third annual meeting of the regional verification …participants of the third annual meeting of the...

18–21 March 2014Seoul, Republic of Korea

Meeting Report

Third Annual Meeting of theRegional Verification Commission

for Measles Elimination in the Western Pacific

Participants of the Third Annual Meeting of the Regional Verification Commission for Measles Elimination in the Western Pacific,

18–21 March 2014, Seoul, Republic of Korea

RS/2014/GE/04(KOR) English Only

REPORT

THIRD ANNUAL MEETING OF THE REGIONAL VERIFICATION COMMISSION

FOR MEASLES ELIMINATION IN THE WESTERN PACIFIC

Convened by:

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR THE WESTERN PACIFIC

Seoul, Republic of Korea

18–21 March 2014

Not for sale

Printed and distributed by:

World Health Organization

Regional Office for the Western Pacific

Manila, Philippines

May 2014

NOTE

The views expressed in this report are those of the participants of the Third Annual

Meeting of the Regional Verification Commission for Measles Elimination in the Western

Pacific, held from 18 to 21 March 2014 in Seoul, Republic of Korea, and do not necessarily

reflect the policies of the World Health Organization.

This report has been prepared by the World Health Organization Regional Office for the

Western Pacific for governments of Member States in the Region and for the participants of the

Third Annual Meeting of the Regional Verification Commission for Measles Elimination in the

Western Pacific held from 18 to 21 March 2014 in Seoul, Republic of Korea.

SUMMARY

The Third Annual Meeting of the Regional Verification Commission for Measles

Elimination in the Western Pacific was held in Seoul, Republic of Korea, from

18 to 21 March 2014.

The Regional Verification Commission (RVC) for Measles Elimination was established in

January 2012 in line with WHO Regional Committee for the Western Pacific resolution

WPR/RC61.R7 and the recommendation of the Technical Advisory Group on Immunization and

Vaccine-Preventable Diseases. The RVC held its inaugural meeting in April 2012 and its second

meeting in March 2013.

In September 2012, the Regional Committee passed a resolution urging Member States to

establish national verification committees (NVC) that would develop regular progress reports for

submission to the RVC (WPR/RC63.R5). The due date for the first submission from the 16

NVCs was 1 October 2013 for documenting progress towards measles elimination or requesting

verification of measles elimination.

The objectives of the third annual meeting were to review the first annual progress reports

of the NVCs to monitor progress towards and make recommendations for measles elimination, to

monitor progress towards control of rubella and congenital rubella syndrome, and to make a

determination for countries and areas for which their NVC has requested verification of measles

elimination.

First annual progress reports were submitted by 14 NVCs. The NVCs for Cambodia, the

Lao People's Democratic Republic and the Subregional Verification Committee for Pacific island

countries and areas did not submit progress reports in 2014. Among countries requesting

verification of measles elimination, Australia, Macao SAR (China), Mongolia and the

Republic of Korea were verified as having achieved measles virus elimination for a period of at

least 36 months since the last known endemic case.

RVC members made country- or area-specific recommendations to each of the NVCs, as

well as to WHO Regional Office for the Western Pacific and the Measles & Rubella Initiative

(M&RI).

The meeting concluded with an award ceremony held to acknowledge the achievement of

verification of measles elimination by the Republic of Korea, the host country for the meeting, at

which a congratulatory video message from Dr Shin Young-soo, WHO Regional Director for the

Western Pacific, was shown. A certificate from the RVC and an endorsement letter from

Dr Shin were also presented to the representative of the Republic of Korea.

LIST OF ACRONYMS

CPHL Central Public Health Laboratory

CRS congenital rubella syndrome

EPI Expanded Programme on Immunization

IgG Immunoglobulin G

IgM Immunoglobulin M

MCV measles-containing vaccine

MCV1 first dose of measles-containing vaccine

MCV2 second dose of measles-containing vaccine

MMR1 first dose of measles-mumps-rubella vaccine

MMR2 second dose of measles-mumps-rubella vaccine

M&RI Measles and Rubella Initiative

NIID National Institute of Infectious Diseases

NIP National Immunization Programme

NIR national immunization register

NVC national verification commission

PHLS Public Health Laboratory Services

RCV Rubella-containing vaccine

RVC Regional Verification Commission for the Western Pacific

SIA supplementary immunization activity

UNF United Nations Foundation

UNICEF United Nations Children's Fund

CDC United States Centers for Disease Control and Prevention

PAHO Pan American Health Organization

WHO World Health Organization

CONTENTS

Page SUMMARY �

LIST OF ACRONYMS�

1. INTRODUCTION.................................................................................................................... 1�

1.1� Objectives ..................................................................................................................... 1�

1.2� Organization ................................................................................................................. 1�

1.3� Opening session ............................................................................................................ 1�

2. PROCEEDINGS ...................................................................................................................... 2�

2.1� Background ................................................................................................................... 2�

2.2� Global and regional progress on measles elimination and rubella control ................... 2�

3. FINDINGS ............................................................................................................................... 2�

3.1� NVC reports .................................................................................................................. 2�

3.1.1�� Australia ................................................................................................................ 3�

3.1.2�� Brunei Darussalam ................................................................................................ 4�

3.1.3�� China ..................................................................................................................... 4�

3.1.4�� Hong Kong SAR (China) ...................................................................................... 5�

3.1.5�� Japan ...................................................................................................................... 6�

3.1.6�� Macao SAR (China) .............................................................................................. 7�

3.1.7�� Malaysia ................................................................................................................ 8�

3.1.8�� Mongolia ............................................................................................................... 8�

3.1.9�� New Zealand ......................................................................................................... 9�

3.1.10 Papua New Guinea .............................................................................................. 10�

3.1.11 Philippines ........................................................................................................... 11�

3.1.12 Republic of Korea ............................................................................................... 11�

3.1.13 Singapore............................................................................................................. 12�

3.1.14 Viet Nam ............................................................................................................. 13�

4. CONCLUSIONS AND RECOMMENDATIONS ................................................................. 14�

4.1� General recommendations to all NVCs ...................................................................... 14�

4.1.1�� Recommendations to the NVC of Australia ........................................................ 14�

4.1.2�� Recommendations to the NVC of Brunei Darussalam ........................................ 15�

4.1.3�� Recommendations to the NVC of China ............................................................. 16�

4.1.4�� Recommendations to the NVC of Hong Kong SAR (China) .............................. 16�

4.1.5�� Recommendations to the NVC of Japan ............................................................. 17�

4.1.6�� Recommendations to the NVC of Macao SAR (China) ...................................... 17�

4.1.7�� Recommendations to the NVC of Malaysia ........................................................ 18�

4.1.8�� Recommendations to the NVC of Mongolia ....................................................... 18�

4.1.9�� Recommendations to the NVC of New Zealand ................................................. 18�

4.1.10� Recommendations to the NVC of Papua New Guinea ........................................ 19�

4.1.11� Recommendations to the NVC of the Philippines............................................... 19�

4.1.12� Recommendations to the NVC of the Republic of Korea ................................... 20�

4.1.13� Recommendations to the NVC of Singapore ...................................................... 20�

4.1.14 Recommendations to the NVC of Viet Nam ....................................................... 20�

4.2� Recommendations to WHO and M&RI partners ........................................................ 21�

4.3� Partner comments ....................................................................................................... 21�

4.4� Closing session ........................................................................................................... 22�

4.5� Award ceremony for the Government of the Republic of Korea ................................ 22�

ANNEXES

ANNEX 1 - TIMETABLE

ANNEX 2 - LIST OF PARTICIPANTS

ANNEX 3 - RVC PRESENTATION

ANNEX 4 - AWARD CEREMONY PHOTO

Keywords:

1. Measles – prevention and control

2. Rubella – prevention and control

3. Vaccination

1. INTRODUCTION

The Third Annual Meeting of the Regional Verification Commission (RVC) for Measles

Elimination in the Western Pacific was held in Seoul, Republic of Korea, from

18 to 21 March 2014.

1.1 Objectives

The objectives of the meeting were:

(1) to review the first annual progress reports of the National Verification

Commission (NVC) to monitor progress towards and make recommendations for

measles elimination;

(2) to monitor progress towards control of rubella and congenital rubella

syndrome; and

(3) to make a determination for countries and areas for which their NVC has

requested verification of measles elimination.

1.2 Organization

The participants of the meeting included the 14 members of the RVC and six WHO staff

members from the WHO Regional Office for the Western Pacific. In addition, representatives

and partners from the Measles and Rubella Initiative (M&RI) including the American Red Cross,

United Nations Foundation (UNF), United Nations Children's Fund (UNICEF) East Asia and

Pacific Regional Office, and the United States Centers for Disease Control and Prevention (US

CDC) attended the meeting. The agenda and timetable for the meeting are provided in Annex 1

and the list of participants in Annex 2.

1.3 Opening session

The meeting was called to order by Dr Sergey Diorditsa, the Responsible Officer for the

meeting. Dr Mark Jacobs, Director of the Division of Combating Communicable Diseases

delivered the opening remarks on behalf of Dr Shin Young-soo, WHO Regional Director for the

Western Pacific. Dr Shin noted that this meeting had historical significance because it was the

first opportunity for countries and areas to be verified as having achieved measles elimination.

He reviewed the resolutions of Regional Committee meetings that had established the

mechanisms to form national verification committees, which would then submit annual progress

reports to the Regional Verification Commission. He acknowledged the efforts made by

Member States to achieve measles elimination and thanked the members of the RVC for their

dedication and service to the Commission.

After participants introduced themselves, Dr Jacobs nominated the office bearers as

follows:

(1) Chair: Professor David Durrheim

(2) Vice Chair: Dr Hiroshi Yoshikura

(3) Rapporteur: Dr Rose Capeding

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2. PROCEEDINGS

2.1 Background

Professor David Durrheim, Acting Chair of the RVC reviewed the meeting objectives and

the expected outcomes of the meeting.

(1) Meeting objectives:

• to review the first annual progress reports of the NVCs to monitor progress

towards and make recommendations for measles elimination;

• to monitor progress towards control of rubella and congenital rubella syndrome;

and

• to make a determination for countries and areas for which their NVC has

requested verification of measles elimination.

