update of the regional immunization programme2015” (wha58.15) world health organization •...
TRANSCRIPT
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization WHO Region for Western Pacific
November 2010 SAGE Meeting
Update of the Regional Immunization Programme
Geneva October 9, 2010
Dr David H. Sniadack, Ag. Team Leader, EPI
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Outline
• Technical Strategic Framework (TSF) • Targeted disease and EPI mandates • Targeted disease updates and linkages to routine
immunization and health systems and child health
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
EPI Mandates - GIVS
“58th WHA urges Member States to adopt the Global Immunization Vision and Strategy as the framework for strengthening of national immunization programmes between 2006 and 2015” (WHA58.15)
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Programme Objectives (Level B) PO 1: Maximize equitable access of vaccine of assured quality to
control VPDs, including pandemic vaccine PO 2: Achieve targeted disease eradication, elimination and control
(polio, measles/rubella, Hep B, MNTE) PO 3: Promote rational introduction of new vaccines PO 4: Strengthen VPD surveillance, lab, monitoring and data use PO 5: Strengthen partnerships, advocacy & communication, and
integration
EPI Technical Strategic Framework
Reduce mortality, morbidity, and disability from vaccine-preventable diseases
Health Goal (Level A)
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Targeted Disease Mandates: RC Resolutions Eradication, Elimination & Control of Specific VPDs
• Polio eradication (1988-2001, 2003, 2005, 2010)
• Measles elimination (2003, 2005, 2010)
• Rubella Control & CRS Prevention (2003, 2010)
• Hepatitis B Control (2003, 2005, 2010)
WPRO EPI Technical Strategic Framework Programme Objective 2
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Routine Immunization Strengthening through Targeted
Disease Approaches The Regional Committee
• recognizing the positive impact of poliomyelitis eradication in the Western Pacific Region on the Expanded Programme on Immunization (EPI) and the wider health sector
• DECIDES that, in the Western Pacific Region, measles elimination and hepatitis B control should be the two new pillars to strengthen the EPI; WPR/RC54.R3
54th Regional Committee Resolution (2003)
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
SIA Linkage to “Routine” Immunization Vax/Log/CC forecast
Vax/Log/CC Management
Operational Planning
Approach Staffing Supplies Safety/Waste
Fixed Site Outreach Temporary Mobile
Monitoring
Supervision Registration Books
Report Forms Tally Forms
Wall Charts
Data Management Coverage Surveillance Indicators
Advocacy, Soc Mob, Communication Partnerships & Financing
Risk Management/ AEFI Surveillance
SIAs incorporate
all aspects of routine
immunization
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
SIA Linkage to Child Health
• Multi-antigens (OPV, DTP/Pentavalent, Measles, TT) • Referral slips for drop-outs/left-outs • Vitamin A, other micronutrients • Deworming medicine • Insecticide-treated bednets • Hand washing/soap • Ante-natal care / Family Planning
1
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization • Source: WHO/UNICEF JRFs ,1980-‐2009
Reported Measles Cases and MCV1 Coverage Western Pacific Region 1980 – 2009*
93%
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Measles “Catch-‐Up” SIAs Western Pacific Region,
1994-‐2010
2008
2003 – 2007
2009
2010
LEGEND:
None
1994 – 2002
1990-1995: measles control 1996-2002: accelerated measles control 2003-2012: measles elimination Source: country SIAs reports
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
SIAs in China 2004-2009 (rolling by province)
• Catch up – 8m-14y: 25/31 provinces • Follow up – 8m-6y: 6 provinces • 160 million vaccinated; coverage ~95%
2010 (nationwide) • 8m-14y: 5 provinces • 8m-6y: 3 provinces • 8-59m: 23 provinces • 102.3 million vaccinated; coverage ~97%
(unoffical, as of Sept 29, 2010)
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
At/near (25)
Likely (5)
LEGEND
Hopefully (7)
4.1% of the regional popula]on
2.6% of the regional popula]on
93.3% of the regional popula]on
Feasibility of Measles Elimina]on by 2012, Western Pacific Region
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization Source: WHO/IVB database, 2010
Reported Vaccination Coverage, Western Pacific Region 1980-2009
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Percent of Districts, by Category of DTP3 Coverage, WPR 2007 - 2009
2007 2008 2009
77% ≥ 90% 70% ≥ 90% 76% ≥ 90%
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Completeness and Timeliness of Country Repor]ng to the Western Pacific Regional Office, 2007-‐2010*
