The Red List : Actions Taken in Central Africa. IMB 11 th meeting, London 30 September 1 October 2014

Transcription

1 The Red List : Actions Taken in Central Africa IMB 11 th meeting, London 30 September 1 October 2014

2 Outline Current Red List countries Developments Since Last IMB Meeting Central Africa TAG and Outbreak Response Plans Actions Taken Remaining Challenges Summary and Conclusions

3 Current Red List Countries The Red List Task Team (RLTT) now renamed Outbreak Risk Mitigation task team identified in May 2014, 10 Red List countries 6 are in Central Africa: Angola, CAR, Chad, Congo, DRC and Gabon 4 are in West Africa: Benin, Cote d Ivoire, Mali and Niger Infected, Outbreak Zone and Red List countries

4 Developments Since Last IMB Meeting WHO AFRO/RD convened a Central Africa extraordinary TAG meeting in July 2014 Cross cutting and country specific recommendations to achieve interruption of wild poliovirus transmission before the end of September Surveillance and SIA performance standards and milestones set Synchronized SIAs across 18 countries of Central and West Africa to vaccinate 94 million children in September & October Polio Outbreak Response Coordinator for Central Africa appointed in June 2014 Based in IST/Central in Libreville, Gabon GPEI Outbreak Risk Mitigation task team meeting in July in Brazzaville identified priority actions Agreed focus of GPEI support on Gabon, Congo, CAR, Niger Focus on immediate short term interventions to reduce risk

5 Joint Action Plan FOR POLIO OUTBREAK RESPONSE IN THE CENTRAL AFRICAN SUB-REGION, JULY-DECEMBER 2014 Endorsed by TAG Central Africa Goal: to support all countries in the Central African sub-region to interrupt poliovirus transmission by end of September Zones identified Objectives: Zone 1: Rapidly interrupt WPV transmission in the central outbreak zone (Cameroon and Equatorial Guinea) Zone 2: Identify and maximize opportunities for immunization in Central Africa Republic and areas in neighbouring countries affected by emergencies/humanitarian crisis Zone 3: Reduce the risk of wild poliovirus spread into non-infected countries in the Central Africa sub-region that are at increased risk of poliovirus transmission Zone 4: Continue to ensure high routine immunization coverage, maintain high quality AFP surveillance and update polio outbreak preparedness plans

6 Gabon Actions Main risks to be addressed: country commitment and surveillance quality Advocacy WHO and UNICEF Representatives advocacy meetings with Minister of Health WHO RD visit in July 2014 to Prime Minister and MOH Government contribution to June and Sept 2014 SIA is USD 412,000 (67% operational costs) Strengthening coordination WHO and UNICEF partnership at country level Improving surveillance Training of surveillance and all regional focal points conducted in April Sensitisation of traditional healers and community leaders in all regions Community informants in 4 regions (Ogooue Lolo, Ogooue Maritime, Haut Ogooue and Woleu Ntem) Active case search of AFP cases being conducted once a week in the community Intensification of active surveillance with WHO staff, STOP teams and international consultants support In August: 66 high, 14 medium and 39 low priority sites visited 4 AFP cases reported including 1 case in Haut Ogooue region SIAs and quality improvement Expanding age group to under 15 in the 2 rounds in 2014 Funding challenges: distribution of funds to the operational level

7 Central African Republic Actions Main risks to be addressed: coordination, surveillance quality, security and human resources gaps Strengthening coordination Security Security level: Substantial (level 4) in 19 districts and Moderate (level 3) in 5 districts Most affected regions are RS4, RS5, RS6 and part of RS3 Human resources Most of national staff displaced 7 regional focal points and 19 district focal points and 9 national, 1 internal and 6 STOP consultants Health services provided with NGOs and WHO/UNICEF support 50% of health facilities functional AFRO and HQ mission in July-Aug 2014 drafted a unified nation-wide action plan Improving surveillance AFP surveillance system disrupted due to insecurity Active surveillance visits intensified July-September: 50 cases reported (all regions reported) as of week 36 vs 41 cases same period in 2013 SIAs and quality improvement Expanding age group to under 10 planned for Sep, Nov and Dec 2014 rounds Microplanning and specific strategies for IDPs camps Funding challenges: distribution of funds to the operational level