(2) Expected outcomes:

• a determination about whether the countries and areas requesting verification

were successful in providing adequate documentation showing that endemic

measles virus transmission was interrupted for a period of at least 36 months since

the time of the last known endemic case, in the presence of verification standard

surveillance and genotyping evidence that supports the interruption of endemic

measles virus transmission;

• review of the first annual progress reports submitted by NVCs to monitor progress

towards measles elimination and control of rubella and congenital rubella

syndrome;

• recommendations to national verification committees about specific strategies that

should be considered to achieve or sustain measles elimination.

2.2 Global and regional progress on measles elimination and rubella control

An update on global and regional progress towards measles elimination and rubella control

was presented by Dr William Schluter. The presentation outlined global and regional targets and

then briefly summarized the progress towards these targets against the five lines of evidence that

are used for regional verification. A copy of the presentation is attached in Annex 3.

3. FINDINGS

3.1 NVC reports

Following these introductory comments, the progress towards or achievement of

elimination was reviewed country by country. For the 2014 RVC meeting, 14 countries and

areas submitted documentation for verification or progress towards measles elimination. The

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NVCs for Cambodia, and the Lao People's Democratic Republic as well as the Subregional

Verification Committee for Pacific island countries and areas did not submit progress reports in

2014.

3.1.1 Australia

Epidemiology

The report of the Australia NVC described the epidemiology of measles cases over an

extended period, which included the consistent detection of imported cases and generally low

numbers of import-related or unknown source cases per imported case. Few cases were reported

in 2009 and 2010. Of concern was the relatively large number of cases with unknown source of

infection reported in 2011 and 2013, but only one case with unknown source of infection was

reported in 2012.

Quality of surveillance

There is consistent detection of imported cases and small outbreaks. Most surveillance

indicator targets were achieved or exceeded. There is a high level of non-measles case testing

nationally and for most states, but these data are not available for all states. There is adequate

quality specimen collection data (although presented only for Victoria) plus a high proportion of

transmission chains with genotyping information. Furthermore, there is consistent linking of

cases in chains of transmission, thorough investigation, and reasonable completeness of

reporting. Surveillance is adequate to detect endemic or re-established measles virus

transmission if it were occurring. There is no regular system, however, for nationally reporting

discarded non-measles non-rubella cases that were investigated.

Population immunity

Australia had high (>92%) coverage with MMR1 nationally and by jurisdiction since 2007

and approximately 90% coverage for MMR2 by six years of age nationally with some variation

by jurisdiction. A series of convenience sample serosurveys indicates low levels of

seronegativity. There appears to be an immunity gap among school-aged children: the age

distribution of cases shows an increased proportion among school-aged children. Seropositivity

is declining in this age group, and there are no active school immunization requirements in place.

Sustainability

Two MCV doses are fully funded by the Australian National Immunization Program.

There has been high (94%) MCV1 coverage and MCV2 coverage close to 90% over the past five

years. A nationwide immunization campaign was previously fully funded.

Genotyping

Separate chains of transmission are documented by country of importation, epidemiologic

week, and genotype (D8, D4, and D9).

Overall conclusion

Australia has provided adequate documentation against all five lines of evidence to

support interruption of endemic measles virus circulation for >36 months along with adequate

surveillance and supportive genotyping evidence. There is no evidence of endemic or re-

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established measles virus circulation. However, there is a concerning immunity gap which should

be addressed and updates provided in subsequent reports.

3.1.2 Brunei Darussalam

Epidemiology

Zero to four cases of measles have been reported annually from 2008 to 2013. The highest

number of cases (four) occurred in 2011 and three of the four cases reported that year were

classified as imported cases.


From 2008 to 2013, Brunei Darussalam had a national discarded case rate of 1.4 to 2.6 per

100 000 population. The proportion of cases with adequate investigation has been >80% since

2007 and the proportion with adequate specimen collection has been >80% since 2010. All

laboratory results have been available within seven days since 2011.

Population immunity

From 2009 to 2012, administrative coverage with two doses of MMR has been >90%. A

2011 serosurvey conducted among children in primary 4 reported 79% positivity for measles-

specific IgG antibodies.

Sustainability

Two doses of MMR are provided at no cost to all children who are citizens or permanent

residents of Brunei Darussalam. Brunei Darussalam has both measles and rubella/CRS

elimination goals.

Genotyping

No genotyping data is available, but Brunei Darussalam has a plan to request genotyping

support from the Regional Reference Laboratory.

Overall conclusion

Brunei Darussalam has likely already achieved measles elimination, but additional

information is needed including detailed geographic distribution of cases, summary table of cases

classified by source of infection, genotyping evidence, and a measles preparedness plan for

outbreak response.

3.1.3 China

Epidemiology

Measles incidence has decreased significantly since implementation of the measles

elimination strategy in China, resulting in a historic low incidence rate in 2012. However, a

resurgence of measles cases occurred in 2013 related to the considerable size of birth cohorts.

- 5 -


Most surveillance performance indicators are met with the exception of the sensitivity

indicator and certain aspects of laboratory surveillance (such as proportion of outbreaks with

viral specimen collected). The national measles laboratory and all provincial labs have passed

WHO accreditation annually. In addition, 98% of all measles suspected cases were tested for

measles-specific IgM by ELISA in 2012.

Population immunity

Administrative coverage for MCV1 and MCV2 were >95% from 2006–2012. A national

immunization coverage survey conducted in 2011 showed 99.5% coverage for MCV1 and 93.4%

for MCV2. No serosurveillance data were available.

Sustainability of NIP

There is a high level of commitment from the Government of China to provide financial,

technical, policy-related support for measles elimination in China. The national leading group

for measles elimination is chaired by a high-level political leader. In addition, an independent

NVC has been established.

Genotyping

The national measles laboratory is responsible for genotyping and analysing molecular

epidemiological data.

Overall conclusion

There is marked heterogeneity among the provinces with regard to measles incidence and

progress towards elimination. While some provinces may be close to elimination, others have

ongoing transmission. There are improved surveillance performance indicators and a stated

commitment by the Government to achieve measles elimination.

3.1.4 Hong Kong SAR (China)

Epidemiology

The incidence rate has been low and almost all cases (n=124 during the period from 2008–

2012) were sporadic with only six brief outbreaks with two cases each.


Indicator targets for discarded non-measles reporting rate at the national level were

achieved in 2011 and 2012. Adequate investigations were conducted for 98% and 92% of

suspected cases in those years, respectively. Public Health Laboratory Services (PHLS) serves as

a WHO-accredited Regional Reference Laboratory.

Population immunity

High vaccination coverage was achieved with two doses of MCV. The second dose is

delivered at school. There has been >98% administrative coverage for MCV 1 and MCV 2 since

2006. Annual convenience seroprevalence studies show >95% immunity in all age groups

except adolescents 15–19 years of age in 2008.

- 6 -

Sustainability

The Government of Hong Kong SAR (China) is committed to measles elimination. An

NVC has been established.

Genotyping

Measles virus with genotype H1 are likely to be detected until China achieves elimination.

It is difficult to interpret whether the H1 strains detected in Hong Kong are endemic or imported,

but it is important to carefully identify their source and characterize chains of transmission.

Overall conclusion

Due to high coverage and sensitive surveillance, Hong Kong SAR (China) may have

already achieved elimination and should consider submitting documentation for verification after

the NVC makes their determination that elimination has been achieved.

3.1.5 Japan

Epidemiology

From 2009 through the first half of 2013, <1000 confirmed cases were reported annually

(range 228 in 2012 to 741 in 2009). Cases have not been classified with regard to source of

infection.


There is no mechanism to identify discarded non-measles cases that were investigated. A

large proportion of the cases are clinically diagnosed. The measles and rubella laboratory at

NIID is WHO-accredited and serves as a Global Specialized Laboratory.

Population immunity

High vaccination coverage was achieved with two doses of MCV in 2012. Administrative

coverage estimates for earlier years were not presented. Japan conducted a successful mass

vaccination campaign targeting two school-age cohorts in each of five years between 2008 and

2012 to address a well-characterized immunity gap.

Sustainability

An infectious diseases control law (including measles) has been in place since 2008.

Funding for measles elimination efforts are provided through Japan's national and local

governments.

Genotyping

Numerous genotypes including B3, D4, D5, D8, D9, G3 and H1 have been detected since

2008.

Overall conclusion

Japan has nearly achieved or already achieved measles elimination. Measles cases with

genotype D5 (the formerly endemic strain) have not been detected since May 2010. However to

- 7 -

be sure that measles virus has not been re-established following multiple importations, more

detailed information is needed that categorizes source of cases, and describes the detailed

epidemiology of clinically diagnosed cases and laboratory-confirmed cases that have not been

genotyped. There is a need to confirm or discard clinically diagnosed cases by laboratory

investigation.

3.1.6 Macao SAR (China)

Epidemiology

There were only six outbreaks and a total of eight cases in Macao SAR (China) between

2006 and 2012. Of these, six were imported cases and two were import-related cases. Four

cases were <1 year of age, and five cases between 8 months and 14 years of age were all

unvaccinated. All cases from 2006–2013 were residents in Macao, had laboratory confirmation,

and a known source of infection. There were no clinically compatible cases.


All surveillance performance indicators exceeded WHO standards: non-measles non-

rubella discarded rate was >2/100 000 between 2006 and 2013. All cases were laboratory

confirmed. All cases had adequate investigations, including adequate specimen collection, and

timely processing and availability of results.

Population immunity

Macao SAR (China) has had a two-dose schedule with MMR since 1990 and a three-dose

schedule (9M, 15M, 4–6 yrs) from 1994 to 2003. The current schedule, implemented since 2013,

has two doses of MMR at 12 and 18 months. Nursery and school entry checks, including

immigrant children, are performed and updated annually. Between 2007 and 2012,

administrative coverage for MCV1 was estimated at 95–98% and MCV2 at 93–96%.