• Reporting through September 2010. Source: WPR surveillance database
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Rubella Rou]ne Immuniza]on Western Pacific Region, 2009
Not Offering (6)
MR (7)
MMR (23)
Type of vaccine:
30 (83%) already use RCV
MR at 8 months MMR at 18-‐24 months
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
< 1.0 (21)
1.0 – 9.9 (8)
10.0 – 19.9 (3)
LEGEND:
20.0 - 99.9 (4)
Rubella Incidence* Western Pacific Region, 2009
Source: WHO-UNICEF Joint Reporting Forms
* per million population
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Hepatitis B Control Milestone Status, By Country and Area, WPR, 2010
ASM
NRU
FJI
MHL
SIN
COK
FSM
BRU
AUS
FRP
NEZ
PHL VTN
GUM
NEC
KIR
PNG
LAO
CAM
MAA
NIU
KOR
JPN MON
CHN
NMI
MAC
SMA
VAN
BLA
WAF
TOK
TON
HOK
TUV
SOL
Priority: have not reached coverage targets (≥85% HepB3 and ≥65% HepB BD)
On-track: reached coverage targets or conducted seroprevalence surveys
Certified: <2% chronic infection among 5y
9 priority countries Intersection of EPI and MCH
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Hepatitis B Control Milestone Status, by Category, Western Pacific Region 2010
*At least 9 countries; some countries with prevalence data need more
Category Actions Countries and Areas
Low vaccination coverage
Detailed action plans 5 non -‐ PICs (CAM, PNG, PHL, LAO, VTN) 4 PICs (VAN, SMA, SOL, KIR)
Lack prevalence data
Survey options for certification
9 PICs (COK, FRP, FSM, GUM, NAU, NUI, TOK, TUV, WAF)*
Have prevalence data
ERP guidance to certify or get more data
5 non -‐ PICs (AUS, CHN, JPN, NEZ, SIN) 7 PIC (ASM, CMNI, FIJ, NEC, BLA,TON, MSI)
Surveys in process
Not Urgent 2 (BRU, MOG)
Certification in process
Not Urgent 2 (HOK, MAA)
Certified Not Urgent 2 (KOR, MAC)
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Maternal and Neonatal Tetanus Elimination (MNTE)
• All countries, except five (Cambodia, China, Laos, Philippines, Papua New Guinea) have achieved MNTE
• New plan of action focusing on integrated approach with MCH programme in progress in three countries (Cambodia, Laos and the Philippines)
21
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
The Region has maintained polio free status
for more than consecutive years
18
Distribution of AFP and Laboratory-Confirmed Polio Cases, by District*, Tajikistan, 2010
= 1 Confirmed wild poliovirus type 1 - Total 455 cases
= Districts with AFP Cases
Data as of 20 Aug 2010 *Dots are placed randomly within district
Source: Weekly AFP reporting to WHO European Region 22
China
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Wild Poliovirus Importation Risk Assessment Parameters
• Population immunity - National and district coverage, trends, last SIA
• Surveillance performance - NPAFP rate; % adequate stool; sub-national gaps
• Programme performance - Dropout rates; stock outs; importation preparedness
plan • Threat
- Probability of importation; bordering polio affected areas
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Low risk (30 countries and areas)
Medium risk (CHN, MAA, PHL, VTN)
High risk (CAM, LAO, PNG)
LEGEND:
Risk Assessment of Wild Poliovirus Importation Western Pacific Region
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Risk Assessment of Wild Poliovirus Importation Western Pacific Region
• High risk – Cambodia: subnational coverage gaps, seriously declining AFP
surveillance, last SIA in 2006 – Lao PDR: low coverage levels, surveillance challenges – Papua New Guinea: low coverage levels, large variance
subnationally, low surveillance quality
• Medium risk – China: subnational coverage and surveillance gaps, mainly due
to population movements (“floating population”) – Malaysia: mainly surveillance challenges in some states – Philippines: mainly based on inadequate AFP surveillance but
also subnational coverage gaps – Viet Nam: mainly subnational surveillance challenges
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Summary Impact of Targeted Disease Initiatives on Routine Systems
• SIAs (polio, measles, rubella, TT, etc.) - Focus on programmatic quality at several levels - Opportunities for integrated health initiatives - Advocacy for immunization
• Hep B - Need for 65% Hep B BD creates linkages with MCH, HIV/AIDS
• MNTE - Need to vaccinate pregnant and/or CBA women creates linkages with
MCH and is being implemented in CAM, LAO, PHL • Polio
- Importation risk assessment and preparedness requires careful review of routine systems and addressing immunity and surveillance gaps
All targeted disease initiatives include strong routine immunization programmes as their #1 strategy
World Health Organization • Western Pacific Regional Office • Expanded Programme on Immunization
Thank You