Interrupting Measles Transmission in China

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Interrupting Measles Transmission in China
Progress and Challenges

• 8th Annual Meeting of the Partners for Measles
  Advocacy
• Washington, D.C.
• Sep 2008

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Outline

• Status of measles elimination
• Epidemiology
• Strategies
• International support
• Challenges
• Plan of action

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Status of Measles Elimination -- Epidemiology
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Measles Incidence, China 1950-2007
Year
Source National Notifiable Disease Reporting
System (NNDRS)
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Geographic Distribution of Measles Incidence,
China 2004-2007
(Incidence per 100,000)
SourceNNDRS
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Measles Incidence by Province, 2007
SourceNNDRS
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Age-Specific Measles Incidence, China, 2004-2007
SourceNNDRS
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Age Distribution of Measles Cases -- Provinces
with Highest Incidence (13-21/100,000) China,
2007
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Status of Measles Elimination -- Strategies
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Elimination Strategies and Implementation (1)

• Strategies
• 1) Strengthen routine coverage
• 2 doses of measles-containing vaccine (MCV)
• MR at 8 months MMR at 18-24 months
• Goal gt 95 coverage

• Implementation
• Immunization free of charge
• Immunization registry system
• Coverage estimates
• MCV1 94
• MCV2 92

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Elimination Strategies and Implementation (2)

• Strategies
• 2) SIAs
• 8m-14y in provinces
• Incidence gt 5/100,000
• Incidence lt 5/100,000, 70 cases aged lt 14y
• 7y-14y in provinces
• MCV1, MCV2 gt 95 in 2y-7y
• Follow up
• To be determined

• Implementation
• Completed
• Catch up 8 provinces
• Emergency wide age-range 3 provinces
• Planned 2008
• Catch up 10 provinces
• Follow up 3 provinces

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Completed Catch Up SIAs China 2004-2007

• Sichuan Shaanxi
• Hebei

2006 Xizhang Qinghai
2005 Ningxia

1. Xingjiang Guizhou

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Elimination Strategies and Implementation (3)

• Strategy
• 3) Enforce school-entry immunization requirement
• Goal gt 95 2-dose MCV coverage
• 4) Outreach activities for special populations
  (migrants, high-risk adults)

• Implementation
• Ongoing in all provinces
• In process

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Elimination Strategies and Implementation (4)

• Strategy
• 5) Strengthen surveillance
• All outbreaks lab-confirmed
• When incidence lt 1/100,000,all cases
  investigated and gt 80 laboratory-tested
• National, provincial, prefecture labs reach WHO
  accreditation standard
• 6) Rapid outbreak response

• Implementation
• Parallel surveillance systems merged
• Reporting from township level and above
• 60-100,000 suspected cases reported annually
• 50-60 suspected cases laboratory-tested
• Ongoing in all provinces

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International Support
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International Support Requested for Measles
Elimination by China

• USD 902 million estimated for achieving measles
  elimination by 2012
• Sustain current routine (USD 567 M--62)
• Strengthen routine (USD 207 M--22)
• SIAs (USD 128 M--14)
• USD 20.8 million requested formally by China to
  international community (2006)
• Initially for SIAs operational support to 8
  priority provinces

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International Support Obtained/Committed for
Measles Elimination China (1)

• Guizhou measles control project 2003-2006
• USD 3.5 million from USCDC to support SIAs,
  surveillance, school entry and routine
• USD 0.37 million from JICA to support
  supplemental cold chain
• Guizhou and Sichuan measles elimination project
  2007-2010
• USD 2.0 million from US CDC to support
  surveillance, enforcement of school entry
  requirement and routine
• USD 2.0 M from Measles Initiative for operational
  support to SIAs.

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International Support Obtained/Committed for
Measles Elimination China (2)

• Measles Olympics training workshop, Atlanta 2007
• Measles Initiative Support to Chinas Earthquake
  Affected Zone
• Reducing the incidence of measles in Chongqing
  from 5/100,000 (2007) to lt 0.5/100,000.

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Challenges
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Challenges

• Persistent high incidence
• Infants
• Adults
• Achieving high-coverage SIAs
• Limited vaccine supply
• Inadequate funding for operational costs
• Maintaining gains of catch up SIAs
• Expense of follow up SIAs
• Strengthening routine to reduce need for follow
  up SIAs
• Measuring MCV1 and MCV2 coverage accurately
• Reaching floating population

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Measles Cases by Month -- Xinjiang 2004-May,
2008
SIAs
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Age-Specific Measles Incidence -- Xinjiang,
2007-May,2008
Covered by SIAs 2004
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Interpretation

• Xinjiang data encapsulate national challenges
• Pre-school--aged children (Major issue)
• Failure to reach children through routine
• Late implementation of follow up SIAs
• School-aged children
• Some missed in 2004 catch up
• Incomplete implementation of school entry
  requirement
• Cases among adults

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Plan of Action
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Plan of Action (1)

• Strengthening routine immunization
• Expansion of EPI to 14 vaccines
• Cold chain renewal
• Training
• Immunization registry
• Measles SIAs
• Assuring funding
• Seeking international support for operational
  costs
• Increasing vaccine production capacity

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SIAs Planned in 13 Provinces-- supported by
central funds in calendar year of 2008

• Catch up (10 provinces)
• Target 8m-14y
• Follow up (3 provinces)
• Target 8m-6y
• National fund covers vaccine and syringe, part of
  vaccinators subsidy
• Shortage of funds for operational costs in
  western provinces

Note Number of SIAs conducted may be limited
due to vaccine shortage
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Plan of Action (2)

• Strengthening measles surveillance
• Single, merged measles surveillance system
• Enhancing outbreak investigation capacity
• Pilot projects for enhanced surveillance among
  adults and infants
• Strengthening school entry requirement
• Ensuring gt95 coverage for two doses MCV
• Considering development of standardized
  approaches to implementation

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Conclusions

• Achieving nationwide measles elimination by 2012
  remains challenging
• Low-incidence measles persists after apparently
  high-quality SIAs
• Rigorous implementation of all strategies is
  required
• Strong international partnerships and resources
  are needed to achieve elimination

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Thank you!

• We acknowledge the support from Measles
  Initiative and US CDC for measles elimination
  activities in China, and welcome a new infusion
  of funds for upcoming SIAs from international
  partners

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Back up Slides
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Gene type of Measles virus strain is H1a