Immunizations provided in the private sector are included in the government health information

system. Seroprevalence testing was conducted since 2003 and demonstrated <5% seronegativity

among children ≥2 years.

Sustainability

There is adequate funding allocated for sustaining the national immunization programme

as well as measures to improve the knowledge of health care workers. Regulation of nursery and

school entry checking, which includes migrant children, has been implemented since 2008. Risk

assessments are conducted regularly showing continued risk due to migration and population

movement of people between Macao SAR (China) and neighbouring countries. In addition,

outbreak response plans are in place, which are regularly reviewed.

Genotyping

There were no endemic cases during the period covered by the report. All cases were

either imported or import-related as supported by genotyping evidence.

Overall conclusion

Macao SAR (China) has provided documentation that supports interruption of endemic

measles virus transmission for >36 months in the presence of sensitive surveillance and

supportive genotyping data.

- 8 -

3.1.7 Malaysia

Epidemiology

There was decreased transmission of measles from 2008 to 2010, however, large outbreaks

occurred in 2011 and 2012.


Annually, the rate of discarded non-measles cases was >2/100 000 from 2009 to 2013.

The proportion of suspected cases with adequate investigation was >80% in 2009 and

2011–2013. Adequate specimen collection was completed for >80% of cases in each of the last

five years except 2011.

Population immunity

Malaysia introduced MCV2 in 2002. Reported coverage with MCV1 has been >95%

since 2009 and for MCV2, >95% since 2008. No serosurveys have been conducted. SIA

coverage was missing from the report.

Sustainability

Funding for the national immunization programme is secure. An initial risk assessment

has been completed.

Genotyping

D8 and D9 genotypes continue to circulate.

Overall conclusion

Malaysia has endemic transmission of measles virus. Major difficulties include mobile

populations at the borders of Sabah and Sarawak. Vaccine refusal is not common, but vaccine

refusers are influential.

3.1.8 Mongolia

Epidemiology

Mongolia experienced measles epidemics every three to four years until 1988, but reported

only 82 measles cases between 2006 and 2012; 71 were laboratory confirmed and 11 were

clinically confirmed. Detailed information is provided on each outbreak that ranged from two to

nine cases. No measles cases have been confirmed since 2011.


The national discarded non-measles rate is >2/100 000, but subnationally <80% of districts

are meeting this level of sensitivity. The proportion of cases with adequate investigation has

gradually improved from 22% in 2008 to 64% in 2012. Adequate specimen collection has been

>80% since 2008.

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Population immunity

Mongolia started a single dose of MCV in 1973 and added MCV2 in 1989. The current

schedule that includes two doses of MMR at nine months and two years of age was adopted in

2009. Administrative coverage with both doses has been >95% every year since 2006.

Sustainability

Immunization services are regulated by law and provided at all levels of the health system.

Genotyping

H1 was detected in 2001, 2008 and 2009. D6 was detected in 2006.

Overall conclusion

Mongolia has documented the interruption of endemic measles virus transmission for a

period of at least 36 months in the presence of sensitive surveillance and supportive genotyping

evidence.

3.1.9 New Zealand

Epidemiology

Since 1997, two significant outbreaks have occurred, in 2009 and 2011. The latter

persisted with ongoing measles virus transmission for a period of 13 months.


Nationally, the rate of discarded non-measles cases has been >2/100 000 from 2011 to

2013. At subnational level, the target was achieved by >90% of second-level administrative

units in 2011 and 2012, but only 56% in 2013. Laboratory support is provided by 5 ISO15189

standard laboratories. The national measles and rubella laboratory is WHO-accredited.

Population immunity

New Zealand provides two doses of MMR at 12–15 months and at 4 years of age. Greater

than 92% coverage for MCV1 was achieved for all birth cohorts since 2006. Coverage for

MCV2 is estimated at 89% for birth cohorts born in 2006 and 2007 at four years of age.

Insufficient population immunity is documented particularly among Maori and

socioeconomically deprived groups.

Sustainability

Two doses of MMR are available at no cost to any New Zealand resident born since 1969.

The national immunization register (NIR) assists with tracing children who are not fully

vaccinated.

Genotyping

Genotypes B3, D4, D8 and D9 have been detected in recent years.

- 10 -

Overall conclusion

New Zealand has likely achieved elimination of re-established transmission since June

2012.

3.1.10 Papua New Guinea

Epidemiology

A large measles outbreak occurred in 2002 and 2003. However, from 2005 no measles

cases were detected until October 2013 when four cases were laboratory confirmed, originating

from Vanimo Green, West Sepik, which is a community close to the Indonesia border.


Case-based surveillance was started in 2008. While epidemiological surveillance

indicators have not reached the required target, it appears that surveillance sensitivity was

sufficient to detect rubella cases as well as dengue and chikungunya outbreaks in 2011/2012 and

the measles outbreak in 2013. The laboratory obtained WHO accreditation in 2011/2012 and has

sufficient capacity to conduct laboratory diagnosis if specimens are received.

Population immunity

Administrative coverage shows an increase of national MCV at 9 months from 54% in

2008 to 67% in 2012, while surveys showed improvement from 78% in 2004 to 86% in 2007–

2009. Biannual SIA from 2008 also showed increasing coverage from 86% in 2008/2009 to 88%

in 2012. The introduction of a second dose of MCV with rubella was discussed in the report and

planned for 2015.

Sustainability

The government funds 81% of the costs for routine immunization vaccines and is

committed to sustaining routine immunization and strengthening primary health care to improve

service delivery. A national expanded programme on immunization (EPI) review was conducted

in 2013. Districts with low vaccine coverage were identified.

Genotyping

Historical information about endemic strains prior to 2005 is not available. Recent

outbreaks in 2013 and 2014 involved D9 and B3 genotypes.

Overall conclusion

Given the extremely challenging environment in Papua New Guinea, the NVC has

identified areas in need of strengthening. It is encouraging that the NVC has made

recommendations and action plans for 2013–2014 and is holding meetings twice yearly to

monitor the progress of action plans. However, low measles incidence despite low vaccine

coverage may possibly reflect underreporting of measles cases. With the government

commitment to a sustainable immunization programme and strengthening of primary health care

services, vaccine coverage and case detection should improve further.

- 11 -

3.1.11 Philippines

Epidemiology

Large measles outbreaks occurred in 1997, 2003, 2010–2011, and 2013–2014 prior to

scheduled supplementary immunization campaigns in 2004, 2011, and 2014. More than 3000

cases were reported in both 2010 and 2011.


National reporting of non-measles discarded cases has ranged from 2.1 to 4.3/100 000

population. The proportion of suspected cases with adequate investigation ranged from 14.5% to

88.6%.

Population immunity

Single antigen measles vaccine is provided as MCV1 at nine months of age with

administrative coverage estimated at 79% to 88% from 2008 to 2012. MMR is used for MCV2

and was introduced in 2010 with coverage estimated at 10% to 38% per year from 2010–2012.

Nationwide SIAs were conducted in 1998, 2004, 2007 and 2011.

Sustainability

The Philippines plans to strengthen routine immunization coverage through the "Reaching

Every Purok" strategy and by conducting a follow up MR SIA in September 2014.

Genotyping

Genotyping has shown different endemic dominant strains in different years: G3 in 2008–

2010; D9 in 2009–2012; and B3 in 2013–2014.

Overall conclusion

The Philippines has endemic measles virus transmission and in 2013 had the highest

incidence of any country or area in the Region. Epidemiological and laboratory surveillance

have improved in recent years. Suboptimal immunization coverage is a major challenge to

measles elimination.

3.1.12 Republic of Korea

Epidemiology

The Republic of Korea declared elimination of measles in 2006 but then experienced small

outbreaks in 2007, 2010, 2011 and 2013. The annual number of cases between 2008 and 2013

varied from 2 to 118 (average = 49). There is no evidence of re-establishment of endemic

transmission lasting 12 months. In 2011–2013, nine unknown source cases, nine imported cases

and 145 import-related cases occurred. All 163 cases were laboratory confirmed.


The discarded non-measles reporting indicator rates at national and provincial level have

not been reached (0.8/100 000 was the highest in 2013). The Republic of Korea has

implemented an active surveillance program in the five large laboratory services (with

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3500–4000 measles tests per annum, immunity screening excluded and conducting 97% of all

tests in the country). This has provided a steady rate >7/100 000 since 2009 and between 75%

and 88% of prefectures meet the target using this system.

There has been adequate investigation of 73%, 84% and 89% of suspected cases in 2011,

2012 and 2013, respectively. All outbreaks had serological confirmation and virology specimens

submitted. The quality of laboratory surveillance discussed in the report was based on the data

from the 17 public laboratories.

Population immunity

Nationwide telephone coverage surveys (by card check) found MMR1 coverage >95% and

>99% in 2011 and 2012. A nationwide survey of MMR2 coverage in 2012 by card found >97%

coverage.

Sustainability

There is a long-term commitment to measles elimination. An NVC has been established.

There is a legal basis for immunization (Infectious Diseases Prevention Act and School Health

Law). A previous large-scale mass campaign was funded by the Government and two doses of

measles-containing vaccine are provided free of charge to any child in the Republic of Korea.

Genotyping

H1 was the endemic genotype historically in the Republic of Korea. There have been no

H1 isolations since July 2010. Epidemiologically distinct D9 and B3 importations have resulted

in sporadic cases and outbreaks since 2011.

Overall conclusions

At the time of their report, the Republic of Korea meets the elimination criteria:

documentation of the interruption of endemic measles virus transmission for a period of at least

36 months from the last known endemic case; in the presence of verification standard

surveillance and genotyping evidence that supports the interruption of endemic transmission.

3.1.13 Singapore

Epidemiology

The most recent resurgence began in 2010 with 49 reported cases (compared to 13 in

2009) and 148 reported cases in 2011. This was largely attributed to single sporadic cases in

infants and young children less than five years of age. Most were unvaccinated. The timing of

both doses was changed so that MMR is given at 12 months and at 15–18 months of age. In

2012, 38 cases were confirmed by laboratory.


