W.H.O. Notes

WHO – Global Measles And Rubella

Strategic Plan 2012-2020

 Working toward virtual elimination of the measles, rubella  & CRS (congenital rubella syndrome) through prevention and  vaccination across the world.

**INTERNATIONAL PLAYERS**

W.H.O., U.S. Centers For Disease Control, United Nations Childrens Fund. American Red Cross, United Nations Foundation, (including GAVI Alliance)

     535,000 children died of measles in 2000.

   By 2012, the global push to improve vaccine coverage resulted in a 74% reduction in deaths. These efforts, supported by the Measles and Rubella Initiative, contributed 23% of the overall decline in under-five deaths between 1990 and 2008.

MEASLES AND RUBELLA-CONTAINING VACCINES ARE AMONG THE

      MOST COST-EFFECTIVE PUBLIC HEALTH TOOLS AVAILABLE.

                                         

** STRATEGIC PLAN**

 1. Acheive and maintain high levels of population immunity (community or herd immunity) by providing high vaccination coverage with TWO doses of measles and rubella-containing vaccines.

2. Monitor disease using effective surveillance and evaluate programmatic efforts to ensure progress.

3. Develop and maintain outbreak preparedness, respond rapidly to outbreaks and manage cases.

4. Communicate and engage to build public confidence and demand for immunization.

5. Perform the research and development needed to support cost-effective operations and improve vaccination and diagnostic tools.

The MR Initiative and its five spearheading partners – The American Red Cross, United States Centers for Disease Control and Preventation, United Nations Children’s Fund, United Nation Foundation and World Health Organization – endorse this Strategic Plan and will work with countries and international donors on its implementation. This group includes the GAVI Alliance (formerly the Global Alliance For Vaccine and Immunization)

What To Know About Measles

Measles is one of the MOST INFECTIOUS diseases and can cause severe illness, life-long complications and DEATH. Prior to the availability of measles vaccine, measles infected over 90% of children before they reached the age of 15. These infections were estimated to cause more than two million deaths and between 15,000 and 60,000 cases of blindness anually worldwide.

The HIGHLY EFFECTIVE, SAFE and relatively inexpensive measles and rubella containing vaccines protect individuals from infection and their widespread use can completely stop the spread of the viruses in populations that achieve and MAINTAIN high levels of immunity (COMMUNITY IMMUNITY).

IMPROVING MEASLES VACCINATION COVERAGE AND REDUCING MEASLES RELATED DEATHS IS A GLOBAL IMPERATIVE.

The infectiousness of measles leads to global spread and even the countries that eliminated their indigenous transmission of measles remain vulnerable to outbreaks from importations.(Unvaccinated travelers bringing measles into a country through international travel)

DEATHS AND DISABILITIES CAUSED BY MEASLES AND RUBELLA ARE COMPLETELY PREVENTABLE WITH SAFE & INEXPENSIVE VACCINES.

The Measles Initiative was launched in 2001 to support technically and financially accelerated measles control activities. As a result of its efforts, measles deaths dropped to 139,000 in 2010 representing a 74% decrease compared with 2000. It represented a 23% decline in under-five deaths worldwide between 1990 and 2008.

      REPEAT THAT!!

THROUGH VACCINE EFFORTS MEASLES DEATHS DROPPED FROM 535,300 IN 2000 TO 139,300 IN 2010.

Measles mortality was reduced by more than three-quarters in all WHO regions except the WHO  SOUTHEAST ASIA REGION.THIS IS WHERE OUR EMMALEE MADELINE SNEHAL PARKER WAS BORN.

INDIA ACCOUNTED FOR 47% OF ESTIMATED MEASLES MORTALITY IN 2010 AND THE WHO AFRICAN REGION ACCOUNTED FOR 36%

      **FUTURE CONCERNS**

The Measles Initiative remains concerned about the reduction in political and financial committment since 2008 which is putting at risk the significant gains made and the global imperative to eliminate measles and rubells. Indeed, outbreaks of measles have been on the rise since 2009, particularly in the African, SOUTH-EAST ASIA and European regions and in North America.

IT IS UNACCEPTABLE THAT EVERY DAY 380 CHILDREN DIE FROM MEASLES AND 300 CHILDREN STILL ENTER THE WORLD WITH THE DIABILITES THAT CONGENITAL RUBELLA SYMPTOM CAUSES DESPITE THE SAFE, EFFECTIVE AND INEXPENSIVE VACCINES.

    **VISIONS – GOALS – MILESTONES**

Vision:

Achieve and maintain a world without measles, rubella and congenital rubella syndrome.

Goals:

By The End Of 2015 : Reduce global measles mortality by at least 95% compared with 2000 estimates.

By the End of 2020 : Achieve measles and rubella elimination in at least five WHO regions.

Milestones:

By The End Of 2015 : Reduce annual measles incidence to less than five cases per million and maintain that level. Achieve at least 90% coverage with the first routine dose of measles-containing vaccine for measles -rubella-containing vaccine as appropriate nationally and exceed 80% vaccination coverage in every district. Achieve at least 95% coverage with measles, measles/rubella or MMR vaccine during supplementary immunization activites. Establish a rubella/Congenital Rubella Syndrome elimination goal in at least three edditional WHO regions and finally establish a TARGET DATE FOR THE GLOABL ERADICATION OF THE MEASLES.

 ** UNBELIEVABLE**

Despite the avialability of a safe, heat-stable, effective and inexpensive measles vaccine and the substantial progress towards measles control, MEASLES REMAINS ONE OF THE LEADING CAUSES OF PREVENTABLE DEATH GLOBALLY AMONG CHILDREN.

Please note, considerable success was achieved by 2010 with the exception of THE SOUTH-EAST ASIA REGION. The 90% measles mortality reduction goal was NOT achieved mainly due to DELAYED IMPLEMENTATION OF MEASLES CONTROL ACTIVITES IN INDIA AND LARGE-SCALE MEASLES OUTBREAKS IN AFRICA.

     **NEW VACCINE SCHEDULES**

During this same period, coverage increase from 58% to 78% in the 47 countries with the highest burden of measles. By the end of 2010, the routine immunization schedules of 139 countries included TWO doses of measles containing vaccine and in 2011, GAVI supported 11 more countries to introduce a routine SECOND dose of measles. The timing of the second dose serves as an important contact between the child and the Expanded Programme on immunization because it provides an opportunity to “catch up” on any missed vaccines and deliver boosters to old age groups when needed.

Because of the terrible birth defects due to Congential Rubella Syndrome, switching from the measles to a measles/rubella vaccine in these countries represents an opportunity that shoud not be missed.

    **RAPID AND ACCURATE DIAGNOSIS**

Rapid and accurate diagnosis of measles and rubella remains essential for monitoring progress and detecting outbreaks.

When looking at current WHO and regional targets it should be noted that the SOUTH-EAST ASIA REGION adopted a resolution urging countries to mobilize resources to support the elimination of measles, for which the target date UNDER DISCUSSION.

Major funding shortfalls have contributed to delays and the deterioration of efforts. Measles outbreaks in Africa and the continued high numbers of measles cases and deaths in INDIA threaten to undermine the contribition of measles mortality reduction.

Is was stated that if financial and political commitments declined from 2010 to 2013 the WHO estimated an additional 200,000 measles deaths in 2011 rising to more than 500,000 worldwide by 2013.

 **TO ELIMINATE**

Measles and rubella elimination require achieving and maintaining high levels of population (community) immunity. For measles, vaccination coverage will need to reach and REMAIN at or exceed 95% with each of the two doses of vaccines.

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