Do we need a measles vaccine stockpile for more effective measles outbreak response? Global Measles...
30
Do we need a measles Do we need a measles vaccine stockpile for vaccine stockpile for more effective measles more effective measles outbreak response? outbreak response? Global Measles and Rubella Management Meeting Global Measles and Rubella Management Meeting Salle B, WHO Headquarters, Geneva, Switzerland, 15 - 17 March Salle B, WHO Headquarters, Geneva, Switzerland, 15 - 17 March 2011 2011 Maya Van den Ent, PharmD, MPH Maya Van den Ent, PharmD, MPH Robin Nandy, MBBS, MPH Robin Nandy, MBBS, MPH Edward Hoekstra, MD. MSc Edward Hoekstra, MD. MSc Measles and Emergencies , Health Section, UNICEF HQ Measles and Emergencies , Health Section, UNICEF HQ
-
Upload
vincent-davidson -
Category
Documents
-
view
227 -
download
0
Transcript of Do we need a measles vaccine stockpile for more effective measles outbreak response? Global Measles...
Do we need a measles Do we need a measles vaccine stockpile for more vaccine stockpile for more effective measles outbreak effective measles outbreak
response?response?
Do we need a measles Do we need a measles vaccine stockpile for more vaccine stockpile for more effective measles outbreak effective measles outbreak
response?response? Global Measles and Rubella Management MeetingGlobal Measles and Rubella Management Meeting
Salle B, WHO Headquarters, Geneva, Switzerland, 15 - 17 March 2011Salle B, WHO Headquarters, Geneva, Switzerland, 15 - 17 March 2011
Maya Van den Ent, PharmD, MPHMaya Van den Ent, PharmD, MPH
Robin Nandy, MBBS, MPHRobin Nandy, MBBS, MPH
Edward Hoekstra, MD. MScEdward Hoekstra, MD. MSc
Measles and Emergencies , Health Section, UNICEF HQMeasles and Emergencies , Health Section, UNICEF HQ
Measles EmergenciesMeasles Emergencies
Disasters
Measles Outbreaks
Funding Disasters through emergency funding
Funding Disasters through emergency funding
Measles vaccination campaign part of initial response
-SPHERE
-Core Commitments For Children
Measles Outbreak ResponseMeasles Outbreak Response
http://whqlibdoc.who.int/hq/2009/WHO_IVB_09.03_eng.pdf
WHO Measles Outbreak Response Guidelines (2009)
WHO Measles Outbreak Response Guidelines (2009)
Critical Aspects Of Measles Outbreak Response Immunisation
Critical Aspects Of Measles Outbreak Response Immunisation
Timing– As soon as possible after confirmation of the outbreak
Age range– Based on susceptibility profile, analysis of outbreak data, etc
Geographical area– Affected areas plus adjacent areas– Other high risk areas or population groups
Campaign coverage/quality
Proportion Cases Prevented By Intervention Coverage & Time: 6 – 59 m, Niamey, Niger
Proportion Cases Prevented By Intervention Coverage & Time: 6 – 59 m, Niamey, Niger
0
10
20
30
40
50
60
70
80
90
100
30 40 50 60 70 80 90 100
Intervention Coverage(%)
Pro
po
rtio
n o
f C
ases
Pre
ven
ted
(%)
2 months 3 months
4 months +6 months
Proportion Cases Prevented By Intervention Coverage & Time: 6 – 15 y, Niamey, Niger
Proportion Cases Prevented By Intervention Coverage & Time: 6 – 15 y, Niamey, Niger
0
10
20
30
40
50
60
70
80
90
100
30 40 50 60 70 80 90 100Intervention Coverage(%)
Pro
po
rtio
n o
f ca
ses
pre
ven
ted
(%
)
2 months 3 months
4 months
Overview Of Recent Outbreaks & Response Efforts
Overview Of Recent Outbreaks & Response Efforts
Measles Outbreaks in AfricaMeasles Outbreaks in Africa
Small fraction of number of cases compared to pre-SIA era
28 countries experience outbreaks in June 2009 – Dec 2010
– Malawi, S. Africa, Zimbabwe, Zambia, Lesotho, Nigeria, DRC, Angola…
– > 200,000 reported cases– > 127,000 confirmed cases– > 1,400 measles deaths
Reported Measles Cases by Month andWHO Regions, 2006-2010
0
5000
10000
15000
20000
25000
30000
35000
Jan2006
Apr Jul Oct Jan2007
Apr Jul Oct Jan2008
Apr Jul Oct Jan2009
Apr Jul Oct Jan2010
Apr Jul Oct
AFR SEAR AMR EMR EUR WPR
Measles deaths, June 2009 – Dec 2010 (n = 1,463)Measles deaths, June 2009 – Dec 2010 (n = 1,463)
Type of Outbreak Response Immunization (ORI) by Number of Confirmed Cases
Type of Outbreak Response Immunization (ORI) by Number of Confirmed Cases
Timing Of Outbreak Response Immunization*Timing Of Outbreak Response Immunization*
Time period between
confirmation of outbreak and ORI
# of countries
Countries
0-3 months1Rwanda
3 – 6 months6Burundi, Cameroon, Chad, Ethiopia, Namibia, Senegal, Zambia
> 6 months5South Africa, Swaziland, Zimbabwe
Malawi, Lesotho (Nationwide)
Unknown12Benin, Botswana, DRC, Ghana, Liberia, Mali, Niger, Nigeria, Tanzania, Togo,Lesotho, Malawi (Initial local response)
*Outbreaks reported cases between June 2009 and Dec 2010
Estimated Number of Doses Used for Outbreak Response in 2010
Estimated Number of Doses Used for Outbreak Response in 2010
About 30 million doses
About $11 million for bundled vaccines
IssuesIssues
Lack of capacity and preparedness
Insufficient use of Government Emergency funds
Measles not always included in preparedness plans
Is a stockpile the solution?Learning from Meningitis
Is a stockpile the solution?Learning from Meningitis
Global Stockpile MeningitisGlobal Stockpile Meningitis
Global shortage of vaccines as compared to demand
– Mechanism to ensure access for most in need
Processing requests full time job during outbreak season
– WHO-HQ hosts ICG secretariat – ICG: IFRC, MSF, UNICEF and WHO
Time between outbreak and response : 4 - 8 weeks
Measles Stockpile?Measles Stockpile?