Achievement against standard indicators is not included in the report. The National

Measles Laboratory is WHO-accredited.

- 13 -

Population immunity

MCV1 coverage by birth cohort has been >95% since 2008. The National Immunization

Registry is used to follow up children that are not fully vaccinated. Immunization status is

checked at school entry. Seroprevalence of measles-specific antibodies among persons aged

18–74 years of age increased from 89.1% in 1998 to 96.7% in 2005.

Sustainability

Resources appear available to sustain routine and supplemental immunization.

Genotyping

Numerous genotypes have been identified including B3, D4, D8, D9, G3 and H1. More

detailed data on lineages are required to confirm interruption of transmission.

Overall conclusion

Singapore may have already achieved elimination and may consider submitting

verification documentation after the NVC has independently determined that the elimination

criteria have been met.

3.1.14 Viet Nam

Epidemiology

Measles outbreaks occurred in 2006, 2008–2009, 2010, 2011, and 2013.


Case-based surveillance started in 2002. Performance on meeting standard indicators

decreased in 2012 relative to previous years.

Population immunity

MCV1 coverage was reported as >95% from 2008 to 2012; while MCV2 was reported as

>95% from 2005 to 2010, but 90% in 2011 and only 83% in 2012. SIA coverage in 2010 was

reported as >95%. School entry immunization checks are in place.

Sustainability

An NVC has been established. The EPI programme is a high priority and vaccines are

provided at no cost for all children.

Genotyping

The genotype previously identified in Viet Nam is H1, but in 2014, D8 strain was also

identified in the southern part of the country.

Overall conclusion

Viet Nam may have interrupted transmission of measles following the 2010 campaign, but

has experienced multiple importations with current ongoing transmission.

- 14 -

4. CONCLUSIONS AND RECOMMENDATIONS

4.1 General recommendations to all NVCs

The RVC wishes to acknowledge the excellent reports received from the NVCs and to

thank the NVCs and their secretariats for their work in preparing such high-quality, thorough

reports.

Although some countries indicated that they had developed the following documentation,

the RVC urges that copies of these documents be submitted with future reports:

(1) NVC plan;

(2) Measles risk assessment; and

(3) Measles outbreak response plan.

A standardized tool for measles risk assessment is currently being developed at the global

level. The draft risk assessment tool will be shared with countries and areas once available. For

countries and areas that have not yet completed a measles risk assessment, the draft global tool

should be considered for adaptation and use.

During the 2013 Technical Advisory Group (TAG) meeting a recommendation was made

to establish a rubella elimination goal with the date for elimination to be determined. As the

Region continues with efforts to control rubella and congenital rubella syndrome (CRS) and

moves toward rubella elimination, the RVC encourages NVCs to include in future reports more

detail on progress towards rubella and CRS control and elimination. This information may

follow the same general format as that proposed for measles, namely:

(1) A detailed description of the epidemiology of rubella since the introduction of

rubella vaccine in the national immunization programme;

(2) Quality of epidemiological and laboratory surveillance systems for rubella;

(3) Population immunity presented as a birth cohort analysis with the addition of

evidence related to any underserved or marginalized populations;

(4) Sustainability of the rubella/CRS control efforts; and

(5) Genotyping data.

4.1.1 Recommendations to the NVC of Australia

• Please provide analysis of population immunity by birth year based on historical

immunization coverage and serosurveys in future reports.

• Consider establishing a system of regularly reporting discarded non-measles cases

to national level from all states.

- 15 -

To avoid re-establishment of endemic measles transmission:

• A targeted strategy to address the immunity gaps demonstrated by multiple data

sources among school-aged children (particularly in New South Wales) appears

essential to maintain adequate population based immunity:

– Encourage collaboration between education and health sectors to identify

schools at high risk;

– Consider referral of school-aged children who present as unvaccinated during

school entry immunization checks; and

– Consider SIAs in schools in high-risk areas or with a larger proportion of high-

risk children.

• In lower-performing states for MCV2 coverage (such as Western Australia and

Northern Territory), document the improvement in vaccination coverage predicted

by scheduling MCV2 from 4 years to 18 months and providing income-tested

payments to families.

• Characterize vulnerable community groups more fully (e.g. ethnicity) with lower

MCV coverage so that they can be more effectively targeted by social

mobilization and culturally-appropriate immunization strategies.

• Assure mechanisms to prevent nosocomial transmission of measles given

increasing cases among infants <1 year of age.

4.1.2 Recommendations to the NVC of Brunei Darussalam

• Brunei Darussalam may have already achieved measles elimination. When the

NVC has independently concluded that measles elimination has been achieved,

the RVC would welcome a report which outlines its achievement against the five

lines of evidence described in the Guidelines for Verification of Measles

Elimination in the Western Pacific Region. Please note that measles incidence

was an interim indicator and is not a necessary indicator for elimination,

particularly in relatively small populations. It is essential that all cases be

classified by source of infection (imported, import-related, endemic, or unknown).

• The RVC encourages Brunei Darussalam to continue with efforts to strengthen the

quality of laboratory and virological surveillance for measles and rubella

including:

– seeking WHO accreditation of the national measles and rubella laboratory;

– finalizing arrangements to obtain genotyping data through the Regional Reference

Laboratory; and

– clarifying appropriate testing to screen for rubella immunity among women during

antenatal care visits.

• Vaccination coverage should be monitored and risk assessments conducted to

ensure no pockets of susceptible populations exist for re-establishing measles

- 16 -

transmission. This is especially important to consider in communities of foreign

workers and their families.

• Consider mechanisms to ensure awareness among clinicians and public health

staff of the clinical presentation of measles and appropriate case confirmation,

reporting and response.

4.1.3 Recommendations to the NVC of China

• Maintain high vaccination coverage for each birth cohort.

• Given that infants have the largest immunity gap, detailed analysis of infant

susceptibility would be informative. Consider including in future reports an

analysis of population immunity by birth year (and by month among those <2

years) based on historical immunization coverage and serosurveys.

• Given that most recent cases were <1 year of age and before the timing of the first

recommended dose, consider an earlier supplemental MCV dose for infants in

areas of high transmission.

• The RVC supports the recommendations of the National and International

Consultation, including assuring strategies to prevent nosocomial transmission

amongst infants <1 year of age.

• A follow-up consultation may be considered as a mechanism to monitor progress

towards implementation of the consultation recommendations and to evaluate their

effectiveness to interrupt endemic measles virus transmission.

• Additional information on outbreak response plans, including outbreak

investigation, classification of chains of transmission, and outbreak response

immunization activities, should be provided.

• Vulnerable community groups (e.g. migrant and inner city populations) should be

carefully characterized to permit more effective implementation of social

mobilization and immunization strategies.

• Noting the heterogeneity among the provinces (in surveillance quality, routine and

supplemental coverage, and progress towards elimination) the RVC encourages

the NVC to receive detailed provincial verification reports against the five lines of

evidence. Lessons learnt from high-performing provinces could be shared with

other provinces. This may require establishment of strong provincial verification

committees.

• The submission of brief province-specific summaries would be informative to the

RVC.

4.1.4 Recommendations to the NVC of Hong Kong SAR (China)

• Hong Kong SAR may have already achieved measles elimination. When the NVC

has independently concluded that measles elimination has been achieved, the RVC

would welcome a report which outlines its achievement against the five lines of

- 17 -

evidence in the Guidelines for Verification of Measles Elimination in the Western

Pacific Region. Please note that measles incidence was an interim indicator and is

not a necessary indicator for elimination, particularly in relatively small

populations. It is essential that all cases be classified by source of infection

(imported, import-related, endemic, or unknown).

• Detailed epidemiological analysis of all cases is required to confirm there is no

ongoing transmission and this should be provided in future reports.

• High vaccination coverage should be sustained and the NVC action plan fully

implemented (in particular to fully investigate all suspected measles cases, with

laboratory confirmation and specimens collected for genotyping for >80% of all

chains of transmission).

• The National Measles Outbreak Response Plan should be submitted.

4.1.5 Recommendations to the NVC of Japan

• The sensitivity of surveillance should be maintained by encouraging the reporting

of cases with clinical features consistent with measles.

• However, at least 80% of reported suspected cases should be adequately

investigated with collection of core variables and appropriate laboratory testing,

preferably serum (or oral fluid) specimen for measles-specific IgM testing, and

reported to the national level.

• Clinically-diagnosed measles cases that are fully investigated and not laboratory or

epi-linked confirmed should be reported as discarded cases.

• Investigations should include a mechanism to identify chains of transmission of

measles virus by place and time.

• >80% of measles chains of transmission should be genotyped with all sequences

reported to the global database, WPRO, and the national programme of Japan

through the NIID.

• All confirmed cases should be classified as to source of infection (imported,

import-related, endemic, or unknown).

• Vaccination coverage monitoring and risk assessment at the prefecture and

municipality level would ensure no pockets of susceptible population exist for re-

establishing measles transmission.

4.1.6 Recommendations to the NVC of Macao SAR (China)

• Maintain homogenous and high vaccination coverage across the entire population.

• Maintain high levels of surveillance sensitivity and quality.

• Given that most cases were <1 year of age and before the timing of the first

recommended dose, consider advising an earlier supplemental MCV dose to

infants travelling to endemic areas.

- 18 -

4.1.7 Recommendations to the NVC of Malaysia

• In settings with endemic transmission of measles virus, the RVC supports the 2012

TAG recommendation that the second dose of measles vaccine should preferably

be administered in the second year of life.

• School entry requirements for evidence of two doses of measles vaccination would

provide an opportunity for checking that all children at school entry were fully

vaccinated.

• A detailed risk assessment that includes unofficial migrants and districts with low

routine immunization coverage, with implementation of mitigation strategies, is

recommended.

• The RVC notes the gains achieved through focal SIAs. Consideration should be

given to conducting a national/larger-scale wide age range SIA to address

immunity gaps.

4.1.8 Recommendations to the NVC of Mongolia

• Maintain the high level of government awareness, commitment and financial

support to the national measles elimination initiative through: (i) developing a

measles elimination maintenance plan; and (ii) documenting ongoing achievement

of elimination.

