Vaccine-preventable Diseases and Immunization: a WHO/EURO Update

Transcription

1 Vaccine-preventable Diseases and Immunization: a WHO/EURO Update Robb Butler, Programme Manager Vaccine-preventable Diseases and Immunization Programme WHO Regional Office for Europe Copenhagen, Denmark IAIM Joint Regional Meeting Madrid February 1-2,

2 WHO Region of Europe 53 Member States 15 time zones (capital cities -2 to +5 hr from Copenhagen) 4 official languages Population 900 Million Infants 11 Million < 5yr 55 Million <15yr 157 Million DPT3+Pol3: 94%, MCV: 94% 2

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4 Sustainable immunization financing Significant progress toward self-sufficiency: Overall government funding for vaccines in the Region continues to increase (MDA to achieve self-sufficiency in 2017; ARM, AZE and GEO in 2018) All countries receiving GAVI support fulfilled their cofinancing requirements in 2015 (ARM, AZE, GEO, KGZ, MDA, TJK and UZB) All (five ARM, AZE, GEO, MDA, UZB) graduating countries received support to assess challenges related to graduation from donor support and have plan to address them to enable smooth transition.

5 Trends of Immunization Coverage of Major Antigens in European Region, * *Data source: WHO/UNICEF Estimates (WUENIC) Data as of 28-Sep

6 MCV1 and MCV2 coverage Reported Measles and Rubella cases Thousands MCV1/MCV2 coverage and Measles/Rubella cases, , EURO Region Measles cases Rubella cases MCV1 MCV2 *Data source: WHO/UNICEF Estimates (WUENIC) Data as of 28-Nov

7 MCV1 and MCV2 Coverage in WHO European Region, 2015 Data source: WUENIC Data as of 21-Aug-2016 *Countries with No data for MVC2 in 2015 Finland, Ireland and Monaco 7

8 Measles Incidence Rate in WHO European Region, Data source: CISID Data as of 01-Nov-2016 *Countries with No data: 2012 San Marino and Bosnia & Herzegovina; 2015 Monaco, San Marino and Turkmenistan 8

9 Number of measles in the WHO European Region, * 35, cases in 33 countries 30,000 25,000 20,000 15,000 Bulgaria ,000 5,000 France Ukraine Georgia Kyrgyzstan * Data extracted 01 November 2016 *First 3 quarters

10 Rubella in the WHO European Region, 2000 & * 98% REDUCTION Number of reported rubella cases 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 Other POLAND ROMANIA * *First 3 quarters

11 All six WHO Regions have measles elimination goals 11

12 European Regional Verification Commission (RVC) To demonstrate interruption of endemic measles and rubella transmission, countries are requested to provide evidence in a standardized format that: endemic measles and rubella cases have not occurred for 3 consecutive years, the disease surveillance system is sufficiently sensitive, specific, timely and complete to detect cases if they occurred, and the absence of endemic cases is supported by genotyping evidence. The 5 th Meeting of the RVC 24 to 26 October

13 Number of countries and their measles elimination status based on data for (n=50) and 2015 (n=51) Conclusions of the 4 th (2015) and 5 th (2016) Meetings of the European Regional Verification Commission for measles and rubella elimination. Eliminated Interrupted 24 months Interrupted 12 months and Interrupted* Endemic No reports 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% * Interrupted transmission in

14 Number of countries and their rubella elimination status based on data for (n=50) and 2015 (n=51) Conclusions of the 4 th (2015) and 5 th (2016) Meetings of the European Regional Verification Commission for measles and rubella elimination. Eliminated Interrupted 24 months Interrupted 12 months Endemic No reports 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

15 WHO EUR Risk Assessment 2016 The boundaries and name shown and the designation used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimination of its frontiers of boundaries. Tajikistan, Israel, Ukraine The RCC assesses the risk of importation and circulation of wild poliovirus or emergence of a vaccine-derived poliovirus. Risk is assessed focusing on surveillance, population immunity and outbreak preparedness Member States at high-risk: Bosnia-Herzegovina, Romania and Ukraine. 15

16 WHO/Europe inventory summary and containment progress Countries with WPV/WPV2* Countries without WPV Countries without any PV 2014 # EU countries /13 12/ Sites in inventory & 118 Sites with WPV/WPV /38 52/34 Sites with Sab/Sab2 Countries planning PEFs No of planning PEFs - 167/72 89/ (BEL, CRO, DNK, FRA, HUN, ITA, LTU, NET, ROM, SWE, UNK) (BEL (5), CRO, DNK, FRA (4), HUN, ITA, LTU, NET (9), ROM, SWE, UNK(3)) Phase I part a containment procedures toward WPV2 materials (to destroy/transfer or to nominate PEF/NAC) * WPV starting from 2015 this definition includes WPVs, VDPVs, WPV-PI # Data from official statements provided by 51 Member States in their APR for Data from official statements provided by 53 Member States as of November 2016 & This number includes all facilities holding WPV and/or Sab materials and registered in regional inventory 16

