PROGRESS TOWARD MEASLES ELIMINATION — WESTERN PACIFIC REGION, 2009–2012

Tuesday, 11th of February 2014

[source]MMWR[|source]

In 2005, the World Health Organization (WHO) Regional Committee for the Western Pacific Region (WPR) resolved to eliminate measles in their region by 2012. Like the Global measles and Rubella/CRS elimination strategic plan, the recommended measles elimination strategies in the region were 1) achieving and maintaining high (≥95%) coverage with 2 doses of measles-containing vaccine (MCV) through routine immunization services and by implementing supplementary immunization activities (SIAs), when required; 2) conducting high-quality, case-based measles surveillance; 3) ensuring high-quality laboratory surveillance, with timely and accurate testing of specimens to confirm or discard suspected cases and detect measles virus for genotyping and molecular analysis; and 4) establishing and maintaining measles outbreak preparedness for rapid response and ensuring appropriate case management.

In this report, CDC described progress towards measles elimination in WPR in the period 2009–2012. The report documented that measles incidence had reached a historic low, decreasing by 83%, from 34.0 to 5.9 cases per million population.  The report also articulated the additional efforts needed to achieve and sustain measles elimination in WPR. More details are indeed available at:  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6222a3.htm

 

Editorial Note

In 2012, the WPR Regional Committee reaffirmed its commitment to eliminate measles and urged member states to interrupt all residual endemic measles virus transmission as rapidly as possible. To achieve elimination, intensified efforts are needed to identify and close gaps in population immunity, by increasing coverage with MCV2 to ≥95% in all countries and areas and by conducting high-quality SIAs in countries with sustained measles virus transmission (e.g., China, Malaysia, and the Philippines). In countries and areas with <95% MCV1 or MCV2 coverage, urgent action is needed to strengthen routine immunization services and to identify and implement targeted SIAs for measles-susceptible populations. In the four remaining countries and areas (Lao People s Democratic Republic, Papua New Guinea, Solomon Islands, and Vanuatu) that do not provide MCV2 in the routine childhood vaccination schedule, strategies are needed to increase MCV1 coverage, conduct periodic SIAs to provide a second opportunity for all birth cohorts to receive MCV, and prepare for introduction of routine MCV2.

The WPR Guidelines on Verification of Measles Elimination were finalized in March 2013; progress toward measles elimination in WPR will be monitored by the Regional Verification Commission through annual progress reports from each country or area and from the Pacific Islands countries and areas reporting as one epidemiologic block. High-quality case-based measles surveillance is critical to the verification process. Despite overall improvement in measles surveillance performance, gaps persist, as reflected by the low proportion of second-level administrative units with one or more non-measles discarded case per 100,000 population. Additionally, incomplete investigations of suspected measles cases in some countries challenge efforts to rapidly identify and respond to outbreaks and to measure and document progress toward elimination. For example, in Vietnam, only six (0.8%) of the 771 suspected measles cases with specimens available for testing reported in 2012 were laboratory confirmed. However, 631 additional cases did not have specimens collected but were reported as clinically confirmed measles. The sensitivity of the measles surveillance system in other countries with discarded non-measles reporting rates of <2 per 100,000 population might be insufficient to rapidly detect and respond to outbreaks or to meet verification criteria.

The WHO Global Vaccine Action Plan calls for the elimination of rubella and congenital rubella syndrome in five of the six WHO regions by 2020. In April 2012, the Measles and Rubella Initiative launched the 2012–2020 Global Measles and Rubella Strategic Plan to integrate rubella with measles elimination efforts. Rubella-containing vaccine is not provided in six WPR countries and areas; five of these countries (Cambodia, Lao People s Democratic Republic, Papua New Guinea, Solomon Islands, and Vietnam) are eligible for financial support offered by the GAVI Alliance to conduct a wide-age-range SIA using combined measles-rubella vaccine followed by the introduction of rubella vaccine in their national routine immunization programs. In addition to contributing to rubella elimination, these SIAs would provide a unique opportunity to boost population immunity to measles and contribute momentum to achieve and sustain measles elimination in WPR.