8 Congo Actions Main risk to be addressed: population immunity Advocacy WHO and UNICEF Representatives advocacy for September and October synchronised polio SIAs GAVI/WHO joint advocacy visit in May 2014 to assess eligibility to GAVI upgrading Strengthening coordination SIAs and quality improvement 2 NIDs conducted in May and July 2014 (6 % missed children) Coordination and supervision reinforced Routine immunisation 60% health districts achieved 80% DPT3 coverage Low performing regions with high number of unvaccinated children mostly in Brazzaville, Likouala, Bouenza, Plateaux and Kouilou Periodic intensified routine immunisation activities planned for Nov and Dec 2014 Improving surveillance Training of surveillance focal points conducted in Sangha and Brazzaville regions in June and August 2014 Active case search of AFP cases being intensified in Brazzaville, Pointe Noire and Sangha regions last 2 months Funding challenges: distribution of funds to the operational level

9 Remaining Challenges Government commitment Persistent sub-national surveillance gaps Ebola outbreaks in West Africa and DRC Shipment of stool specimen in Ebola context Limited lab capacity for environmental surveillance Sub optimal SIAs quality Low population immunity Gaps in micro planning & denominator figures Shortcomings in service delivery strategies Disbursement of funds up to the operational level on time Insecurity and conflict areas

10 Summary and Conclusions Mitigating risk in high risk polio free countries ongoing in Central Africa Framework for risk mitigation is in the context of the new Central African Outbreak Response Plan Oversight by Central Africa TAG and supervision of Outbreak Coordinator in IST /Central Africa, supported by Outbreak Risk Mitigation task team under EMG Context of aiming for a polio-free Africa by end 2014

11 Equatorial Guinea

12 Distribution of WPV1 cases and Spread to Brazil January - September 2014 EQG-BIN-MAL Gabon SÃO PAOLO

13 SIAs conducted, 2014

14 Independent assessment summary September 2014 The response to the polio outbreak in Equatorial Guinea has gathered momentum and met 4/7 of the milestones recommended by WHA. The assessment team recognizes the tremendous regional challenges presented by the Ebola epidemic, and is grateful to the Equatorial Guinea Government for having maintained a steady pace of Polio activities in this context Initial response experienced delays (1 st NID and deployment of surge) IM has consistently been conducted across the 5 NIDs and has had results 95% as of the 3 rd round AFP Surveillance, in practice, solely relies on Polio campaigns, which is neither sufficient nor sustainable. A good plan exists to address this in a systematic fashion, but the plan needs to be resourced and implemented Routine immunization coverage remains low (30% OPV3), and is without noticeable improvement since the beginning of the outbreak response Important community mobilization resources are underutilized Opportunity exists for closer operational coordination and planning between ministries and partners Continuous delays in administrative processes undermine the ability to respond 14

15 Thank you

16 Red List Additional Slides

17 Advocacy Other Actions (1) WHO AFRO /RD held a Ministerial meeting on polio eradication at 67 th WHA with MOH Cameroon, Equatorial Guinea, Gabon, Congo and CAR, with GPEI partners Strengthening coordination Central Africa weekly PEI bulletin WHO, UNICEF, CDC and BMGF Weekly TCs with 8 Central Africa countries Weekly AFRO and Partners TC with priority countries including Chad and DRC to monitor roadmaps Improving surveillance Surveillance review and active case search of AFP cases being conducted in Angola Training of surveillance focal points conducted in Angola and Chad Sensitisation of traditional healers and community leaders in Angola Environmental surveillance being established in Angola, Chad and DRC

18 Improving SIAs quality Other Actions (2) Specific strategies for refugees camps in CAR, Chad and DRC Cross border activities during planned synchronised SIAs Vaccination teams posted at crossing points Strengthening routine immunisation Routine improvement plan developed Trainings and microplanning conducted RED strategies being implemented Periodic intensification of Routine immunisation activities conducted IMG Funds to improve routine immunisation in Angola, DRC and Chad Human resource and surge capacity Deployment of technical staff and consultants in all countries to support surveillance activities, polio SIAs and routine immunisation Funding Improving tracking and disbursement mechanisms at country level

19 AFP Surveillance Indicators in Central Africa, Roll 6 M 15 Mar 16 Sep 2014 NP AFP rate Stool Adequacy 2 1 to < 2 < 1 80% < 80%