17 POSE New Developments National for self-delivery a scenario-based discussion exercise complete with suggested list of key questions Available online: One country conducted national POSE in Nov 2016 Regional inter-country Inter-Regional EURO+WPRO 17

18 % coverage DTP3 coverage in the WHO European Region,

19 DTP3 coverage in the WHO European Region, Change in 2015 (Ref:2014) Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic (the) Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands (the) Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan Region Bosnia and Herzegovina -4% Bulgaria +3% Georgia +3% Kazakhstan +3% Latvia +3% Republic of Moldova -3% Romania -5% San Marino -4% FYRM -4% 19

20 Number of reported diphtheria cases Reported diphtheria in the WHO European Region, Number of reported diphtheria cases Diphtheria is now a rare disease in the Region 58 cases reported in 2015 (35 cases in 2014) 60,000 50,000 40,000 30, ,000 10,

21 Countries reporting cases of diphtheria in 2015 Number of reported diphtheria cases France Germany Latvia Netherlands Belgium Norway Russian Federation Ukraine Denmark Georgia Ireland Italy Spain Sweden United Kingdom Rare reports of fatal toxigenic cases: Spain year-old boy Latvia 2015 one death Belgium year-old boy 21

22 Number of reported pertussis cases Reported pertussis in the WHO European Region Thousands of cases of pertussis continue to be reported Recent large outbreaks in Spain, Denmark and Austria 180, , , , ,000 80,000 60,000 40,000 20,

23 HPV introduction in WHO European Region: now also in middleincome countries Introduced (29) Plan intorduction 23

24 Pneumococcal and Rotavirus Vaccine Introduction Status in WHO European Region Pneumococcal Rotavirus Data source: WHO/UNICEF JRF Updated on 11-Aug

25 Regional Viral Hepatitis Action Plan Endorsed by at 66 th session of Regional Committee for Europe, 14 September 2016 Includes hepatitis B immunization priority activities and targets: o 95% coverage with three doses of HBV vaccine o 0.5% HBsAg prevalence in vaccinated cohorts o 80% of health-care workers vaccinated against HBV o 90% coverage with timely HBV birth dose vaccination OR o 90% coverage with screening in pregnant women and 95% coverage with post-exposure prophylaxis in infants born to infected mothers

26 Strengthening NITAGs NITAG (41 contries) ## Participation of NITAGs in SAGE meetings Study tour to JCVI for Albanian NITAG, October 2016 Evaluation of NITAGs; discussion of results at regional meeting, 14 October

27 U5 mortality in all MICs Nigeria MICs facing the biggest challenges are getting donor support through a wellcoordinated strategy Angola Gavi status Non-Gavi MIC Gavi-graduating Gavi-eligible LMIC 63 non-gavi MICs are not meeting GVAP targets and would benefit from a unified international strategy. Equity is a concern for people living in countries without sufficient support. India Philippines Morocco Iran China

28 There are 63 non-gavi MICs: a heterogeneous group

29 Conclusion of the initial EURO analysis Performance of the Middle-income Countries (MICs) with no donors support are lagging behind the other groups in the European Region of WHO (green light for further analysis) Number of antigens accommodated by national immunization programmes Number of new vaccines introduced (out of 3 made available for use, namely PCV, rota and HPV vaccines) by national immunization programmes Coverage for the third dose DTP containing vaccines Coverage for the first dose Measles containing vaccines 29

30 WHO Euro countries sharing pricing information 24 Member states (2013) 28 Member states (2014) 30 + Member states (2015) Participating EURO Member states by income level

31 V3P Euro - 3 years data snapshot (I): Any trends in the price paid? MMR Hepatitis B (pediatric) 31

32 V3P Euro - 3 years data snapshot (II): Any trends in the price paid? HPV PCV 32

33 V3P Euro - 3 years data snapshot (III): Any trends in the price paid? DTaP-Hib-IPV-HepB DTaP-Hib-IPV 33

34 In summary Characterized by high national but sub-optimal coverage sub-nationally Resurgence of some forgotten diseases Measles and rubella: job not done Polio: containment and transition focus Hep b control goal set and verification underway MIC challenges HMIC paying highest prices Demand and acceptance variable 34

35 Thank you 35

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