Download Vaccine-Preventable Disease Control in the Western Pacific Region

Vaccine-Preventable Disease Control
in the Western Pacific Region
Mark Jacobs
Director, Communicable Diseases
Outline
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Regional goals
Disease-specific updates
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Hepatitis B
Measles
Polio
Rubella
Tetanus
Remaining challenges
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Regional goals related to specific
vaccine-preventable diseases
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Hepatitis B: Reduce chronic infection rate among 5-yearolds to less than 1%
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Japanese encephalitis: To accelerate control
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Measles: To achieve and sustain measles elimination
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Polio: Sustain regional polio-free status until global
certification; eliminate vaccine-derived poliovirus risk
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Rubella: Eliminate rubella and prevent congenital rubella
syndrome
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Tetanus: By 2015 to achieve maternal and neonatal
tetanus (MNT) elimination
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Hepatitis B goal
64th WHO WPRO Regional Committee Meeting,
October 2013
Resolution WPR/RC64.R5:
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The Western Pacific Region should aim to reduce
HBsAg seroprevalence to less than 1% in 5-year-old
children by 2017;
– Ensure at least 95% coverage of the eligible population at the
national level of the hepatitis B vaccination regimen (including
the birth dose), and at least 85% coverage in all districts
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Hepatitis B birth dose coverage
improvement strategies
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Increase health facility deliveries
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Increase hepatitis B education during ANC
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Increase links with communities and outreach
vaccination
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Use hepatitis B outside the cold chain where needed
(with guidelines and NRA approval)
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Hepatitis B vaccination coverage,
Western Pacific Region, 1990-2014
100
V
a
c
c
i
n
a
t
i
o
n
C
o
v
e
r
a
g
e
90
80
70
60
50
40
30
20
(
%
)
10
0
2014
2013
2012
2011
2010
2009
HepB Birth Dose Coverage
2008
2007
2006
2005
2004
2003
2002
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2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
HepB3 Coverage
Status of verification towards reaching the
<1% prevalence goal, WPR, 2015
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Impact of hepatitis B vaccination
and birth dose
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>7 million deaths estimated to have been prevented by
hepatitis B vaccination in the Western Pacific Region in
the past 25 years
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548 094 deaths prevented by hepatitis B vaccination
among children born in 2014
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Regional hepatitis B prevalence now estimated to be
0.96% among children in 2012 birth cohort (those who
will be 5 years old in 2017)
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Key challenges for hepatitis B
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Birth dose vaccination coverage is still low in several
countries (Lao PDR, Papua New Guinea, the
Philippines, Solomon Islands, Viet Nam)
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Recent hepatitis B related AEFIs led to increased
vaccination hesitancy in some countries
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Even with high coverage, substantial numbers of new
infections (50 000) are occurring among new birth
cohorts in China
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Goal of measles elimination
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In 2005, WPRO Regional Committee resolved to
achieve measles elimination by 2012
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In 2012, WPRO Regional Committee reaffirmed its
commitment to eliminate measles as quickly as possible
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The World Health Assembly endorsement of the Global
Vaccine Action Plan includes goals that:
– By 2015, four of six WHO regions achieve measles elimination
– By 2020, five of six WHO regions achieve measles elimination
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Key facts on measles elimination
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Measles is one of the leading causes of death among young children
even though a safe and cost-effective vaccine is available
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In 2013, there were 145 700 measles deaths globally – about 400
deaths every day or 16 deaths every hour
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Measles vaccination resulted in a 75% drop in measles deaths
between 2000 and 2013 worldwide
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In 2013, about 84% of the world's children received one dose of
measles vaccine by their first birthday through routine health services
– up from 73% in 2000
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During 2000-2013, measles vaccination prevented an estimated
15.6 million deaths making measles vaccine one of the best buys in
public health
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Key strategies for measles elimination
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Achieve and maintain high (>95%) coverage with two
doses of measles containing vaccine
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Monitor disease using effective case based surveillance
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Develop and maintain outbreak preparedness
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Communicate and engage the community to create
demand for vaccination
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Reported Measles Incidence Rate*,
Jul 2014 to Jun 2015
*Rate per 1'000'000 population
<1
(73 countries or 38%)
≥1 - <5
(36 countries or 19%)
≥5 - <10
(18 countries or 9%)
≥10 - <50
(30 countries or 15%)
≥50
(20 countries or 10%)
No data reported (17 countries or 9%)
to WHO HQ
Not applicable
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Data source: surveillance DEF file
Data in HQ as of 10 August 2015
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 2015. All
rights reserved.
