Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th...
-
Upload
elmer-spencer -
Category
Documents
-
view
214 -
download
1
Transcript of Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th...
![Page 1: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/1.jpg)
Challenges in Measles Outbreak Responses
MSF Perspectives
Florence Fermon - Myriam Henkens10th Annual Measles Initiative Meeting
14/09/2011
![Page 2: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/2.jpg)
Measles resurgence in Africa
• Resurgence comes after a period of intensified efforts – Since 2000, routine measles vaccination coverage has
increased from an estimated 52% to 85%
• In 2009, 30 African countries experienced measles outbreaks – >60,000 reported cases and >1000 reported deaths (WHO)
• In 2010, 28 countries experienced measles outbreaks – 223,000 reported cases and 1200 deaths (WHO)
• Real numbers of measles cases and deaths are considerably larger than the numbers reported
• WHA resolution (RC61) calls for measles elimination in AFRO by 2020
![Page 3: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/3.jpg)
Why the resurgence?
1. Build-up of susceptible children and adolescents
2. Failure to vaccinate rather than vaccine failure
3. Programmatic, political and financial challenges
![Page 4: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/4.jpg)
1. Susceptibility build up
• Two sources of immunity• Natural immunity due to infection
• Vaccine derived immunity
• As vaccination increases • Less circulating virus
• Age distribution of cases changes - a natural consequence of the success of vaccination programs
– Children (on average) are older when they become infected
![Page 5: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/5.jpg)
Different age distributions
Malawi: 2010
Burkina Faso: 2009
Niger: 2004DRC: 2006In endemic countries, outbreaks are limited to young age classes.
Outbreaks in countries following “elimination” extend evenly age classes
Countries in transition are intermediate
Source: courtesy Matthew Ferrari
![Page 6: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/6.jpg)
2. Failure to vaccinate rather than vaccine failure
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
200000
2002 2003 2004 2005 2006 2007 2008 2009 2010
Année
Cas
de
rou
geo
le
0
10
20
30
40
50
60
70
80
Co
uve
rtu
re v
acci
nal
e (%
)
cas CV
Source: VC(WHO 2002-2009 and MICS 2010), cases: Rapports épidémiologiques annuels, 4ème direction, RDC
![Page 7: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/7.jpg)
Programmatic, political and financial challenges
• Measles victims of MI success and outbreak responses low on politicians and donors agenda
• Delays/reluctance in implementing outbreak responses, despite international recommendations
• Lack of efficient coordination• Lack of rapid funding
• Delays in implementing campaigns - SIAs – despite strong international support (vaccines and operating costs)DRC 2010 => outbreak 2011
![Page 8: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/8.jpg)
MSF & measles outbreak responses
Surveillance, treatment, vaccination (when authorized)• 2009: Chad, Ethiopia, DRC, Pakistan, Bangladesh,
Nigeria, Sudan, Burkina Faso– 1.4 million vaccinated, 202 000 treated
• 2010: Malawi, Chad, DRC, Ethiopia, Yemen, Zimbabwe, Mozambique, Burundi, South Africa, Somalia, Zambia– 4.6 million vaccinated 190 000 treated
• 2011: DRC Bangladesh Burundi, Chad, Ethiopia, Kenya, Niger, Somalia, Zambia– already 3 million vaccinated in DRC only, more than 4 million
total in August – More than 50 000 treatments in DRC only
![Page 9: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/9.jpg)
0
500000
1000000
1500000
2000000
2500000
3000000
3500000
4000000
4500000
5000000
2004 2005 2006 2007 2008 2009 2010 2011
Measles outbreak responses in Africa 2004-2011Persons vaccinated – MSF On going
- DRC- Burundi- Chad- Ethiopia- Kenya- Niger- Nigeria- Somalia- Zambia
![Page 10: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/10.jpg)
Challenges
1. Outbreak detection and recognition
2. Outbreak response plan
3. Outbreak response implementation
4. Outbreak prevention
![Page 11: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/11.jpg)
1. Outbreak detection & recognition
• Inaccurate (inflated) vaccination coverage data biased risk assessment
• Weak surveillance system late detection of increase in case number