• Clarify the methods for determining the numerator and denominator (i.e. target

population) for calculating immunization coverage in the next NVC report.

• Monitor and review reported vaccination coverage and conduct risk assessment at

subnational level to ensure no pockets of susceptible population exist for re-


• Pursue plans with the Ministry of Education to establish a national system for

checking vaccination history at the time of school entry.

• Ensure the sensitivity of surveillance, including case investigation at subnational

level.

• Actively conduct genotyping of all confirmed cases (to confirm genotype of >80%

of chains of transmission).

4.1.9 Recommendations to the NVC of New Zealand

• New Zealand has clearly demonstrated immunity gaps among adolescents and

young adults. The RVC looks forward to learning how these immunity gaps will

be addressed as they pose an ongoing risk of re-established transmission.

• Plans to address immunity gaps should particularly focus on defined risk groups

including low-coverage districts and Pacific peoples who have experienced a

higher disease burden during recent outbreaks.

- 19 -

• There is a need to reconcile current classification criteria of source of infection with

the WHO recommended classification and provide data accordingly.

• The NVC plan should be provided.

4.1.10 Recommendations to the NVC of Papua New Guinea

• Continue implementing the Reaching Every Child strategy to achieve and record

high routine immunization coverage at local levels as recommended by the

International EPI Review.

• The RVC encourages measles elimination activities to be used as an opportunity to

strengthen routine primary health care services including routine immunization.

• The RVC notes and supports the NVC recommendations of conducting risk

assessments and establishing an outbreak response preparedness plan.

• Consider mechanisms to ensure awareness among clinicians and public health staff

of the clinical presentation of measles and appropriate case confirmation,


• Maintain and further improve the laboratory performance of the national measles

laboratory (Central Public Health Laboratory). Genotyping could be performed in

collaboration with WHO Regional Reference Laboratories.

• Strengthen accountability at each level for improving routine vaccination coverage

throughout the country.

4.1.11 Recommendations to the NVC of the Philippines

• To progress towards elimination, it is essential that >95% coverage be achieved in

all communities during the planned 2014 MR SIA.

• The RVC notes with concern the low coverage for MCV2 and encourages the

Philippines to continue with the Reaching Every Purok strategy to achieve and

record high routine immunization coverage with two doses of MCV at local level.

• Accountability should be strengthened at each level for improving routine

vaccination coverage throughout the country.

• Further improvements of epidemiologic surveillance are recommended, including

active case investigation.

• Genotyping should be actively pursued for more of the confirmed cases.

- 20 -

4.1.12 Recommendations to the NVC of the Republic of Korea

• Monitor vaccination coverage and conduct risk assessment at the third

administrative level to ensure no pockets of susceptible population exist for re-


• Prepare and submit the NVC's annual plan of action and a national plan on

preparedness and response to measles outbreaks in the next annual NVC report to

RVC.

• More actively conduct genotyping (to confirm genotype of >80% of chains of

transmission).

• Consider conducting an investigation to determine the apparent higher-than-

expected vaccination failure rate in the Incheon outbreak.

• Continue to conduct thorough outbreak investigations and provide descriptions of

all outbreaks in subsequent annual reports.

• Actively conduct case investigations to identify the sources of infection.

4.1.13 Recommendations to the NVC of Singapore

• Ensure harmonization of data in the NVC report and that submitted to WHO,

especially genotyping data, by including laboratory data from all laboratories

conducting measles and rubella testing.

• More detailed genotype lineage data are needed to differentiate between re-

established transmission and multiple imported strains.

• Genotype as many cases as possible.

• Conduct and provide detailed epidemiological analysis including chains of

transmission, source of infection (imported, import-related, endemic or unknown)

and residence status (resident or visitor).

• The RVC encourages submission of detailed outbreak investigation reports.

• Conduct and provide birth-cohort analysis by year to reflect population immunity.

• Prepare and submit the NVC's annual plan in future reports to the RVC.

4.1.14 Recommendations to the NVC of Viet Nam

• Consider mechanisms to ensure awareness among clinicians and public health staff

of the clinical presentation of measles and appropriate case confirmation,


• Recognizing the challenges of reaching children in mountainous and remote areas,

special efforts should be made to ensure high routine immunization coverage

among these hard-to-reach populations.

- 21 -

• The RVC noted with concern the recent declines in routine immunization coverage

and recommends a detailed evaluation of root causes followed by implementation

of necessary activities.

• Continue to progress the recent strengthening of the surveillance system by fully

investigating suspected measles and rubella cases with collection of appropriate

laboratory specimens including genotyping.

• The RVC draws the attention of the NVC to the recent Strategic Advisory Group of

Experts on Immunization (SAGE) recommendation that following wide age range

catch-up campaigns, countries introducing rubella-containing vaccines (RCV) for

the first time should provide MR or MMR in routine immunization as the first

dose of MCV.

4.2 Recommendations to WHO and M&RI partners

• The RVC encourages WHO and M&RI partners to facilitate international cross-

border and cross-regional collaboration to enhance surveillance, improve routine

and supplemental immunization, and strengthen outbreak response and

information sharing.

• Technical and financial support should be prioritized by WHO and M&RI partners

to the endemic and outbreak-affected countries in the Region.

• Provide guidance to NVCs for submitting to the next RVC meeting risk

assessments and outbreak response plans including for countries and areas

previously verified.

• Provide support to NVCs to standardize the report content, especially for

epidemiological and virological surveillance data including genotyping. Best

practices from previous reports should be considered for dissemination with

country-specific permission.

• Provide support for countries and areas that have not yet submitted reports

(Cambodia, Lao People's Democratic Republic, and the Pacific Islands).

4.3 Partner comments

Partner comments were presented by Andrea Gay on behalf of all five partners of the

Measles & Rubella Initiative:

The M&RI started in 2001 as "the Measles Initiative" with five partner organizations: the

American Red Cross, UNICEF, the United Nations Foundation (UNF), the U.S. Centers for

Disease Control and Prevention (CDC), and the World Health Organization. The M&RI

recognized the work that had been done in this Region, not only by the countries putting these

reports together but by the RVC members who read and evaluated the reports. Ms Gay

acknowledged the importance of this first opportunity for any countries or areas outside of the

Americas to be verified as having achieved measles elimination. She noted that the verification

of Australia, Macao SAR (China), Mongolia, and the Republic of Korea had global implications

that reach beyond the Region and will help motivate and mobilize other regions and countries.

The lessons learnt from the process, the Guidelines, the materials, and planning will be useful to

other regions as they begin their verification process. Lessons from Hong Kong SAR (China),

- 22 -

Macao SAR (China) and Singapore provide important information about the need for very high

coverage with excellent surveillance systems in densely populated urban areas to prevent re-

establishing transmission from multiple importations. China can also serve as an example to

large countries. Lastly, she noted that Tim Wirth, the former Director of UNF once said, “Our

main responsibility is to make sure people want to come back.” She expressed appreciation to

Professor Durrheim, Acting Chair of the RVC and noted that he had achieved this. She

expressed appreciation to the WHO Regional Office for the Western Pacific secretariat for their

support to the meeting.

4.4 Closing session

Closing comments on behalf of the Regional Director for the Western Pacific were shared

by Dr Mark Jacobs. The Regional Director recognized the important role of the M&RI partners

in measles elimination as collaborators in this regional effort. Dr Shin thanked the members of

the RVC for their tremendous efforts in reviewing the NVC reports that were submitted this year.

RVC members were originally appointed to a two-year term of service from approximately

February 2012 to March 2014. Therefore, RVC members were asked to indicate by email to the

Secretariat their willingness to continue serving on the Commission. Finally, he closed by noting

that the verification of the four countries and areas may serve to encourage others in the Region,

noting in particular that the verification of Mongolia highlights an important achievement among

low- and middle-income countries.

4.5 Award ceremony for the Government of the Republic of Korea

Following the close of the meeting, an award ceremony was held to acknowledge the

achievement of the verification of measles elimination by the host country of the meeting, the

Republic of Korea. At the ceremony, the Acting Chair of the RVC, Professor David Durrheim

provided an overview of the verification process and a description of what it means to be verified

as having achieved measles elimination. Next, Dr Mark Jacobs provided the background and

progress towards measles elimination. This was followed by a congratulatory message from the

Dr Shin Young-soo. A certificate of verification of measles elimination from the RVC signed by

Professor Durrheim and a letter of endorsement signed by Dr Shin were presented to

Dr Yang Byungguk, Director for the Korea Centers for Disease Control and Prevention.

THIRD ANNUAL MEETING OF THE REGIONAL VERIFICATION COMMISSION FOR MEASLES ELIMINATION

IN THE WESTERN PACIFIC

ANNEX 1

14 March 2014

English only Seoul, Republic of Korea, 18–21 March 2014

TIMETABLE

Time Tuesday, 18 March 2014 Time Wednesday, 19 March 2014 Time Thursday, 20 March 2014 Time Friday, 21 March 2014

08:00–08:30

08:30–09:00

REGISTRATION

Opening Session

• Opening remarks

• Self-introduction

• Administrative announcements

08:30–09:00

09:00–10:00

9. Review recommendations from

Day 1

10. Report from Macao (China)

08:30–09:00

09:00–09:30

09:30–10:00


Day 2

21. Report from Singapore

22. Draft recommendations to

Singapore

08:30–9:00

09:00–09:30

09:30–10:00


Day 3

32. Report from Papua New Guinea


Papua New Guinea

09:00–09:45 GROUP PHOTO AND COFFEE

BREAK

10:00–10:30 COFFEE BREAK 10:00–10:30 COFFEE BREAK 10:00–10:30 COFFEE BREAK

09:45–10:00

10:00–11:00

11:00–12:00

1. Meeting objectives

2. Global and regional progress on

measles elimination and rubella

control

3. Report from the Republic of Korea

10:30–11:00

11:00–12:00


Macao (China)

12. Report from Mongolia

10:30–11:30

11:30–12:00

23. Report from China


China

10:30–11:30

11:30–12:00

34. Review all recommendations

Closing session:

