MenA vaccine Introduction Country Experience, Ethiopia

Transcription

1 MenA vaccine Introduction Country Experience, Ethiopia Meningitis Vaccine Project, Closure Conference February 22, 2016 Addis Ababa, Sheraton Hotel

2 Background ü Country background ü EPI Background Meningococcal Disease Outline Meningitis A Campaigns in Ethiopia ü Rationale ü Opportunities ü Strength ü Challenges Disease surveillance Future Plan

3 Country background Projected total popula.on (census 2007): 92.2 million Rural: 83%; Under-1: 2.9%; Under-5: 14.6%; under 15: 44.9% > 3million birth cohorts annually Administra.ve: 9 Regions, 2 City Administra.ons 957 Districts 16,447 Health Posts 3,550 Health Centers >38,000 Salaried Health Extension Workers ( community Health Workers) Child Mortality Rate: 64/1000 LB, MDG4 target met by 2012 PopulaGon Density

4 EPI background Six tradi.onal an.gens since 1980 Ten an.gens in the infant na.onal immuniza.on schedule currently Es.mated surviving infants at 1 year account for 3.2% of the total popula.on; thus, the rou.ne immuniza.on program targets nearly 3 million birth cohorts every year Women of child bearing age group are targeted for Tetanus Toxoid vaccine

5 BCG DPT-Hib- HepB OPV IPV Measles Rota PCV HPV* MenA** EPI background Birth 6wk 10wk 14wk 9-12m 1-6 yrs Adolesc 9-13 yr Special 1 dose; 1-29yr *Two dose HPV demonstra.on program started Dec 2015 in two districts for two years **MenAfrivac given in the form of campaign in 2013, 2014 and in 2015

6 Meningococcal disease Caused by Nisseria meninigitidis affects the brain membrane, causing severe brain damage CFR 5-15%; and it can be fatal in 50% of cases. Occurs periodically across the meningitis belt (from Senegal to Ethiopia) ( 7-14 yrs) The predominant cause of large outbreaks is due to sero type A

7 Meningococcal disease... Risk factors for MenA in Africa are not all understood, but associated conditions include: ü Medical conditions: immunological susceptibility of the population, ü Demographic conditions: travel and large population displacements, ü Socioeconomic conditions: poor living conditions and overcrowded housing, and ü Climatic conditions: drought (epidemics are recorded in dry seasons) and dust/sand storms. `

8 Meningococcal disease: Control Strategies Prevention Chemoprophylaxis for close contacts exposed to cases Vaccinate people at high risk to prevent spread of infection Treatment Early Dx & prompt Rx of case reduces CFR & sequellae Intensive & supportive hospital care, including anti-microbial drugs Prompt reporting of case

9 Epidemic Meningitis elimination strategies (AFRO) 1. Rapidly inducing herd immunity: Single dose in mass immuniza.on campaigns targe.ng 1 to 29 years olds (70 % of the popula.on); 2. Protec.ng birth cohorts: by introducing the vaccine into rou.ne EPI by Organize follow up campaigns every 5 years targe.ng 1-4 years olds, not covered by rou.ne EPI (missed during Rou.ne Immuniza.on ) è Strengthening Surveillance and epidemic response

10 MeningiGs A Campaigns in Ethiopia

11 RATIONALES Ethiopia has suffered major outbreaks with predominance of sero-group A In 1981, massive epidemic due to Nm A group during which about 50,000 cases with a thousand deaths were recorded mostly from Oromia, Amhara and SNNPR regions. The disease takes a heavy socio-economic and human toll in the above men.oned areas

12 MenAfriVac introduction strategies in Ethiopia l In 2012 risk mapping was completed IDSR based data Outbreak based data l Order of priority within the country was decided DPT quantitative assessment History of epidemic investigations and situations Expert opinion (accounting for factors such as population movements, crisis, quality of surveillance etc.) Importance of herd immunity at regional level A total target population of 61.7 million Approx. (70% of total population) aged 1-29 years were targeted for implementation in three years:

13 MenA campaign targeted areas by phase

14 MenA Preventive campaigns General objective: To eliminate epidemics of meningococcal meningitis due to serotype A from Ethiopia and reduce morbidity and mortality among the population Specific Objectives: Vaccinate at least 95% of the targets (1-29yrs) by end 2015 Ensure immunization safety practices during the campaign Establish a pharmaco-vigilance system for monitoring AEFI Strengthen the case and laboratory based surveillance system for Cerebro Spinal Meningitis