Reported confirmed measles cases by month of
onset, Jan 2010-Jun 2015, Western Pacific Region
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Summary of Progress Towards Measles Elimination,
as assessed by the Regional Verification Commission, March 2015
Categories
Countries, Areas,
Epidemiological Blocks
Verified as having achieved
1
elimination
Australia, Brunei Darussalam,
Cambodia, Japan, Macao (China),
Mongolia, Republic of Korea (n=7)
<36 months since achieving
2 interruption of endemic measles
transmission
New Zealand (n=1)
May be ready for verification but
3
additional information needed
4
Periods with low/no documented
transmission followed by outbreaks
5 Ongoing measles virus transmission
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Hong Kong SAR (China), Singapore
(n=2)
Lao People’s Democratic Republic,
Pacific islands (n=2)
China, Malaysia, Papua New Guinea,
the Philippines, Viet Nam (n=5)
Key challenges in measles elimination
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Measles virus is one of the most (or perhaps the most)
infectious of all viruses
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Very high (>95%) population immunity required
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Complacency or vaccine hesitancy because measles is
considered a “benign childhood illness” rather than
recognized as the fifth leading cause of death among
children under 5 years of age
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Immunity gaps among very young children (eg too
young to be vaccinated) and adult populations that
missed vaccination and not previously infected
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Goal of polio eradication
1954: Jonas Salk develops a
killed polio virus.
1961: Albert Sabin develops an
oral polio vaccine.
1988 World Health Assembly resolved to eradicate polio by 2000
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Progress on polio eradication
1988: 125 countries;
350,000 cases per year
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2015: 2 countries with
reported cases;
36 cases year to date
Progress on polio eradication
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Poliovirus types
– Type 1: Ongoing transmission
– Type 2: Last reported from India in 1999
– Type 3: Last reported from Nigeria in 2012
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Regional certification of polio-free status
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–
–
–
–
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1994:
2000:
2002:
2014:
2014:
Region of the Americas
Western Pacific Region
European Region
South East Asia Region
Last wild poliovirus case reported from African Region
Key strategies for polio eradication
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Poliovirus detection and interruption: Maintaining
sensitive surveillance systems worldwide
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Strengthening immunization systems and
withdrawal of OPV: Introduce at least one dose of IPV
and switch from tOPV to bOPV
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Containment and certification: Contain polioviruses
and potentially infected waste to prevent accidental
reintroduction
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Legacy planning: Turn over polio programme assets
for use in other disease control programmes
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IPV introduction in the Western Pacific
Approximate number of live births 2012 (JRF)
IPV using country/area
Country/area with sequential (IPV/OPV) schedule
OPV country/area not GAVI eligible
OPV country/area eligible for GAVI support for IPV
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Key challenges for polio eradication
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Reaching children in insecure border area of Afghanistan
and Pakistan where polio workers have been killed
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Polio eradication is not just the job of polio-infected
countries; all countries should
– Maintain high population immunity
– Maintain sensitive surveillance for acute flaccid paralysis
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Very rapid timelines for IPV introduction
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Identification and containment of all polioviruses and
potentially infectious material in all laboratories (private
and public) world wide
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Goal of rubella elimination
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In 2012, World Health Assembly endorsed the Global
Vaccine Action Plan goals that:
– By 2015, two of six WHO regions achieve rubella elimination
– By 2020, five of six WHO regions achieve rubella elimination

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In 2013, the Regional Committee for the Western Pacific
resolved to eliminate rubella and prevent congenital
rubella syndrome (CRS)
Rubella incidence per million, 2014
0
1,050
2,100
4,200 Kilometers
<1 case per million (82 countries or 42%)
>1--<5 (21 countries or 11%)
>5--<10 (12 countries or 6%)
>10--<50 (12 countries or 6%)
>= 50 (7 countries or 4%)
Not available / No data reported to WHO HQ (60 countries or 31%)
Not applicable
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Source: Joint Reporting Form as at 15 May 2015.