• Comments by M&R Initiative

o American Red Cross

o UN Foundation

o UNICEF

o US CDC

• WHO Closing remarks

12:00–13:00 LUNCH BREAK 12:00–13:00 LUNCH BREAK 12:00–13:00 LUNCH BREAK 12:00–13:00 LUNCH BREAK

13:00–13:30

13:30–14:30

14:30–15:00

4. Draft recommendations to the

Republic of Korea

5. Report from Australia

6. Draft recommendations to Australia

13:00–13:30

13:30–14:00

14:00–14:30

14:30–15:00


Mongolia

14. Report from Brunei Darussalam


Brunei Darussalam

16. Report from Hong Kong (China)

13:00–13:45

13:45–14:15

14:15–15:00

25. Report from Malaysia


Malaysia

27. Report from the Philippines

14:00–15:00 Presentation to the Government of

the Republic of Korea

15:00–15:30 COFFEE BREAK 15:00–15:30 COFFEE BREAK 15:00–15:30 COFFEE BREAK

15:30–16:30

16:30–17:00

18:00–19:30

7. Report from Japan

8. Draft recommendations to Japan

Regional Director's Reception

15:30–16:00

16:00–16:30

16:30–17:00


Hong Kong (China)

18. Report from New Zealand


New Zealand

15:30–16:00

16:00–16:30

16:30–17:00

28. Draft recommendations to the

Philippines

29. Report from Viet Nam


Viet Nam

15:00–16:30 Reception hosted by the Korea

Centers for Disease Control and

Prevention (KCDC)

ANNEX 2

LIST OF REGIONAL VERIFICATION COMMISSION MEMBERS

OBSERVERS/REPRESENTATIVES AND SECRETARIAT

1. REGIONAL VERIFICATION COMMISSION MEMBERS

Dr Maria Rosario Capeding, Head, Department of Microbiology, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City 1781, Philippines Mobile No. (63) 9178509788. Tel. No. (632) 7724916. Fax No. (632) 7724916 E-mail : [email protected]

Professor David Durrheim, Professor of Public Health Medicine, University of Newcastle District, Locked Bag 10, Wallsend, New South Wales 2287, Australia. Tel. No. (612) 49246395. Fax No. (612) 49246215. E-mail : [email protected].; [email protected]

Dr Kee Tai Goh, Senior Consultant, Ministry of Health, College of Medicine Building, 16 College Road, Singapore 169854, Republic of Singapore. Tel. No. (65) 63258450. Fax No. (65) 62241677 E-mail : [email protected]

Dr Dukhyoung Lee, Director, National Cancer Control Institute, 323 Ilsan-ro, Goyang-si, Gyeonggi-do 410-769, Republic of Korea. Tel. No.: (8231) 9202003. Fax No.: (8231) 9202909. E-mail : [email protected]; [email protected]

Dr Wilina Wei Ling Lim, Honorary Consultant, Department of Health, Hong Kong Government 9F Public Health Laboratory Centre, 382 Nam Cheong Street, Shek Kip Mei, Kowloon Hong Kong. Tel No. :(882) 94994006. Fax No.: (852) 23195989. E-mail : [email protected]

Dr Pagbajabyn Nymadawa, President and Leader, Molecular Epidemiology Team, Mongolian Academy of Medical Sciences, P.O. Box 596, Central Post, Ulaanbaatar 15160 Mongolia. Tel no. : (976) 99112306. Fax no.: (976) 11450267. E-mail : [email protected]

Dr Mark James Papania, Medical Epidemiologist, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, Georgia 30249, United States of America. Tel. No.: (770) 265 6483. Fax No. : (404) 6398761. E-mail : [email protected]; [email protected]

Dr Phan Trong Lan, Director, Pasteur Institute, Hanoi, Viet Nam. Tel. No.: (844) 0913002797. Fax No.: (848) 8231419 E- mail: [email protected]

Dr Bounpheng Philavong, Director, Centre for HIV/AIDS and STI, Ministry of Health, Km3 Thadeua Road, Vientiane, Lao People's Democratic Republic. Tel. No. (856) 20 23671175. Fax No. (856) 21 315500. E-mail : [email protected]

Dr Paul Rota, Lead Scientist, Measles Team, Measles, Mumps, Rubella and Herpesvirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Mailstop C-22, 1600 Clifton Road, Atlanta, Georgia 30333, United States of America. Tel. No.: (404) 6394181. Fax No.: (404) 6394187. E-mail : [email protected]

Dr Soo Thian Lian, Senior Consultant Paediatrician and Head, Paediatric Department, Sabah Women and Children's Hospital, Kota Kinabalu 88996. Tel. No.: (6088) 522600. Fax No.: (6088) 437185. E-mail : [email protected]

Annex 2

Dr John David Vince, Ex-officio Member, National Verification Committee, Director, Taurama Postgraduate and Research Centre, Deputy Dean, School of Medicine and Health Sciences University of Papua New Guinea, Box 5623 Boroko, Papua New Guinea. Tel No.: (675) 73260185. E-mail : [email protected]

Dr Xu Aiqiang, Deputy Director, Shandong Center for Diseases Prevention and Control 16992 Jingshi Road, Jinan, Shandong Province 250014, China. Tel. No.: (86) 531 82679606 Fax No.: (86) 531 82679620. E-mail : [email protected]

Dr Hiroshi Yoshikura, Adviser, Department of Food Safety, Ministry of Health Labour and Welfare, Japanese Government, 1-2-2 Kasumigaseki Chiyoda-ku, Tokyo 100 8916, Japan. Tel. No.: (813) 35952326. Fax No.: (813) 35037965. E-mail : [email protected]

2. REPRESENTATIVES AND OBSERVERS

AMERICAN

RED CROSS

Dr Myrna Charles, Senior Technical Advisor, International Services, American Red Cross, 2025 E Street, NW, 3rd Floor, Washington DC 20006, United States of America. Tel. No.: +1 (202) 303 5243. Fax No.: +1 (202) 303 0052. E-mail : [email protected]

UNICEF Ms Karen Mah, Communicaitons Specialist, Measles and Rubella Initiative, UNICEF, 3 United Nations Plaza, New York, New York 10017, United States of America. Tel. No.: +1 (917) 265 4603. E-mail : [email protected]

Dr Wang Xiaojun, Immunization Specialist, UNICEF East Asia and Pacific Regiona Office, 19 Phra Atit Road, Chanasongkram, Phra Nakorn, Bangkok, 10200, Thailand. Tel. No.: (+662) 3569468. Fax No.: (662) 2803563. E-mail : [email protected]

UNITED

NATIONS

FOUNDATION

Ms Anrea Gay, Executive Director, Children's Health, United Nations Foundation, 1750 Pennyslvania Avenue NW, Suite 300, Washington D.C. 20006 United States of America. Tel. No.: (202) 8879040. Fax No.: (202) 8879021. E-mail : [email protected]

UNITED

STATES

CENTERS FOR

DISEASE

CONTROL AND

PREVENTION

Dr Eugene Lam, Medical Officer, Global Immunization Division, Center for Global Health, Center for Disease Control and Prevention, 1600 Clifton Road, NE Mailstop A-04, Atlanta, Georgia 30333, United States of America. Tel. No.: +1 (404) 7184294. Fax No.: +1 (404) 2350011. E-mail : [email protected]

Annex 2

3. SECRETARIAT

Dr Mark Jacobs, Director, Combating Communicable Diseases, World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines. Tel. No. : (632) 5289701. Fax No.: (632) 5211036. E-mail : [email protected]

Dr Sergey Diorditsa, Team Leader, Expanded Programme on Immunization, World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines. Tel. No.: (632) 5289745. Fax No.: (632) 5211036. E-mail : [email protected]

Dr Youngmee Jee, Scientist and Regional Laboratory Coordinator, Expanded Programme on Immunization, World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines. Tel. No.: (632) 52889744. Fax No. (632) 5211036. E-mail : [email protected]

Dr Jorge Mendoza-Aldana, Technical Officer (Vaccine Safety and Management), Expanded Programme on Immunization, World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines. Tel. No.: (632) 5289751. Fax No.: (632) 5211036. E-mail : [email protected]

Dr William Schluter, Medical Officer, Expanded Programme on Immunization, World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines. Tel No.: (632) 5289748. Fax No.: (632) 5211036. E-mail : [email protected]

Dr Yoshihiro Takashima, Medical Officer, Expanded Programme on Immunization, World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines. Tel. No.: (632) 5289746. Fax No.: (632) 5211036. E-mail : [email protected]

1

Third Annual Meeting of the Regional

Verification Commission for Measles

Elimination in the Western Pacific

Global and Regional Progress on

Measles Elimination and Rubella

Control

1

18-21 March 2014

Sheraton D Cube City Hotel

Seoul, Republic of Korea

Measles and Rubella Targets

Global targets by 2015:

Measles mortality reduction of 95% vs. 2000

Measles reported incidence <5 cases per million

Measles vaccination coverage

national level: 90%

every district: 80%

Regional targets:

Measles Elimination goals:

2000 AMRO

2012 WPRO

2015 EURO, EMRO

2020 AFRO, SEARO

Rubella Elimination goals:

2010 – AMRO, 2015 – EURO

GVAP goal:

2020 Measles and rubella elimination in 5 WHO regions

2

Reported measles cases by WHO

Region, 2000-2012

0

100

200

300

400

500

600

700

800

900

Re

po

rte

d n

um

be

r o

f ca

ses

10

00

s

Year

WPR

SEAR

EUR

EMR

AMR

AFR

0.1

1.0

10.0

100.0

1,000.0

Me

asl

es

inci

de

nce

pe

r m

illi

on

po

pu

lati

on

(lo

g s

cale

)

GOAL

AFR

EMR

EUR

SEAR

WPR

AMR

GLOBAL

needed

2015 Goal

Projected 10-

yr trend

Trend to

reach

goal

77% Reduction in Global Measles Incidence per Million Population, 2000-2012

4

ANNEX 3RVC Presentation

2

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Reported Measles Incidence Rate*,

Feb 2013 to Jan 2014 (12M period)

*Rate per 1'000'000 population

Data source: surveillance DEF file

Data in HQ as of 10 March 2014

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 2014. All

rights reserved.

