KEY ISSUES IN IMMUNIZATION IN AFRICA

Transcription

1 SAGE Meeting April 2011 KEY ISSUES IN IMMUNIZATION IN AFRICA Deo NSHIMIRIMANA IVD / ARD / AFRO 1

2 Outline Efforts to reduce un-immunized children in Africa Attaining Global Polio Eradication Initiative Milestones in Africa Summary of discussions and Way forward 2

3 Reducing the Un/Under-immunized children in Africa 3

4 DTP3 containing vaccine coverage by country Jan-Dec. 2009/ Cap Verde Cap Verde STP Comoros Seychelles STP Comoros Seychelles Regional Cov: 81% Mauritius 4/46 Countries: <70% <70% 23/46 Countries: 70-89% 19/46 Countries: 90% 70-89% 90% EMRO Countries No data Mauritius Regional Cov: 82% 8/46 Countries: <70% 22/46 Countries: 70-89% 15/46 Countries: 90% 4

5 Reduction of DTP3 under immunized children in the top 10 countries, Jan-Dec ,400,000 1,286, ,200,000 1,000, , , , , , , , , , , , , , ,660 87, , ,018 8/10 have reduced the number of under immunized children 151, , , ,246 91,876 73,346 - Nigeria Tanzania Ethiopia Kenya Uganda Angola RDC Cameroun Cote d'ivoire Chad 5

6 Countries with 100% of districts with 80% DTP3 Coverage, Jan-Dec 2010 Cap Verde Seychelles STP Comoros 100% of districts with 80% <100% of districts with 80% EMRO Countries No Data Mauritius 5/46 Countries with 100% of dist with 80% DPT3 coverage compared to 3 in

7 Number of DTP3 under immunized children in Tanzania, Jan Dec 2009 vs 2010 Under-immunized Children 800, , , , , , , , , , % drop in underimmunized children compared to

8 Strategies used to reduce un/under-immunized children in Tanzania In 2009, the country introduced the Reaching Every Child (REC) approach to address the large numbers of un/under-vaccinated children. The use of vaccination coverage (%) can be misleading distracted the focus of where un-immunized children are: 83.4% of the unvaccinated children in 2009 were living in only 51 districts (16 provinces). Selection of health facilities which are contributing a big number of un/under-vaccinated children: avoid to over stretch the resources Majority of health facilities identified local tailored solutions for their local specific problems which were done without additional funding. Introduction of the pay for performance scheme in some districts as an innovative strategy to increase immunization coverage. 8

9 Number of DTP3 under immunized children in Ethiopia, Jan Dec 2009 vs 2010 Unimmunized Children 600, , , , , , % drop in underimmunized children compared to 2009 Reduction is mostly attributed to HEWs activities and implementation of ERIA. 9

10 Health Extension Program in Ethiopia Health Extension Programme: a vehicle to achieve access to universal primary health care services through community based health care 2 Health Extension Workers (HEWs) per community are paid by Government Health Extension Programme delivers a 16 Essential Health Services Package in 4 main areas: Hygiene and environmental sanitation Disease prevention and control Family health services (including immunizations) Health Education and Communication Roles of HEWs in Routine immunization: Conduct regular RI sessions Conduct Enhanced RI Activities (ERIA) in areas with large numbers of unimmunized children 10

11 Registration of eligible children in households, ERIA, 2010 Registration in Oromia region - Ethiopia, 2010 Registration in SNNPR - Ethiopia, 2010 Reconciling registration data & existing health post records for quality ERIA microplanning Registration in households is a critical step for defaulter tracing, social mobilization and gathering data for ERIA micro-planning 11

12 Top 10 Countries with DTP3 Under-immunized children, Jan-Dec 2010 Cote d'ivoire 107,246 Zambia 110,060 Cameroun Tanzania Kenya Uganda Mozambique Ethiopia 154, , , , , ,918 75% of all under vaccinated in the Region RDC 815,018 Nigeria 846, New countries: Zambia & Mozambique. 2 Countries out of the top10 : Angola & Chad 12

