“SPEED-UP” CAMPAIGNS IN THE AMERICAS Siena, Italy May 10-11, 2016 DESIREE PASTOR MD, MPH Regional Immunization Advisor PAHO/WHO
“SPEED-UP” CAMPAIGNS
IN THE AMERICAS
Siena, Italy
May 10-11, 2016
DESIREE PASTOR MD, MPH
Regional Immunization
Advisor
PAHO/WHO
OUTLINE
• Historic perspective on measles and rubella
elimination in the Americas
1
• Speed-up campaigns: a magnificent vaccination strategy
• Lessons learned and conclusions
• Next steps towards maintaining measles and rubella elimination in
the Americas
WE CAME A LONG WAY
3
XXIV PAN-AMERICAN SANITARY
CONFERENCE,WASHINGTON
PAHO, SEPTEMBER 1994
“To congratulate all the Member States, their health authorities, their health workers and the
communities themselves on their continuing commitment and efforts toward attainment of the historical
accomplishment represented by the eradication of poliomyelitis from the Western Hemisphere, as
well as other major advances in their immunization programs…
To establish the regional goal of elimination of measles by the year 2000 and urge the Member
Governments to make every effort to achieve this goal as soon as possible.”
MEETING OF AD-HOC PANEL OF EXPERTS ON
RUBELLA AND MEASLES ELIMINATION
6
4
ALIGNMENT OF MEASLES AND
RUBELLA ELIMINATION STRATEGIES
VACCINATION SURVEILLANCE
“Catch-up” campaign; children
aged 1 to 14 years
“Keep-up: to maintain coverage
≥95%in the routine program;
children aged 1 year
“Follow-up” campaign;
preschool-aged children
Introduction of MMR or MR
In routine program; children
aged 1 year
“Speed-up” campaign in
adolescents and adults
Integrated measles/rubella
surveillance
CRS surveillance
Laboratory activities
• Serological diagnosis
• Viral detection/isolation
‘80 ‘81 ‘82 ‘83 ‘84 ‘85 ‘86 ‘87 ‘88 ‘89 ‘90 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 ‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ’06 ’07 ’08 ’09 ’10 ‘11 ’12 ‘13 ‘14 ‘15
050,0
00
100,0
00
150,0
00
200,0
00
250,0
00
020
40
60
80
100
%
MEASLES CASESRUBELLA CASES MEASLES COVERAGE
Confi
rmed C
ase
s%
Vaccin
atio
n C
overa
ge
LAST ENDEMIC
MEASLES CASE
LAST ENDEMIC
RUBELLA CASE
FOLLOW-UP CAMPAIGNS FOR MEASLES
SPEED-UP CAMPAIGNS
FOR RUBELLA
CATCH-UP CAMPAIGNS
FOR MEASLES
IMPACT OF MEASLES AND RUBELLA
ELIMINATION STRATEGIES IN THE AMERICAS
5
8
24
68
10
12
14
16
18
20
DISTRIBUTION OF IMPORTED RUBELLA CASES AFTER INTERRUPTION OF
ENDEMIC TRANSMISSION, THE AMERICAS, 2010-2015*N
UM
BER O
F R
UBELLA C
ASES
2010 2011 2012 2013 2014 2015
8 CRS CASESARGENTINA
BRAZIL
CANADA
CHILE
COLOMBIA
EUA
FRENCH GUAYANA
MEXICO
Source: ISIS, MESS and country
reports to FGL-IM/OPS.
* Data as of 31 March 2016.
65 RUBELLA CASES
DEVASTATING CONSEQUENCES OF CRS
7
Cataract, High Myopia,
Severe Deafness
Infant with CRS
(3 days old)
CRS with Autism,
Mental Retardation
Sensorineural,
Profound Deafness
Congenital Glaucoma
Photo credit: Louis Z. Cooper, MD
Seated from left: Isabel Pachón (member), Louis Cooper (member), Merceline Dahl-Regis (president), Mirta Roses (former PAHO’ Director), Jose
Cassio de Moraes (member), Natasha Crowcroft (member) and Jose Ignacio Santos (member). Standing: Jon K. Andrus (former PAHO’s Deputy
Director).
FIRST MEETING OF THE INTERNATIONAL EXPERT
COMMITTEE IN THE AMERICAS (2010)
Bye-bye, rubella! ¡Adiós rubéola!
HOW DID WE ACHIEVE THE
ELIMINATION GOAL?
SPEED-UP CAMPAIGNS:
A MAGNIFICENT STRATEGY
How to get commitment from the governments and
donors to financially support the vaccination of nearly
the 40% of the Latin American and the Caribbean
population?