<1 (83 countries or 43%)

≥1 - <5 (35 countries or 18%)

≥5 - <10 (12 countries or 6%)

≥10 - <50 (38 countries or 20%)

≥50 (14 countries or 7%)

No data reported

to WHO HQ

(12 countries or 6%)

Not applicable

0.7 1.4 2.3 3.2 4.15.2 6.3

7.6 8.910.1 11.3 12.5 13.8

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Est

ima

ted

me

asl

es

de

ath

s (m

illi

on

s)Year

Estimated measles deaths in absence of vaccination

(numbers give the cumulative number of deaths prevented in millions)

95% CI of estimated measles deaths with vaccination

Estimated measles deaths with vaccinationDeaths averted by measles vaccination

Global estimated measles mortality and measles

deaths averted, 2000 - 2012

78% reduction from 2000 to 2012

Measles Surveillance System Sensitivity

Feb 2013 to Jan 2014 (12M period)

reporting rate of discarded cases* per 100'000 population**

Target: at least 2 discarded cases

per 100'000 population by country

in last 12 month period.

*discarded cases are suspected

measles cases which have been investigated

and discarded as non-measles cases using

laboratory testing and/or epidemiological-

linkage.

** World population prospects, 2012 revision.

Data source: surveillance DEF file

Data in HQ as of 10 March 2014






rights reserved.

≥2 (60 countries or 31%)

>1 - <2 (23 countries or 12%)

≤1 (48 countries or 25%)

No case based

surveillance or

No or insufficient data reported

(63 countries or 32%)

Not applicable

16

1920

37

42

4847

54

63

68

73

69 6970

7273 73

7172 72

73 7372

74

7776

81 81

8384 84 84 84

86

88

90

0

10

20

30

40

50

60

70

80

90

100

MC

V1

Co

ve

rag

e*

(%)

Global AFR SEAR EMR AMR EUR WPR

Global coverage has levelled off at 84%1st Dose measles vaccine coverage by WHO region, 1980-2012

8

Source: WHO/UNICEF coverage estimates 2012 revision. July 2013; Immunization Vaccines and Biologicals, (IVB), World Health Organization.

194 WHO Member States. Date of slide: 17 July 2013

Annex 3

3

Weak Immunization Systems

• 21 million infants

missed MCV1 in 2012

• 2/3 live in

– India

– Nigeria

– Ethiopia

– Indonesia

– Pakistan

– DRC

21 million infants not immunized (MCV1), 2012

India, 6.37

Nigeria, 3.76

Ethiopia, 1.00Indonesia, 0.92

Pakistan, 0.73Democratic Republic

of the Congo, 0.68

Philippines, 0.35

United States of

America, 0.34

Afghanistan, 0.31

Iraq, 0.31

Rest of the world,

6.38

0 2,400 4,8001,200 Kilometers

Measles 2nd dose introductions planned in 9 more

countries during 2013-14

10

Not available

Not applicable

No (39 member states or 20%)

Introduced or planned 2013-2014 (9 member states or 5%)

Introduced prior to 2013 (146 member states or 75%)

2013: Kenya, Rwanda, Sao Tome e Principe,

Zambia

2014: Burkina Faso, Nepal, Senegal, Sierra

Leone, Tanzania

Data in HQ as of 15 October 2013

Measles campaigns in 32 countries in 2012

11

Vitamin A – 18

De-worming – 11

Bed nets – 1

OPV – 18

Other interventions -8 Not Applicable

Not Available

Measles (10)

Measles and OPV (15)

Measles and Rubella (7)

• 112 million children reached• 81% (26 of 32) SIAs integrated 1

or more other interventions

Not applicable

Distribution of measles genotypes

from Jan to Dec 2013

Data source: MeaNS Database

Updated on 03 February 2014






rights reserved.

Annex 3

4

In the Western Pacific Region

13

• 2003: Measles elimination to be used to strengthen

routine immunization

• 2005: By 2012, the Region should aim to eliminate

measles;

• 2010: Reaffirms the 2012 measles elimination goal and

calls to accelerate control of rubella; and to develop

regional verification mechanism;

• 2012: Reaffirms the commitment to eliminate measles

and accelerate rubella control; NVCs should develop and

submit regular reports to the RVC

Regional Measles and Rubella Goals

• Measles

– The TAG urges countries to make intensified efforts to

accelerate progress towards achieving and sustaining

measles elimination.

• Rubella

– The TAG recommends establishing a regional goal of

eliminating rubella, with a target date to be determined

Technical Advisory Group on Immunization

Recommendations, June 2013

Line of Evidence 1: Measles Epidemiology

Measles Cases by Month and Year, Region, 2008–2013

Data as of 20 February 2014Source: National measles and rubella monthly report

0

5 000

10 000

15 000

20 000

25 000

30 000

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2008 2009 2010 2011 2012 2013

Number of measles cases

China Japan Philippines Viet Nam Others

Annex 3

5


Measles incidence per million population by country/area, WPR, 2013

Source: National measles and rubella month reports as of 20 February 2014

0

5

10

15

20

25

BRN KHM MNG PIC NEZ PNG JPN KOR HOK MAC MYS AUS VNM LAO SGP CHN PHL

Source: National measles and rubella country reports by 20 February 2014

Source of infection

Method of confirmation

Total

Laboratory Epi-linked

Imported 90 2 92

Import-related 141 9 150

Unknown 29 625 848 30 473

Endemic 121 45 166

Total 29 977 904 30 881


Source and method of measles case confirmation, WPR, 2013

Source: WPRO surveillance database and WHO-UNICEF JRF

¹ Data as of 20 February 2014

2

Only lab and epi linked cases for 2013

Category Target 2009 2010 2011 2012 2013

Quality of epidemiological

surveillance

National reporting of discarded

measles cases

> 2 per

100,0002.8 1.7 2.8 2.4 3.5

% of 2nd level admin units reporting

≥ 2/100 000 discarded measles cases> 80% 23% 28% 40% 35% 38%

% of suspected cases with adequate

investigation> 80% 38.% 74% 70% 89% 94%

% of suspected cases with adequate

blood specimens > 80% 79% 89% 78% 93% 92%

Quality of laboratory surveillance

% of specimens with results <7 days > 80% 54.9 41.4 78.5 96.0 84.2

% of specimens with results <4 days > 80% 66.3

Line of Evidence 2: Quality of Surveillance Systems

Regional surveillance indicators, WPR, 2009-2013

+331 prefectural labs

1 GSL3 RRLs17 National (15 fully functional)31 provincial in China + 3 subnational labs in Vietnam(2) and Malaysia added + 331 prefectural

386 laboratories: WHO Accredits 53 labs

New sub-national labs

Line of Evidence 2: Quality of Surveillance Systems

Fully WHO accredited laboratory network, WPR, March 2014

Annex 3

6

Line of Evidence 3: Population Immunity

MCV1 and MCV2 coverage and reported cases, 1980-2012

21

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

200

400

600

800

1000

1200

1400

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Measles cases Rubella Cases

Source: WHO-UNICEF Joint Reporting Form (data for 2012)

Category 2009 2010 2011 2012 2013

High population immunity

% countries with MCV1 ≥90% 57% 66% 70% 76%

% countries with MCV1 ≥80% in all

dist46% 46% 41% 63%

Source: WPRO surveillance database and WHO-UNICEF JRF

¹ Data as of 20 February 2014

2

Only lab and epi linked cases for 2013


Regional estimates of population measles immunity, WPR, 2009-2012


MCV2 introduction into routine EPI in (region) 2014


MCV2 introduction into routine EPI in (region) 2014

Only 4 countries or areas have not yet introduced

MCV2:

• Lao People’s Democratic Republic

• Papua New Guinea: 2013 GAVI application

• Solomon Islands

• Vanuatu

With MCV2

With no MCV2


Measles Supplemental Immunization Campaigns, WPR, 2013-2015

24

Country Vaccine Target Age Dates Geographic Extent

Micronesia MR 9-59 m Jul 2013 Chuuk State

Vanuatu MR 9-59m Q2 2013 Nationwide

Cambodia MR 9m-15y Q4 2013 Nationwide

Micronesia MMR 12-59 m Jun 2014 Pohnpei State

Viet Nam MR 9m-15yQ3 2014 –

Q2 2015 Nationwide

Philippines MR 9-59 m Sept 2014 Nationwide

Lao PDR MR 9-59 m Nov 2014 Nationwide

Papua New Guinea MR 9m-15y 2015 Nationwide

Solomon MR 9m-15y 2015 Nationwide

Annex 3

7

D4

D8

D9

D11

G3

H1

B3

* Reports as of 20 February 2014

Line of Evidence 5: Genotyping Evidence

Genotypic distribution of measles virus, WPR, 2013

Line of Evidence 5: Genotyping Evidence

Genotypic distribution of measles virus, WPR, 2013Regional Progress Towards Verification,

March 2014

Categories Countries and Areas

1 Requesting verification Australia, Japan, Macao (China),

Mongolia, Republic of Korea

2 <36 months since achieving

interruption of endemic measles

transmission

Cambodia, New Zealand

3 May have interrupted endemic

transmission

Brunei Darussalam, Hong Kong

(China), Singapore

4 Few or no cases, but surveillance

of uncertain quality

Pacific islands, Papua New Guinea

5 Periods with low/no documented

transmission followed by

outbreaks

Lao People’s Democratic Republic,

Viet Nam

6 Ongoing active transmission China, Malaysia, the Philippines

26

News on Recent Measles Outbreaks

27

Confirmed measles cases by month of rash onset, Philippines, 2013

*National measles and rubella monthly reports as of 20 February 2014

*Clinically confirmed is not applicable for 2013

0

200

400

600

800

1000

1200

1400

1600

1800

Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov

2009 (N=1490)

Lab & Epi=668

Clinically=822

2010 (N=6388)

Lab & Epi=3020

Clinically=3368

2011 (N=6555)

Lab & Epi=3411

Clinically=3144

2012 (N=1473)

Lab & Epi=599

Clinically=874

2013 (N=2440)

Lab & Epi=2440


Laboratory Epi-Linked Clinically

Annex 3

8

Laboratory and epi-linked confirmed measles cases by province,

Philippines, 2012 and 20131

1 dot = 1 case

20122013

1National measles and rubella monthly reports as of 20 February 2014

Dots are placed at random within the corresponding

province, and might not reflect the exact location of the case.

