Measles Elimination in Southeast Asia 公开

Abstract

Background: The eleven countries of The World Health Organization for South East Asia Region (SEARO) have a target of measles elimination by 2020. Despite having relatively strong measles routine immunization programs and supplementary measles immunization activities measles remains a significant problem in the SEARO countries. In 2012, there were 46,945 reported measles cases in the region, 39.8% (18,668) from India. Objectives: The objectives of this study are 1) to describe current measles routine immunization, surveillance and measles supplementary immunization activities in the SEARO countries; and 2) to identify key challenges for meeting the measles elimination target by 2020. Methods: The primary method employed was a thorough document review of both published and unpublished information on all aspects of the measles immunization program in each SEARO country. Additionally aggregate measles data reported to SEARO and made available by CDC were used to show trends in each component of measles activities from 1995 to 2012. Results: Among the SEARO countries Bhutan, Sri Lanka, Maldives, Thailand and Bangladesh consistently achieve the target of greater than 90% measles immunization coverage. These three countries have maintained high level routine immunization coverage of more than 95% at national and subnational level. India, Indonesia and Timor-Leste are far behind if they are to meet the elimination target. In 2012, measles (MCV) coverage was 74% in India with great variance in coverage among states. Indonesia achieved 80% coverage in 2012 while Timor-Leste only achieved coverage for MCV of 62% in 2012. Nepal has not yet reached coverage of 90% but at 86% is making considerable progress and has conducted measles and rubella (MR) campaigns targeting children 9 months to 15 years of age to reduce the number of measles cases. Recommendations: Community based micro planning has been shown to improve routine immunization by involving local authorities at every stage of routine immunization and campaigns. High level advocacy is needed for each round of measles campaigns.

Table of Contents

Table of Contents

1.1 Rationale ........................................................................................................................................ 8

1.2 Problem Statement .................................................................................................................... 10

1.3. Significance Statement ............................................................................................................... 10

1.4.Purpose statement ........................................................................................................................... 11

1.5. Study- Specific aims .................................................................................................................... 11

1.6. Research questions .................................................................................................................... 11

2. Literature review ............................................................................................................................... 12

2.1. Clinical manifestation of measles and its complication (Perry & Halsey, 2004). ............................. 12

2.2. Measles epidemiology and outbreak investigation using IgM test in Laos ............................... 13

(Kuroiwa et al., 2001) .............................................................................................................................. 13

2.3. Improving immunization coverage through budgeted microplans and sub national performance agreements: early experience from Cambodia (Soeung et al., 2006) .................................................... 14

2.4. Measles Elimination Strategies ................................................................................................... 16

2. 4.1. (Biellik et al., 2002) First 5 years of measles elimination in southern Africa: 1996 - 2000:16

2.4.2 Lessons and challenges for measles elimination (Minetti et al., 2013) .............................. 17

2.4.3. South East Asia Regional update on measles reduction and elimination, 2003 - 2008 (O'Connor et al., 2011) ........................................................................................................................ 18

2.4.4 Measles and Rubella Surveillance ....................................................................................... 20

2.5. Summary of literature review ..................................................................................................... 23

3. Methods .......................................................................................................................................... 24

3.1. Selection of countries ................................................................................................................. 24

3.2 Design ........................................................................................................................................ 24

3.3. Data analysis: ............................................................................................................................. 25

3.4. Ethical Considerations ................................................................................................................. 25

4. Results ................................................................................................................................................... 25

4.1. Measles routine Immunization services in SEARO ........................................................................... 25

4.2.1. Current measles routine immunization services in India ................................................... 25

4.2.2. Measles routine immunization services in Nepal. .............................................................. 28

4.2.3 Measles routine immunization program in Bhutan ................................................................... 29

4.2.4. Measles routine immunization services in Sri Lanka ................................................................ 30

4.2.5. Measles routine immunization services in Bangladesh. .................................................... 31

4.2.6. Measles routine immunization services in Myanmar ........................................................ 32

4.2.7. Measles routine immunization services in Maldives ......................................................... 33

4.2.8. Measles Routine immunization services in Thailand ......................................................... 34

4.2.9. Measles routine immunization services in Democratic People's Republic of Korea (DPRK) 35

4.2.10. Measles routine immunization services in Timor-Leste ................................................. 36

4.2.11 Measles routine immunization services in Indonesia ......................................................... 37

5. Current measles surveillance system in SEARO countriesSurveillance is the ongoing, ..................... 38

6. Performance of measles and rubella supplementary activities in SEARO 1995 to 2012 ....................... 41

6.1. Measles supplementary immunization in India ............................................................................... 41

6.2. Supplementary immunization in Nepal ........................................................................................... 42

6.3. SIAs in Myanmar ......................................................................................................................... 43

6.4. SIAs in Bangladesh ..................................................................................................................... 43

6.5 SIAs in Indonesia ......................................................................................................................... 44

6.6. SIAs in Maldives ............................................................................................................................... 44

6.8. SIA In other SEARO countries ........................................................................................................... 44

7. Discussion and Recommendations ..................................................................................................... 45

7.1. Linkage between measles surveillance and rubella. ................................................................... 45

7.2. Linkage between measles case based surveillance and measles elimination ............................ 46

7.3. Linkage between measles supplementary immunization and measles epidemic. ..................... 48

7.2. Strength of the study ....................................................................................................................... 50

7.3. Weakness of the study ................................................................................................................ 50

7.4. Recommendations ........................................................................................................................... 50

7.4.1. Recommendation for improving measles routine immunization activities........................ 50

7.5. Recommendation for supplementary measles campaign ........................................................... 51

7.6. Recommendation for measles surveillance activities: ............................................................ 52

Conclusions ............................................................................................................................................... 53

References ................................................................................................................................................

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
关键词	Routine immunization coverage Measles Passive surveillance Supplementary immunization activities Southeast Asia Sentinel Electronic surveillance Rubella Infants Active surveillance Follow up campaign Mumps Case based surveillance Immunity Catch up campaign
Committee Chair / Thesis Advisor	McFarland, Deborah A, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti) International Non-governmental organization (e.g., CARE, Inc.) CDC

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