15
COST-SAVING
INTERVENTIONS
MEASLES
Vaccination strategy costs
$1.10/individual
PAHO strategy saves
$280 million in treatments
To contain outweigh costs
to treat
16
COST-SAVING
INTERVENTIONS
RUBELLA AND CRS
Saves $3 billion
Prevented >112,500
cases in Latin America
and Caribbean
No more children born
with CRS-led birth defects
17
19
How to plan, implement and monitor High-
Quality Speed-Up Campaigns to vaccinate ~250
million adolescents and adults?
THE TARGET POPULATION…?
• Every country conducted an analysis regarding the susceptible population and the analysis of the burden of disease in the population.
• Some seroprevalence studies were implemented (i.e. Argentina, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Haiti, Mexico, Panama, Peru) to complement the analysis, before and after the campaigns.
• Most of the countries targeted the age group to be vaccinated in adolescents and young adults aged 15-39 years old.
MONTH 1 2 3 4 5 6 7 8 9
PLANNING AND ORGANIZATION
NATIONAL
SUB NATIONAL AND LOCAL
EXECUTION
EVALUATION
SENSITIZATION, POLITICAL COMMITMENT, AND SUPPORT
ADVOCACY
MONITORING AND SUPERVISION
VACCINATION SAFETY
Action Plan
Organization
Resources
Guidelines and operative manuals
Strategy and communication
materials
Information system
Training
Microplanning
Management resources
Communication and
mobilization
Supply distribution
Communication
and mobilization reinforcement
National vaccination
campaign
Launch post-partum
vaccinationCoverage verification
Campaign evaluation
Final report
STAGES FOR SPEED-UP CAMPAIGN: ORGANIZATION,PLANNING, DEVELOPMENT, AND VERIFICATION
WEEK 1 2 3 4 5 6
CAPTIVE POPULATION
HOUSE TO HOUSE
COVERAGE
VERIFICATION
CENTRAL DAY ADDITIONAL
OPPORTUNITYANNOUNCEMENT
POST PARTUM AND POST ABORTION VACCINATION
NATIONAL LAUNCHING
COMMUNICATION
REINFORCEMENT
SOCIAL
COMMUNICATION
Rapid Coverage Monitoring
School
Institutional
Labor
Transient populations and places of
high circulation
Fixed and mobile posts
SPEED-UP VACCINATION CAMPAIGN PHASES
50
,00
01
00
,000
150
,000
1996 1998 2000 2002 2004 2006 2008
RUBELLA
MEASLES
CANADA, CUBA, PANAMA
UNITED STATES, URUGUAY
ENGLISH-SPEAKING
CARIBBEAN
CHILE**
BRAZIL** (2001-02)
COSTA RICA
HONDURAS
EQUADOR
EL SALVADOR
COLOMBIA,
NICARAGUA,
PARAGUAY,
VENEZUELA
ARGENTINA**,
BOLIVIA,
DOMINICAN REP.,
PERU
ARGENTINA (2),
BRAZIL (2),
HAITI, MEXICO
BOLIVIA (2), CHILE (2),
CUBA,
GUATEMALA, HAITI,
VENEZUELA (2)
SOURCE: Country reports to FCH/IM
* Includes rubella and measles cases reported to PAHO as of epidemiological week 52/2009
** Countries that implemented “speed-up” campaigns (1st phase) in women only
NU
MBER O
F C
ASES
YEAR
ADOLESCENT AND ADULT RUBELLA VACCINATION
“SPEED-UP” CAMPAIGNS
MEXICO2008
19-29 yr., 99% MR
Pop. 22,231,820
EL SALVADOR2004
15-39 yr., 98% MR
Pop. 2,796,391
GUATEMALA2007
9-39 yr., 99% MR
Pop. 7,172,847
HAITI2007-2008
1-19 yr., 99% MR
Pop. 6,242,197
CUBA2007
12-24 yr., 97% MMR
Pop. 1,991,513
DOMINICAN
REPUBLIC2006
7-39 yr., 95% MR
Pop. 4,847,150
THE CARIBBEAN1998-2001
20-39 yr., 84% RVM/MR/MMR
Pop. 4,847,150
COSTA RICA2001
15-39 yr., 98% MR
Pop. 1,635,445
ARGENTINA2006
15-39 yr., WOMEN, 98% MR
Pop. 6,718,314
2008
16-39 yr., 90% MR
Pop. 6,478,313
BOLIVIA2006
15-39 yr., 93.7% MR
Pop. 4,015,554
2007
2-14 yr., 98% MR
Pop. 3,086,545
BRAZIL2001-2002
12-39 yr., WOMEN, 96% MR
Pop. 29,006,806
2008
20-39 yr., 96% MR
