbreaks 65 outbreaks Confirmed Mixed outbreaks 14 outbreaks
# ##
#
## #
# #### # #
##
#
########
#### # #### ###
## ### #####
#
# # ### ### # #
# # ## ##
#
#### # # # #
# ####### ##### ## # # ## # # #
# # #### # ## ## # #
# # ### # # #
# ## # # # # #
# #####
# # # ## ## # ##
#
# # # ### # ## # # # # ## # # #
# # # # # #
# ## # # # ## # # ### #
# # # ### # ## #
#### # # ## #
# ## #
## # # # #
###
# # # ## #
# ##
# # ### # #
# ## #
# # #
# # # #
## # #
# # # # # #
# # #### #
# # # #
# #
# # # # # # # #
# # #
## # # #
# # # #
## # # ## # ## #
#
# #
# #### #
###### # ## ## # #
#
# #
# # #
# #
#
#
#
#
#
### # #
#### #
#
#
# # ##
###
##
#
#
#
Confirmed Rubella outbreaks 267 outbreaks Confirmed Rubella outbreaks 105 outbreaks
Confirmed Mixed outbreaks 65 outbreaks Confirmed Mixed outbreaks 14 outbreaks
Partial data may not reflect true case burden as India is in outbreak surveillance
70000 JAM MU & KASHM IR
HIMACHAL PRADESH
PUNJAB
CHANDIG ARH
61255
UT TARAKHAND
HARY ANA
DEL HI
ARUNACHAL PR.
SIKKIM
UT TAR PRADES H
RAJASTHAN
ASSAM
NAGAL AND
BIHAR
MEGHAL AYA
MANIPUR
JHARKHAND
TRIPURA
MADHYA PRADE SH
60000
MIZ ORAM
56486
WEST BENGAL
GUJARAT
53216
TELANG ANA
GO A ANDHRA PRADESH
KARNAT AKA
PONDICHERRY
TAMIL NADU
50000
20000 16478
10000 7642
344
0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
(1 state) (3 state) (6 states) (6 states) (7 states) (8 states) (11 states) (12 states) (15 states) (34 states/ (36 states/ (36 states/ (36 states/
No. of States UTs) UTs) UTs)
UTs)
Partial data may not reflect true case burden as India is in outbreak surveillance mode
30000
JAM MU & KASHM IR
29132
HIMACHAL PRADESH
PUNJAB
CHANDIG ARH
UT TARAKHAND
HARY ANA
DEL HI
RAJASTHAN
UT TAR PRADES H
SIKKIM
ASSAM
ARUNACHAL PR.
NAGAL AND
26461
BIHAR
MEGHAL AYA
MANIPUR
JHARKHAND
TRIPURA
MADHYA PRADE SH
WEST BENGAL MIZ ORAM
GUJARAT
ODISHA
TELANG ANA
GO A ANDHRA PRADESH
KARNAT AKA
PONDICHERRY
TAMIL NADU
20000
No. of cases
15210
15000
10308
10000 8984
8579
7858
7131 7070
5227 4566
5000 42284454
3122 3314
2855 2734
1941
1130 1186
779
238 247 372
0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
No. of States (1) (3) (6) (6) (7) (8) (11) (12) (15) (34) (36) (36)
10000 10000
~ 94% Measles < 15 years of age ~ 95% Measles < 15 years of age
8000 8000
39% 37%
6000 6000
4000 4000
5000 5000
~ 92% Rubella < 15 years of age ~ 87% Rubella < 15 years of age
39%
4000 4000
32%
3000 3000
2000 2000
14%
7% 8% 37%
1000 1000
23% 20%
7% 13%
0 0
< 1 year 1-4 years 5-9 years 10-14 years >= 15 years < 1 year 1-4 years 5-9 years 10-14 years >= 15 years
2015 2016
~ 96% Measles < 15 years of age ~ 95% Measles < 15 years of age
15000 15000
44%
12000 12000
35%
9000 9000
39%
38%
6000 6000
3000
8% 8% 3000
4% 7% 11%
5%
0 0
< 1 year 1-4 years 5-9 years 10-14 years >= 15 years < 1 year 1-4 years 5-9 years 10-14 years >= 15 years
2015 2016*
26% 23%
29%
32%
51%
39%
N=30,606 N=17,301
Vaccinated
Not Vaccinated
Unknown
* data as on April 2017 Cases from serologically confirmed measles & mixed outbreaks
Country measles virus genotypes, 2014-17
2017
2016
#
###### #
# ##
### # # ##
# # # # #
## ## # ## ## # #
## # # ## # # ##
## # #
##
#
# # # ## ## ###
##
# ###
##
### ##
## ##
#
# # # # ##
# #######
##
## #
# #
# ## # #
#
#
## #
#
#
#
# ##
#
#
#
## ## T
$
## ##
# # #
## ## ## #
# # ### # ##
# ####### #
# #
# #
## ## # #
### # # # #
### # # # ##
### ## # # # #
# # #### # # # #
# # ## ## # # ## #
# # # #
# ### # # #
## #
## # ## #
# # ##
#
#
#
#
#
##
T
$ # #
#
#
# # ##
#
#
# B3 (n=2) #
B3 (n=0)
T
$
#
T#T
$ $## #
### #
#
##
D4(n=15) $#### ## # T
T $ D4(n=7)
T#
$ T
$
# ######
#
#
##
D8(n=202) #
D8(n=83)
#
2B(n=3) 2B(n=8)
##
##
2014 #
# 2015 #
# ###
## # #
# ## #
## #
# ##
###
##
##
###
## # # # #
###
# # #
# # # # #
# ## # # # # ######
# ####
# # #
#
# # # #### # #
######
#
# # ## #
# # #
# # # #
# ## ## # # ## # #
##
## ## # #
#
# # # #### # #
### #
## # # ## ## #
# ## #
# # ### ###
#
## # ## ##
#
# # #
### # # ## # # ### ##
# ## # ##### # # ##
# ## # # # #
## ## #
# # #
###
##
# # #
## # #
#
# # ## ##
## #
$
# ###
# #
# ## #
# ##
## #
#
## B3 (n=1)
B3 (n=1)
###
# # # D4(n=15)
D4(n=19) D8(n=129)
D8(n=127) ##
##
####
2B(n=1)
##### # #
#