Measles Mortality Reduction Efforts in Pakistan Dr. Tamur

Measles Mortality Reduction Efforts in Pakistan Dr. Tamur Mueenuddin UNICEF, Pakistan 7th Annual Measles Partners Meeting Washington, D.C 27-28 February 2007 Situation analysis Approximately 2.1 million measles cases occur annually in Pakistan WHO estimates approximately 21,000 children die from measles and its complications every year in Pakistan National Measles vaccine coverage is (CES-2006) 62.6%

Daily 58 children die in Pakistan due to Measles Position of the Government of Pakistan Endorsed the measles mortality reduction goal set at the UN special session on Children in May 2002 and World Health Assembly in 2003 Reaffirmed its commitment through endorsing the Cape Town declaration on measles, October 2003 Adopted a National Plan of Action for Measles control based on WHO regional plan that includes: Continue efforts to Strengthen Routine EPI

Second dose of Measles at the age of 15 Months (Mid-2007) National Measles Campaign throughout the country (2007-08) Immunity from 1 dose of Measles Vaccine at 9+ months in Pakistan Coverage = immunity Coverage x seroconversion = immunity 0.63 x 0.85 = 0.53 (= 53%) = 47% susceptible = future outbreaks Effect of 2nd Dose of Measles Vaccine after Catch-up Campaign in Pakistan After 1st dose: 53% immune

After 2nd dose: 47% susceptible x 95% coverage x 95% seroconversion = 42% immune 1st + 2nd dose = = 53% + 42% 95% population immunity Rationale for Measles campaign in Pakistan 4,500,000 newborns annually Measles vaccine coverage = 63% 2,835,000 vaccinated vaccine efficacy = 85% 1,665,000 unvaccinated + 2,409,750 protected

425,250 vaccinated but not protected 2,409,750 protected 2,090,250 susceptible Population Immunity = 53.55% Susceptible accumulates in less than 2 years equal to a birth cohort Campaign Targets 36% of the countrys total population Approximately 63 million children Target age: 9 months up to 13 years; irrespective of their prior vaccination status and disease history: including children who previously received measles vaccine already suffered measles infection

Campaign Strategy: Timeline: Between March 2007 to March 2008 The campaign will be implemented in 5 phases Each phase of the campaign will continue for consecutive 18 days Vaccination Sites:

Children who go to school / madrassah will be vaccinated in their respective institution Community outreach session will be undertaken in each locality on a specific date according to microplan All government health facilities will serve as a fixed center and will provide measles vaccine to any target aged children daily for 18 days throughout the campaign period Campaign Schedule Phase Province / Areas Targets Timeline 2,235,244

1 Mardan (NWFP), Mirpur (AJK), Gujrat (Punjab), Dadu (Sindh) March 2007 7,771,566 2 FATA, FANA, AJK, part of NWFP and Balochistan July 2007 Rest of NWFP and Balochistan 5,768,727

Aug-Sep 2007 3 4 Sindh 13,613,703 Nov 2007 5 Punjab 33,551,325 March 2008 Challenges Achieving high coverage

Ensure safe vaccination Only by skilled, trained vaccinators Strong social mobilization Unless very high coverage (>95%) is achieved, this campaign will have limited impact on reducing child mortality and morbidity due to measles Unless everybody participate enthusiastically in this campaign, especially parents, it will not succeed Sustaining achievement

Strengthening routine immunization Strengthening measles surveillance Better case management with Vitamin A Supplementation Our Focus Multi-Sectoral approach Strong political commitment at all levels Advocacy of the campaign among all sectors Involvement of all line departments i.e. education, local government, interior, religious affairs, information, etc. Involvement of non-government organizations and media Motivating parents to vaccinate their children

Highlight risk of measles vs benefits of vaccination Alleviating rumors against vaccination Mobilizing local resources Coordination and collaboration among all stakeholders Keen supervision and monitoring of preparations and implementation Thank you

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