Pop. 67,197,649
VENEZUELA2005-2007
12-17 yr., 99% MR
Pop. 4,657,332
2007
18-39 yr., 99% MR
Pop. 10,278,024
CHILE1999
10-29 yr., WOMEN, 98% RMV
Pop. 2,467,495
2007
19-29 yr., MALE, 93% MR
Pop. 1,348,315
COLOMBIA2005
14-39 yr., 96.6% MR
Pop. 17,619,141
EQUADOR2004
16-39 yr., 98% MR
Pop. 4,982,760
NICARAGUA2005
6-39 yr., 99% MR
Pop. 3,845,869
HONDURAS2002
5-39 yr., 98% MR
Pop. 3,234,375
PARAGUAY2005
5-39 yr., 99% MMR
Pop. 3,753,392
PERU2006
5-39 yr., 99% MR
Pop. 20,070,343
FINANCIAL SOURCE
FOR RUBELLA CAMPAIGN
PARAGUAY, 2005
43%Local
financing
44%National
financing13%Other
sources
18
THREE KEY FACTS OF
SPEED-UP CAMPAIGNS
BETWEEN 2003-2008
ALTOGETHER
FAST-PACED
SYNCHRONIZED CAMPAIGNS IN LAC
15-39 YEARS OLD, MEN AND WOMEN
LARGE IN SCOPE
WE MET OBSTACLES
50
100
150
200
250
300
600
350
400
450
500
550
2000 2001 2002 2003 2004 2005 2006 2007 2008*
SOURCE: COVERCGDT/DEVEP/SVS/MS
* Preliminary data
n = 15,413
CONFIRMED RUBELLA CASES BY WEEKBRAZIL, 2000-2008*
Mass campaign, 26 million
women12-39y, 2001-2002,
96% coverageSpeed-up campaign,
65.9 million men and
women 20-39y, 96%
50
01
00
01
50
02
00
02
50
03
00
03
50
04
00
04
50
05
00
0
20
40
60
80
10
0
‘97 ‘98 ‘99 ‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 ‘07 ‘08 ‘09
OUTBREAKS IN MALE POPULATIONS
SPEED-UP CAMPAIGN
10-29 YR. WOMEN ONLY
R
98%
FOLLOW-UP CAMPAIGN
1-4 YR.
M
99%
FOLLOW-UP CAMPAIGN
1-5 YR.
MR
93%
SPEED-UP CAMPAIGN
19-29 YR. MEN ONLY, MR 93%
CO
NFIR
MED
CASES
RO
UTIN
E IN
FAN
T V
ACCIN
ATIO
N C
OVERAG
E (%
)
CASESROUTINE
COVERAGE
* Data until EW 52/2009
SOURCE: Country reports to PAHO
ROUTINE MCV1 COVERAGE, MEASLES-RUBELLA ELIMINATION
CAMPAIGNS AND CONFIRMED RUBELLA CASES, CHILE, 1997-2009*
LAC countries that implemented “speed-up” campaigns in
women and men did not re-establish endemic measles
transmission, after an importation.
Brazil, however, is the exception: a ~5% left out during “speed-
up” resulted in thousands of susceptible individuals. A “ drop by
drop transmission” was interrupted, after indiscriminate
vaccination of adolescents and adults (5-29yr).
37
CONTRIBUTION OF SPEED-UP CAMPAIGNS IN
SUSTAINING MEASLES ELIMINATION
WE LEARN THROUGH
EXPERIENCE
STRONG LEADERSHIP
IMPLEMENTATION OF SPEED-UP
AS A MASTER STRATEGY TO ELIMINATE RUBELLA
AND MEASLES
AT THE HIGHEST LEVELS OF POWER
PAN-AMERICANISMALL LATIN AMERICAN LOW AND MIDDLE
INCOME COUNTRIES DECIDED TO INVEST
IN ELIMINATION
Lessons learned
Promote a pool of leaders
at national, and local level
Build a timeline for
planning synchronized,
rapid, and massive
vaccination strategies
Strategies tailored for
conflict areas (violence,
armed groups, crisis, etc)
31
FEB 2016Request update
from countries
APRIL-MAY
2016Review of the
countries’
updates
AUGUST
4-5 2016Presentation
of regional report
SEPTEMBER
2016Declaration of
measles
elimination in the
Americas
MAY
2017WHA resolution
for global
eradication
MR goal
SEPTEMBER
2017Regional
Framework for
Sustainability
Standardized template
2012-2015 period
Signed by National Verification
Commission
PAHO + IEC PAHO + IEC To be presented
at PAHO Sanitary Conference
(2017)
ROADMAP TO DECLARE MEASLES
ELIMINATION IN THE AMERICAS2016-2017
35
PARTNERS FOR MEASLES, RUBELLA,
AND CRS ELIMINATION
32
“Any measles vaccination campaign that does not include the rubella vaccine is a missed opportunity”
Ciro de Quadros
THANK YOU