15 Planning and coordination Activities

16 Strategies of the campaign Campaign activities were coordinated by the taskforce through MenAfrivac TWG Facilitated vaccine licensure and registration Microplaning exercise was done for each phase Bottom up - targets setting Special population groups were identified Identified fixed post, mobile and campout teams Training materials prepared, printed and distributed 2 days training conducted at all levels RI topics were incorporated

17 Planning and implementation of the campaigns Social mobilization / Communication: Communication plan, advocacy and IEC materials were developed and translated in to local languages for each round. The community structure mainly the health development army and the social mobilization networks were used to mobilize and inform communities. Messages were also broadcasted using national and regional radio and Television.

18 Planning and implementation of the campaigns Vaccine & Cold chain: Rapid cold chain assessments were done Implementing areas were prioritized for cold chain rehabilitation as per the cold chain rehab. Plan Timely vaccine, dry supplies and printed materials distribution was done by PFSA according to the distribution plans

19 Planning and implementation of the campaigns AEFI monitoring: Prepared training modules and AEFI management protocols integrated with the overall campaign training materials and tools. Strengthened the AEFI guideline The existing AEFI committee was used to coordinate AEFI surveillance and classify AEFI cases. daily command post with involvement of FMHACA, regulatory body and the EPI task force members during the campaign days Woredas and HFs provided adrenalin for each vaccination teams

20 Waste Management Waste management plan was developed and adequately budgeted Additional one day training on sharp and waste management given Mapping of existing waste management facilities was done in all implementing districts. waste management task force committees

21 Men A Budget The campaigns operational cost and vaccines & supplies were funded by GAVI

22 Admin coverage of the campaigns S.No Phase Target population Coverage MenAfrivac Vaccine utilized WR No of AEFI cases 1 Phase I (October 17 to 26, 2013) 18,926,853 18,616,135 (98.4%) 19,675,280 doses 3% 422, no death 2 Phase II (October 18-27, 2014) 26,910,795 26,268,708 (97.6%) 26,999,587 doses 2.7%. 1,698, no death 3 Phase III (October 26 to November 6, ,910,620 16,174,546 (101.7%) 17,629,000 million doses 3% 740, no death

23 OPPORTUNITIES Local partners (NGOs, Privates). Partners provided vehicles and human resources. Meningitis disease: people know about CSM and its consequences and are therefore willing to receive the MenAfriVacR vaccine. Gathering areas: teams have vaccinated beyond the daily requirement in gathering areas including churches and market places. Health Extension Workers (HEW) have been the paramount source of information about Men A campaign especially in rural areas.

24 STRENGTHS High government commitment at all levels. Strong Commitment of peripheral teams Campaign reviewed together with existing QRM Good waste Management Practice Local initiative of producing IEC materials; Timely distribution of vaccines and logistics Post campaign coverage survey is conducted

25 CHALLENGES Heavy rains in some areas disturbing the campaign activities Hard to reach areas leading to a delay in starting the campaign and sending compiled results. Logistics Packaging of vaccination cards Targe Distribution Gap

26 SUMMARY l All the three rounds were successfully implemented l High coverage (98.4%) was achieved for all rounds with post coverage survey findings of 92.4% for Phase I, Phase II 93.5 % and 92.9% for Phase III campaigns l There was high acceptance of the vaccine l The impact will continue to be monitored

27 Disease surveillance The country has a well structured PHEM system from national up to community levels Meningococal meningitis is among the weekly reportable public health priority diseases Six sentinel surveillance sites established as part of the enhanced meningococcal surveillance Sentinel sites are also available for other new vaccines such as pediatric bacterial meningitis and Rota. Opportunities of PBM sentinel sites are also used to isolate meningococcal bacteria.

28 Introduction of meningitis vaccine in RI The country has rich experience in successfully introducing new vaccines: Pentavalent introduced in 2007 Pneumococcal vaccine introduced in October 2011 Rotavirus vaccine introduced in November 2013; and post introduction evaluation conducted in 2015 IPV introduced in Dec 2015 HPV Demonstration project in two districts in Dec 2015

29 Introduction of meningitis vaccine in RI.. With the aim to maintain herd immunity through vaccination of ongoing new birth cohorts to sustain meningitis elimination, the country has a plan to introduce Men A vaccination in the RI.

30 አመሰግናለሁ!!!