DISCLAIMER: The boundaries and names shown and the designations used on the maps 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 Regional Office for the Western Pacific 2009. All rights reserved.

D9

genotype

B3

genotype

Laboratory and epi-linked confirmed measles cases by age group and

vaccination status, Philippines, 2013 (N=2440)


0

100

200

300

400

500

600

700

800

<1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-24 yrs 25-39 yrs ≥40 yrs

Me

asl

es

case

s

0 dose 1 dose ≥2 doses Unknown

0

100

200

300

400

500

600

700

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 ≥40

Measles cases

Age in years


Laboratory and epi-linked confirmed measles cases by age in year and

vaccination status, Philippines, 2013 (N=2440)


32

Emergency Outbreak Response Immunization Campaign

Philippines, Jan 22 to Feb 14, 2014

Annex 3

9

33

0

100

200

300

400

500

600

01

/01

/20

14

02

/01

/20

14

03

/01

/20

14

04

/01

/20

14

05

/01

/20

14

06

/01

/20

14

07

/01

/20

14

08

/01

/20

14

09

/01

/20

14

10

/01

/20

14

11

/01

/20

14

12

/01

/20

14

13

/01

/20

14

14

/01

/20

14

15

/01

/20

14

16

/01

/20

14

17

/01

/20

14

18

/01

/20

14

19

/01

/20

14

20

/01

/20

14

21

/01

/20

14

22

/01

/20

14

23

/01

/20

14

24

/01

/20

14

25

/01

/20

14

26

/01

/20

14

27

/01

/20

14

28

/01

/20

14

29

/01

/20

14

30

/01

/20

14

31

/01

/20

14

01

/02

/20

14

02

/02

/20

14

03

/02

/20

14

04

/02

/20

14

05

/02

/20

14

06

/02

/20

14

07

/02

/20

14

08

/02

/20

14

09

/02

/20

14

10

/02

/20

14

11

/02

/20

14

12

/02

/20

14

13

/02

/20

14

Measles Cases by rash onset and case classification,

Philippines, 2014

PENDING MEASLES COMPATIBLE EPI-LINKED CONFIRMED MEASLES LABORATORY CONFIRMED MEASLES

Source: National Epidemiology Center (as of February 15, 2014)

Note: 670 Cases with unknown rashonset

Outbreak response immunization

campaign from 22 Jan to 14 Feb

targeting 2.2 million children 6-36 months

of age

Confirmed measles cases by month of onset,

Malaysia, 2009–2013



0

50

100

150

200

250

300

350

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2009 (N=56)

Lab & Epi=55Clinically=1

2010 (N=74)


2011 (N=1603)


2012 (N=2112)


2013 (N=174)

Lab & Epi=174



Laboratory and epi-linked confirmed measles cases,

Malaysia, 2012–20131

1 dot = 1 case

2012

2013








Laboratory and epi-linked confirmed measles cases by age

group and vaccination status, Malaysia, 2013 (N=174)


group and vaccination status, Malaysia, 2013 (N=174)


0

10

20

30

40

50

60

70


Me

asl

es

case

s


Annex 3

10

Confirmed measles cases by month of rash onset, China, 2013


Source: Measles Surveillance System (MSS)

Laboratory and epi-linked confirmed measles cases by province, China,

2012 and 20131

Note: Dots are placed at random within the county, and might not reflect the exact location of the case within the county.

2012 2013



vaccination status, China, 2013


Age distribution of measles cases, China, 2013

Age (months)

<1 year: 50%

1-4 years: 19%

5-19 years: 5%

≥20 years: 26%

Annex 3

11

Select Recommendations from National / International

Consultation on Measles, China, June 2013

• Provincial (or smaller) SIAs needed to fill

immunity gap

• Survey population coverage among young

children at national and subnational levels

• Develop stronger immunization practice

standards to reduce missed opportunities

• Reduce nosocomial transmission of

measles by reducing admissions, isolating

cases, and vaccinating health workers

Measles in Viet Nam, 2014

Confirmed measles cases by month of rash onset, Viet Nam, 2013



0

200

400

600

800

1000

1200

1400

1600

1800

2000

Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov

2009 (N=5222)

Lab & Epi=4958

Clinically=264

2010 (N=1826)

Lab & Epi=847

Clinically=979

2011 (N=745)

Lab & Epi=103

Clinically=642

2012 (N=550)

Lab & Epi=5

Clinically=545

2013 (N=802)

Lab & Epi=802



Laboratory and epi-linked confirmed measles cases by province, Viet Nam, 2012 and 20131

1

National measles and rubella monthly reports as of 20 February 2014

1 dot = 1 case



2012 2013





H1

genotype

D8

genotype

Annex 3

12


vaccination status, Viet Nam, 2013 (N=802)


0

50

100

150

200

250

300

350

400


Me

asl

es

case

s


Confirmed measles cases by month of rash onset, Lao PDR, 2013



0

10

20

30

40

50

60

70

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2009 (N=72)

Lab & Epi=72

Clinically=0

2010 (N=153)

Lab & Epi=6

Clinically=147

2011 (N=113)

Lab & Epi=29

Clinically=84

2012 (N=36)

Lab & Epi=32

Clinically=4

2013 (N=68)

Lab & Epi=68



Laboratory and epi-linked confirmed measles cases by province, Lao

PDR, 2012 and 20131


1 dot = 1 case



2012 2013






vaccination status, Lao PDR, 2013 (N=68)


0

2

4

6

8

10

12

14

16

18

20


Me

asl

es

case

s


Annex 3

13

Rubella-containing vaccine introduction in (region) 2013Rubella-containing vaccine introduction in (region) 2013

Only 4 countries and areas have not introduced

RCV in RI in 2013:

• Cambodia: 2013 MR SIA (9 mos to <15 years)

• Papua New Guinea: 2013 GAVI application

• Vanuatu: 2013 MR SIA (9 to 59 months)

• Viet Nam: 2014 MR SIA

With RCV

With no RCV

Summary

• In 2013, number of measles cases and incidence markedly

increased since 2012

– Large and ongoing outbreaks in China, Philippines and Viet Nam

• 99% of confirmed cases have unknown source of infection

• Epidemiological and laboratory surveillance performance are high

and improving

– Increased sensitivity needed at subnational levels

• Very high regional routine immunization coverage but significant

heterogeneity among countries/areas and districts

• All but three countries have introduced (or planned) routine MCV2

• Many countries still require periodic measles SIAs to increase

population immunity

• Multiple genotypic changes in the Region should be considered

when assessing virological data 50

Acknowledgements

• WHO/HQ (slides 2-12)

• Department of Health, Philippines (slide 33)

• China CDC (slide 40)

51 52

Annex 3

14


Singapore, 2009–2013



0

5

10

15

20

25

30

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2009 (N=16)

Lab & Epi=16

Clinically=0

2010 (N=54)

Lab & Epi=54

Clinically=0

2011 (N=143)

Lab & Epi=143

Clinically=0

2012 (N=40)

Lab & Epi=37

Clinically=3

2013 (N=56)

Lab & Epi=56




Singapore, 2012–20131

1 dot = 1 case

2012

2013









group and vaccination status, Singapore, 2013 (N=56)


group and vaccination status, Singapore, 2013 (N=56)


0

5

10

15

20

25


Me

asl

es

case

s



Hong Kong (China), 2009–2013



0

1

2

3

4

5

6

7

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2009 (N=22)

Lab & Epi=9

Clinically=13

2010 (N=11)

Lab & Epi=4

Clinically=7

2011 (N=12)

Lab & Epi=7

Clinically=5

2012 (N=8)

Lab & Epi=5

Clinically=3

2013 (N=34)

Lab & Epi=34



Annex 3

15


Hong Kong (China), 2012–20131

1 dot = 1 case

2012

2013









group and vaccination status, Hong Kong (China), 2013 (N=34)


group and vaccination status, Hong Kong (China), 2013 (N=34)


0

2

4

6

8

10

12

14

16


Me

asl

es

case

s0 dose 1 dose ≥2 doses Unknown


Papua New Guinea, 2009–2013



0

1

2

3

4

5

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2009 (N=0)Lab & Epi=0

Clinically=0

2010 (N=0)Lab & Epi=0

Clinically=0

2011 (N=0)Lab & Epi=0

Clinically=0

2012 (N=0)Lab & Epi=0

Clinically=0

2013 (N=7)Lab & Epi=7




Papua New Guinea, 2012–20131

1 dot = 1 case

2012

2013








Annex 3

16


group and vaccination status, Papua New Guinea, 2013 (N=7)


group and vaccination status, Papua New Guinea, 2013 (N=7)


0

1

2

3

4


Me

asl

es

case

s



New Zealand, 2009–2013



0

20

40

60

80

100

120

140

160

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

2009 (N=253)Lab & Epi=190

Clinically=63

2010 (N=48)Lab & Epi=36

Clinically=12

2011 (N=599)Lab & Epi=533

Clinically=66

2012 (N=55)Lab & Epi=50

Clinically=5

2013 (N=3)Lab & Epi=3




New Zealand, 2012–20131

1 dot = 1 case

2012 2013









group and vaccination status, New Zealand, 2013 (N=3)


group and vaccination status, New Zealand, 2013 (N=3)


0

1

2

3


Me

asl

es

case

s


Annex 3

ANNEX 4

Award Ceremony Photo

Award ceremony in Seoul, Republic of Korea, 21 March 2014.

www.wpro.who.int

third annual meeting of the regional verification …participants of the third annual meeting of the...

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