• Outbreaks = “failure to vaccinate” late official recognition of outbreak (MOH and main actors)
• But outbreaks do and will occur in many countries
![Page 12: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/12.jpg)
Measles resurgence in Europe/USA
![Page 13: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/13.jpg)
2. Outbreak response plan
• Lack of knowledge of the WHO recommendations
• Lack of knowledge of the usefulness of vaccination in outbreak
• No standard tools nor technical recommendations for reactive campaigns
• Lack of organized technical support (measles >< polio or meningitis)
![Page 14: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/14.jpg)
3. Outbreak response implementation
• Coordination between the different partners
• Competition with other priorities (polio campaigns)
• Free treatment, increased access to treatment
• Timely vaccines availability
• Timely funding
![Page 15: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/15.jpg)
4. Outbreak prevention
• Maintain the number of susceptibles as low as possible
• EPI– Flexibility in age range– Immunization included in comprehensive package of
care – Special approach to reach children never vaccinated
(“reach the un reached”)– Reduce missed opportunities (surveys, health care
contacts, etc)– More accurate data in performance, coverage, etc
![Page 16: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/16.jpg)
Reaching the unreached
BeforeCampaign
AfterCampaign
2005 2010 2005 2010
Card %(95% CI)
7.6 (6.3-8.9)
5.5 (4.1-5.6)
53.0 (50.6-55.4)
40.2 (36.9-43.5)
Card/Recall %(95% CI)
33.0 (30.9-35.1)
68.7 (66.7-70.7)
80.6 (78.6-82.6)
81.1 (79.8-82.4)
Vaccination coverage before and after campaign (6-59 m), Ndjamena, Chad
![Page 17: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/17.jpg)
Lessons learned, N’djamena, Chad
• Chronically low vaccine coverage – Failure to reach older children through routine
services – Measles-susceptibles built up and to
precipitate the 2010 epidemic• 18% received their first dose in 2010
– previously vaccinated children were easier to reach during the outbreak than unvaccinated children
![Page 18: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/18.jpg)
Missed opportunities
• CAR - Paoua and Congo Brazza - Betou (MSF - 2010)– limited access to care areas– children were not offered vaccination (in or
outpatients)– 0 to 11 m: 65 to 94% were not immunized
according to recommendations – 12 to 59 m: 86% to 98% were not immunized
and could not be according to the EPI schedules
![Page 19: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/19.jpg)
4. Outbreak prevention (2)
• SIA / vaccination campaign– Implement TAG recommendations and adjust
age group to local epidemiology– Fixed duration of campaigns >< coverage
reached– Adapt SIA intervals to needs – Accurate data collection – Independent coverage surveys– Implementation according to plan (DRC 2010)
![Page 20: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/20.jpg)
What could be done?
• Outbreak response included as a component of the Measles Initiative
• Outbreak response included into national control programs
• Renewed political and financial commitment • Strategies to ensure countries implement SIAs according
to plan
• Improved coordination in country – Meningitis and Polio could be used as example
• Limitations / constraints of implementing recommended strategies should be acknowledged
![Page 21: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/21.jpg)
What could be done? (2)• Creative strategies
– to reduce the missed opportunities, – to reach the unreached
• Consider multi Ag campaign (polio, MenA conj, etc)
• Develop a risk assessment tool (susceptible population, social determinants, operational strategy)
• Develop supporting tools/documents (WHO 2009 recommendations in French, practical accompanying document)
• Financial mechanism for rapid response
• New vaccines (easy to administer, no cold chain, etc)
![Page 22: Challenges in Measles Outbreak Responses MSF Perspectives Florence Fermon - Myriam Henkens 10th Annual Measles Initiative Meeting 14/09/2011.](https://reader030.fdocuments.in/reader030/viewer/2022032723/56649d0f5503460f949e4c04/html5/thumbnails/22.jpg)
Acknowledgments
• MSF teams – field and HQ• Epicentre (Rebecca Grais, Andrea Minetti)• Matthew Ferrari
Thank You For Your Attention