Measles stockpile – Make funding available to respond to outbreaks– Questionable whether donors are willing to fund
Where should it be managed?– At global level?– In AFRO?– At national level?
What are criteria for allocation?
Does stockpile address the current problems?
Stockpile Managed at Global/Regional Level
(The Meningitis & YF Model)
Stockpile Managed at Global/Regional Level
(The Meningitis & YF Model)Requires:
Clear decision mechanism– Outbreak investigation standards– Risk analysis standards– Outbreak response standards
Interagency decision body
Emergency shipping mechanism
Monitoring and Evaluation
Pros and ConsStockpile Managed at Global / Regional Level
Pros and ConsStockpile Managed at Global / Regional Level
Pros
Enabling systematic outbreak response
Response time can be short, if mechanism well developed
Potential new source of funds
Cons
No country ownership
Time consuming at global level
Possible disincentive for other non contributing donors to support outbreak response
May detract countries from focusing on improving the quality of routine programmes
Stockpile Managed at National LevelStockpile Managed at National Level
Requires:
Full country buy-in to reserve % of RI stock for outbreak response preparedness
Pros
Country buy in
Part of program planning & preparedness
Faster response, as vaccines are already in country
Cons
Quality of outbreak response depending on country level understanding of ORI
Local politics may interfere in decision making
Difficult to monitor & follow up from global & regional level
Pros and Cons Stockpile Managed at National Level
Pros and Cons Stockpile Managed at National Level
QuestionsMeasles Stockpile?
QuestionsMeasles Stockpile?
Can we raise the funds?– $ 10 - 15 million annually– Revolving Fund?
What is the best mechanism?– Global / Regional vs National– Country/region specific?
Will the stockpile address the problems in Outbreak Response Immunization?
AcknowledgementsAcknowledgements
EPICENTRE– Rebecca Freedman-Grais
WHO– Peter Strebel– Alya Dabbagh– Balcha Masresha– William Perea– ICG secretariat
CDC– Robb Linkins
UNICEF– Robin Nandy– Rouslan Karimov
Extra slidesExtra slides
Simulated Measles Cases In Niamey, Niger (2003-2004)
Simulated Measles Cases In Niamey, Niger (2003-2004)
8.1%[ 4.9 ,8.9 ]averted with intervention on day 161
Reasons for outbreaksReasons for outbreaks
1. Still gaps in routine immunization coverage
2. Suboptimal coverage during recent SIAs (ZIM, NAM, ANG, BOT)
3. Too long (> 3 yrs) interval between SIAs (ZAM, LES, SEN)
4. Pockets of unvaccinated & resistant populations (ZIM)
5. Lower demand due to disappearing disease
6. Accumulation of susceptibles in older age groups
Type Of Outbreak Response Immunization*Type Of Outbreak Response Immunization*
Outbreak Response Immunization (ORI)Type
# of countries
Countries
No ORI7Angola, Burkina Faso, Cote d’Ivoire, Guinea Conakry, Mauritania, Sierra Leone
Selective ORI (6/9m – 59 m) in affected areas
6Benin, Botswana, Ghana, Mali, Mozambique (some DS) Nigeria, Zambia
Non Selective ORI (6/9m – 59 m) in affected areas
5Cameroon, Chad, Ethiopia, Senegal, Togo
Non selective wide age range ORI (6/9m – 14 y) in affected areas
4Burundi, DRC, Lesotho, Malawi
Nationwide ORI (6/9m – 59 m)
2Liberia, Swaziland
Nationwide wide age range ORI (6/9m – 14 y)
4South Africa, Zimbabwe, Lesotho, Malawi, following initial limited ORI
ORI with unknown age range
6Kenya, Mozambique (some DS), Namibia, Niger, Rwanda, Tanzania
*Outbreaks reported cases between June 2009 and Dec 2010
Measles reported cases, 2009-2010 (1 dot = 50 cases)Measles reported cases, 2009-2010 (1 dot = 50 cases)
Measles confirmed cases, 2009-2010 (1 dot = 50 cases)Measles confirmed cases, 2009-2010 (1 dot = 50 cases)