194 WHO Member States.
Map production: Immunization Vaccines and Biologicals, (IVB). World Health Organization
Date of slide: 15 May 2015
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 2015.
All rights reserved
Vaccination for rubella
in the Western Pacific Region
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Regional progress toward rubella elimination
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Australia, New Zealand, the Republic of Korea and
Singapore have been approaching rubella elimination
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Japan developed and officially issued a national plan and
strategy for rubella elimination in 2014 and determined
2020 as target year
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Mongolia aims to eliminate rubella by 2020 and has
started development of a National Strategy for Measles
and Rubella Elimination 2016-2020
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Cambodia will start development of a national plan and
strategy for rubella elimination
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Key strategies for rubella elimination
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Use only combination measles-rubella vaccines for all
routine and supplementary doses
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Monitor rubella disease and occurrence of CRS using
sensitive case based surveillance
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Communicate with and engage community to create
demand for vaccination
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Key challenges for rubella elimination
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Disease control programme is not as well established
as measles; many countries do not include rubella as
reportable disease
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Three countries in region have not yet introduced
rubella vaccine into routine programme, but are
expected to do so by 2016 (Papua New Guinea,
Vanuatu, and Viet Nam)
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In the past, many countries vaccinated only girls, which
leaves a large susceptible pool for disease
transmission among adult men
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Maternal and Neonatal Tetanus Elimination
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The World Health Assembly first called for elimination of neonatal
tetanus in 1989
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In 1999, goal was expanded to include elimination of the maternal
tetanus
– Neonatal tetanus (NT)— occurring ≤28 days of life
– Maternal tetanus — occurring during or ≤6 weeks following delivery
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At that time, 57 countries had not eliminated MNT
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In October 2014, WHO Regional Committee for the Western Pacific
endorsed goal of MNT elimination in all countries by 2015
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Key strategies for MNT Elimination
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Tetanus toxoid containing vaccine supplementary
immunization campaigns for all women of reproductive
age in high risk districts
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Tetanus toxoid containing vaccination of pregnant
women
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Clean delivery and clean umbilical cord care (ideally
through skilled birth attendants in health care facility
setting)
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Neonatal tetanus surveillance
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From 2000 to April 2015, 37 countries eliminated MNT
*(Plus Ethiopia except Somali Region; 30 of 34 provinces in Indonesia; and 16 of 17 regions in Philippines)
Source: WHO/UNICEF Database
Date of slide : 26 May 2015
Map production: Immunization Vaccines and
Biologicals, (IVB), World Health Organization
0
750 1,500
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3,000
4,500
6,000
Kilometers
MNT not eliminated (N=22)
MNT eliminated from 2000- April 2015 (N=37)
MNT eliminated before 2000
Not Applicable
MNT elimination in the Western Pacific:
Only 6 countries included in list of 59 high risk countries
Viet Nam: Validated in 2005
China: Validated in 2012
Lao PDR: Validated in 2013
Philippines: 16/17 regions validated in
Feb 2015
Cambodia: Validated in June 2015
Papua New Guinea: Pending
LEGEND:
Validated
16 of 17 regions validated (Philippines)
Not yet validated (Papua New Guinea)
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Key challenges for MNT elimination
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Philippines: Insecurity in the Autonomous Region of
Muslim Mindanao
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Papua New Guinea: Competing priorities for scarce
resources in a setting of developing health care
delivery system
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In conclusion
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Enormous strides made by countries of WPR in tackling VPD
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Elimination of measles and rubella, and eradication of polio, is within
our grasp

Some key challenges remain–
–
–
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Expanding coverage in hard to reach groups
Maintaining national focus as case numbers drop
Retaining community support
Balancing opportunities re new vaccines with achieving and sustaining necessary
coverage with existing vaccines
– Reduced donor support for immunisation in some countries, adding to difficulty of
maintaining national focus and building on past success
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