13 Achieving Global Polio Eradication Milestones in Africa 13

14 GPEI milestones By mid-2010: Cessation of all polio outbreaks with onset in 2009 (any new importations stopped within 6 months): 15 countries with outbreaks in 2009 Senegal with outbreak starting in 2010 By end-2010: Cessation of all re-established poliovirus transmission: Angola, Chad, D.R.Congo By end-2011: Cessation of all polio transmission in at least 2 of 4 endemic countries (including Nigeria) By end-2012: Cessation of all poliovirus transmission 14

15 Milestone 1: status as of 31st Dec 2010 Last cases IST WA : - MAU 28 April SEN 30 April 2010 WPV type3 WPV type1 3 countries with WPV After 30th June 2010: - Liberia: 1 WPV-1, Onset 8 Sept Mali: 1 WPV-3, Onset 17 Sept Uganda: 4 WPV-1, last date of onset 15 Nov

16 Milestone 2: Re-established countries Angola: 2010 milestone missed WPV-1 transmission still ongoing. The date of onset of latest case is 04/02/2011. Chad: 2010 milestone missed Type 3 transmission continued in Date of onset of last case: 23/12/10 New outbreak of WPV-1 experienced since 17/09/2010. Date of onset of last case: 28/02/2011 DR Congo: 2010 milestone missed Confirmed orphan WPV-1 in Katanga related to Equateur and Oriental transmission in 2008, and North & South Kivu in 2009 New importation of WPV 1 since May Latest case reported from this outbreak in 2010 is 29/12/

17 Milestone 2: Actions taken by the 3 countries Angola: High political commitment and advocacy Development of a 6 months emergency plan Community-based strategy Chad: Sustained high level political commitment Governors, local and community leaders commitment Specific strategies for nomadic and mobile populations DRC: High level advocacy visits with DG and RD/AFRO Emergency plan developed with emphasis on strengthening routine immunization: 17

18 Milestone 3: Interrupting endemic transmission, Nigeria 2008 WPV= 796 (719 W1 and 77 W3) Infected LGAs = 243 Infected States = % reduction in WPV WPV= 388 (71 W1 and 313 W3) Infected LGAs = 198 Infected States = 27 WPV= 21, (8 W1, and 13 W3) Infected LGAs = 21 Infected States =

19 circulating Vaccine Derived Poliovirus in Nigeria OPV3 coverage: 37% 2010 OPV3 coverage: 74% No of cvdpv cases Yr'2005 Yr'2006 Yr'2007 Yr'2008 Yr'2009 Yr'2010 Source of Immunization coverage data: 2006 and 2010 National Immunization Coverage Surveys 19

20 Remaining risks in Nigeria in 2011 Epidemiological Persistent WPV and cvdpv transmission in Nigeria and neighbouring countries. Insufficient population immunity in some States Operational Risks: quality of SIAs, vaccine management, low routine immunization coverage Continued non compliance in several high risk areas. Preparations for the National elections in April 2011 associated with decreased engagement/commitment from political leaders at the local level. Vaccine security: availability & funding. 20

21 Congo outbreak: distribution of polio confirmed cases October 2010 November 2010 December 2010 New outbreak of type 1 affecting mostly adults was confirmed in Sept confirmed polio cases in 2010 (CFR: 32%) Only 1 WPV type 1 in 2011 with date of onset 22/01/20 (as at 31/03/2011) 21

22 Impact of SIAs on Congo outbreak 140 SIA Rd1 Week 45, 2010 SIA Rd2 Week 48, SIA Rd3 Week 2, Nombre de Cas Cases SIA Rd4 Week 8, Semaines Weeks DCD Death PVS+ Compatibles Confirmed polio 22

23 Summary Targeted approaches are yielding positive results in reducing number of un/under-immunized children in several countries in Africa. Significant progress in achieving GPEI milestones 1 and 3. Remaining risks for the attainment of milestone 2 in Angola, Chad and DRC. Reducing un-immunized children in some key areas in Nigeria has contributed to progress in reducing intensity of transmission of poliovirus. 23

24 Way Forward Expand and consolidate the targeted initiatives to reduce the un/underimmunized children in Africa Continue high level advocacy to increase domestic financing for immunization programmes in Africa Implement high quality synchronized SIAs rounds in April 2011 to interrupt the transmission by the end of June Re-emphasize critical linkage between improving routine immunization systems, polio eradication and other accelerated control disease initiatives. 24

25 Thank you 25