BULLETIN World Health Organization Regional Office for the Western Pacific Expanded Programme on Immunization World Health Organization, Western Pacific Regional Office, Manila, Philippines Issue 12 April 2007 ISSN 1814 3601 Global reduction in deaths exceeds target the Western Pacific Region leads all other regions in per cent reduction in deaths In a joint news release, the Global Measles Initiative Partnership announced that global deaths had fallen 60% from 873 000 in 1999 to 34 000 in 200, exceeding the 0% reduction goal set by the World Health Assembly 1. Among the six WHO Regions, the African Region had the greatest reduction in estimated numbers of deaths, from 06 000 in 1999 to 126 000 in 200, whereas the Western Pacific Region had the greatest percentage reduction in deaths, from 27 000 to 000 (81%) 1 (Figure 1). Figure1. Regional progress in reducing mortality, 1999 200 The Western Pacific Region s success in substantially reducing mortality during this period was achieved by maintaining high population immunity against through routine immunization with a first dose of containing vaccine (MCV1) and providing a second dose of vaccine (MCV2) either through routine immunization or supplementary immunization activities (SIAs). In 1999, the Western Pacific Region led the other four -endemic regions in MCV1 coverage with 8%. By 200, MCV1 coverage in the Region increased to 87% 1. In addition, more than 0 million children in Western Pacific Region countries (Cambodia, the Lao People s Democratic Republic, Papua New Guinea, the Philippines and Viet Nam) which did not have MCV2 as part of their national routine immunization programme were provided vaccine through SIAs. China also conducted SIAs in several large provinces. The countries of the Western Pacific Region are to be commended for their outstanding achievements in surpassing the global goal of 0% reduction in deaths by 200, and nearing achievement of the next global goal of a 90% reduction in deaths by 2010. These efforts, especially when integrated with other child health interventions (e.g. vitamin A supplementation, deworming medicine), also contribute to achieving Millennium Development Goal Number 4: a two thirds reduction in child deaths from 1990 to 201. The Western Pacific Region has a goal to eliminate by 2012, and achieving that goal will require the concerted effort of all countries in the Region to increase routine MCV1 and MCV2 coverage to 9%, conduct SIAs when needed to prevent epidemics, and establish sensitive case-based surveillance to identify virus circulation and monitor progress towards the elimination goal. To that end, many countries in the Region (Cambodia, China, the Lao People s Democratic Republic, Mongolia, Papua New Guinea, the Philippines and Viet Nam) are conducting SIAs in 2007. To sustain the gains from SIAs, countries must also focus their efforts on increasing routine coverage and establishing sensitive case-based surveillance. 1 Wolfson LJ, et al. Has the 200 mortality reduction goal been achieved? A natural history modeling study. Lancet 2007; 369:191-200. 2 AMRO WHO Regional Office for the Americas 3 EURO WHO Regional Office for Europe 4 WPRO WHO Regional Office for the Western Pacific EMRO WHO Regional Office for the Eastern Mediterranean 6 SEARO - WHO Regional Office for the South East Asia 7 AFRO - WHO Regional Office for Africa
BULLETIN Cambodia Population: 14 638 07 (2007) MCV1: at 9 months: coverage 79% (200) MCV2: currently not given Measles campaigns: a. National campaign from 2000 to 2004: 98% coverage. b. February to March 2007; target 1. million children 9-9 months old Surveillance: reporting rate decreased from 94 to 1.06/100 000 from 2000 to 200 2 20 Figure 1. Number of suspected cases by week, Cambodia, 2006 Unconfirmed cases Confirmed cases Total suspected cases: 08 Total confirmed cases: 188 (37%) Total pending cases: 33 Number of cases 1 10 0 Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec 2
BULLETIN F ig u re 2. N u m b e r o f s u s p e c te d m e a s le s c a s es b y a g e gro u p, C a m bo d ia, 2 0 0 6 200 180 160 U n con firm e d C o nfirm ed Number of cases 140 120 100 80 60 40 20 0 0 8 9 1 1 1 2 2 3 2 4 3 3 6 4 7 4 8 9 9 1 0 1 4 1 2 > 2 U n k n o w n Of 188 confirmed cases, 106 (6.3%) were <9 months, 62 (32.9%) were 9 9 months, 13 (6.9%) were 14 years, and 7 (3.7%) were adults. Figure 3. Confirmed cases by immunization status Cambodia, 2006 <9 months old 0% 18% 9 9 months old 14 years old 8% 100% 82% 92% N=106 N=62 N=13 For those 9 9 months, 11 out of 62 (18%) confirmed cases were vaccinated. For those 14 years old, 1 out of 13 confirmed cases was vaccinated. For the confirmed cases <9 months old, there were no cases immunized. The first vaccine dose is given at 9 months of age in the national immunization programme.
Country Table 1. Country surveillance data, Western Pacific Region, 2007* Australia 20.8 124 0.61 0 124 124 6.09 0 0 0.00 21 Nov 2006 Brunei Darussalam 0.39 Cambodia 14.64 08 3.4 186 2 188 13.10 33 0 0.00 92 0.63 44 0 44 3.01 0 0 0.00 22 Feb 2007 China 1,331.36 107,38 8.12 - - 107,38 81.24-31 0.00 29,124 2.19 - - 29,124 21.88-20 0.69 - Hong Kong (China) 7.19 139 1.9 38 68 106 14.89 0 0 0.00 13 Dec 2006 Japan Ω 128.33 Lao People's Democratic Republic 6.19 22 0.36 18 0 18 2.97 4 0 0.00 - Macao (China) 0.47 3 0.6 0 2 2 4.32 0 0 0.00 0 0.00 0 0 0 0.00 0 0 0.00 01 Jun 2006 Malaysia 26.24 1,731 6.71 96 18 983 38.11 0-304 1.16 148 17 16 6.29 0 - - - Mongolia 2.71 26 0.97 0 26 26 9.71 0 0 0.00 0.18 0 1.84 0 0 0.00 04 Feb 2007 New Zealand 4.09 20 0.49 18 2 20 4.92 0 0 0.00 9 0.22 7 2 9 2.20 0 0 0.00 23 Mar 2007 Papua New Guinea 6.11 Philippines Ω 8.88 312 0.37 210 6 216 2.6 0 3 0.01 43 0.0 16 0 16 0.19 0 0 0.00 22 Mar 2007 Republic of Korea 48.14 112 0.23 0 2 2 0.2 3 1 0.04 2 0.00 0 0 0 0.00 0 0 0.00 14 Nov 2006 Singapore 4.43 28 0.64 0 28 28 6.39-0 0.00 3 0.07 0 3 0 0.68 0 0 0.00 17 Mar 2007 Viet Nam 86.44 6,461 7.7 36 1,61 1,971 23.09 291 3 0.00 30 Dec 2006 Pacific island countries: American Samoa 0.06 0 0.00 0 0 0 0.00 0 0-0 0.00 0 0 0 0.00 0 0 - - Cook Islands 0.02 0 0.00 0 0 0 0.00 0 0-0 0.00 0 0 0 0.00 0 0 - - Fiji 0.86 132 1.34 110 22 132 13.36 0 0 0.00 French Polynesia 0.26 0 0.00 0 0 0 0.00 0 0 - - Guam 0.17 1 0.7 0 0 0 0.00 0 0-0 0.00 0 0 0 0.00 0 0 - - Kiribati 0.09 0 0.00 0 0 0 0.00 0 0 - Marshall Islands 0.0 0 0.00 0 0 0 0.00 0 0 - - Micronesia, Federated States of 0.11 0 0.00 0 0 0 0.00 0 0-0 0.00 0 0 0 0.00 0 0 - - Nauru 0.01 2 1.31 0 0 0 0.00 0 0-1 7.66 0 0 0 0.00 1 - - - New Caledonia 0.2 2 0.82 0 0 0 0.00 1 0-2 0.82 0 0 0 0.00 2 - - - Niue 0.00 0 0.00 0 0 0 0.00 0 0 - Northern Mariana Islands 0.08 0 0.00 0 0 0 0.00 0 0-0 0.00 0 0 0 0.00 0 0 - - Palau 0.02 1 4.88 0 0 0 0.00 1 0-4 19.2 0 0 0 0.00 4 - - - Samoa 0.18 Solomon Islands 0.48 0 0.00 0 0 0 0.00 0 0-0 0.00 0 0 0 0.00 0 0 - - Tokelau 0.00 0 0.00 0 0 0 0.00 0 0-0 0.00 0 0 0 0.00 0 0 - - Tonga 0.10 0 0.00 0 0 0 0.00 0 0 - Tuvalu 0.01 0 0.00 0 0 0 0.00 0 0-0 0.00 0 0 0 0.00 0 0 - - Vanuatu 0.21 0 0.00 0 0 0 0.00 0 0-0 0.00 0 0 0 0.00 0 0 - - Wallis and Futuna 0.01 0 0.00 0 0 0 0.00 0 0 - Western Pacific Region 1,776.20 117,162 6.60 1,901 1,938 111,377 62.71 333 38 0.00 29,89 1.67 21 27 29,363 16.3 7 20 0.00 * Data are based on country reports and other sources available to EPI/Western Pacific Regional Office. Φ Population figures from World Population Prospects: The 2004 Revision, New York, United Nations, 200. Case Fatality Rate Ω Sentinel surveillance system Population Φ (in millions) cases cases (/100 000) 2006 No. pending confirmation Confirmed No. No. of No. confirmed No. confirmed pending deaths Measles cases (/1 confirmation 000) due to CFR cases (/100 Clinical Lab/Epi Total cases 000 000) Clinical Lab/Epi Total 2007 Confirmed cases (/1 000 000) No. of deaths due to Measles CFR Rash onset of last confirmed case
BULLETIN Australia Brunei Darussalam Table 2. Country surveillance data, Western Pacific Region, 2007 Cambodia 18 92 7 48 92 - - China - 29124 - - - - - Hong Kong (China) Japan Country Lao People's Democratic Republic Macao (China) 1 3 0 100 100 33 - Malaysia - 304 - - - - - Mongolia 22 0 100 100 - - New Zealand - 9 - - - - - Papua New Guinea No. of districts* Total number of suspected cases % districts with > 1 suspected case/100 000 % suspected cases with adequate investigation % suspected cases with adequate specimen % specimens with lab results within 7 days % of transmission chains with viral isolate Philippines 78 43 1 79 67 - - Republic of Korea - 2-100 100 100 0 Singapore 1 3 0 - - - - Viet Nam * or 2nd administrative unit investigated within 48 hours with following data: age or DOB, vaccination status, date of last vaccination, district, date of rash onset, date of specimen collection excluding from denominator cases that are epidemiologically linked to a laboratory-confimed case Expanded Programme on Immunization WORLD HEALTH ORGANIZATION Regional Office for the Western Pacific, United Nations Avenue, P.O. Box 2932, 1000 Manila, Philippines Fax No. (632) 211036, 260279, 260362 Tel. No. (632) 288001 Comments may be sent to WHO/WPRO Measles Bulletin _bulletin@wpro.who.int. Please send quarterly data to Mr Dexter Bersonda at bersondad@wpro.who.int