20 AFP Surveillance Indicators in Central Africa, Roll 12 M 15 Oct Sep 2014 NP AFP rate Stool Adequacy 2 1 to < 2 < 1 80% < 80%

21 AFP Surveillance Indicators in Central Africa 1 Jan 16 Sep 2014 NP AFP rate Stool Adequacy 2 1 to < 2 < 1 80% < 80%

22 SIAs in Red List Countries, Jan-December % 560% 550% 300% 300% 445% 400% 400% 204% Percent SIA figures indicate proportion of all <5 children targeted for vaccination once or multiple times 200%

23 1) % missed children and parent awareness during end process independent monitoring, monitoring, SIAs Results in Aug-14 Mar-14 Apr-14 May-14 May-14 Jul-14 Jun-14 CAR Chad Congo Gabon 2) % districts with CV >=95% during end process independent Aug-14 Mar-14 Apr-14 May-14 May-14 Jul-14 Jun-14 CAR Chad Congo Gabon % missed children % parents aware 3) % districts accepted with CV >=80% based LQAs, Mar-14 Apr-14 May % rejected % accepted Chad

24 OPV3 Routine Immunisation Coverage, WUENIC <50% >=50% <80% >=80% <90% >=90%

25 OPV3 Routine Immunization coverage WHO/UNICEF estimates 2000, 2005, 2008, 2011 & 2013 Source : WHO/UNICEF estimates 2013, released in 2014

26 OPV3 Routine Immunization Reported Coverage at Sub National Level, * (Janv-June) <50% 50% - <80% 80% - <90% 90% Source : monthly RI data by district submitted by member states to WHO AFRO *2014 completeness low

27 OPV status of NP AFP cases, 6-59 months 15 Oct Sep 2014

28 AFP Surveillance Indicators in Gabon 2013 vs 2014 as of week 36 Gabon Province < 15 pop 2013 (week 1-36) 2014 (week 1-36) No of AFP reported Non Polio AFP Rate % Stool Adequacy < 15 pop No of AFP reported Non Polio AFP Rate % Stool Adequacy Estuaire 41, , Haut Ogooue 117, , Libreville 358, , Moyen Ogooue 29, , Ngounie 48, , Nyanga 24, , ogooue Ivindo 31, , Ogooue Lolo 31, , Ogooue Maritime 66, , Woleu Ntem 76, , National 823, ,

29 AFP Surveillance Indicators in CAR 2013 vs 2014 as of week 36 Cen.Afr.Rep Province < 15 pop 2013 (week 1-36) 2014 (week 1-36) No of AFP reported Non Polio AFP Rate % Stool Adequacy < 15 pop No of AFP reported Non Polio AFP Rate % Stool Adequacy RS1 297, , RS2 344, , RS3 393, , RS4 252, , RS5 91, , RS6 231, , RS7 324, , National 1,936, ,975,

30 AFP Surveillance Indicators in Congo 2013 vs 2014 as of week 36 Congo Province < 15 pop 2013 (week 1-36) 2014 (week 1-36) No of AFP reported Non Polio AFP Rate % Stool Adequacy < 15 pop No of AFP reported Non Polio AFP Rate % Stool Adequacy Bouenza 173, , Brazzaville 771, , Cuvette 87, , Cuvette-Ouest 40, , Kouilou 51, , Lekoumou 54, , Likouala 86, , Niari 129, , Plateaux 97, , Pointe-Noire 399, , Pool 132, , Sangha 48, , National ,136,

31 AFP Surveillance Indicators in Angola 2013 vs 2014 as of week 36 Angola Province < 15 pop 2013 (week 1-36) 2014 (week 1-36) No of AFP reported Non Polio AFP Rate % Stool Adequacy < 15 pop No of AFP reported Non Polio AFP Rate % Stool Adequacy Bengo 104, , Benguela 1,281, ,317, Bie 700, , Cabinda 251, , Cunene 237, , Huambo 795, , Huila 995, ,023, Kuando Kubango 227, , Kwanza Norte 188, , Kwanza Sul 617, , Luanda 2,810, ,889, Lunda Norte 337, , Lunda Sul 179, , Malange 327, , Moxico 335, , Namibe 118, , Uige 732, , Zaire 143, , National 10,385, ,675,

32 AFP Surveillance Indicators in Chad 2013 vs 2014 as of week 36 Chad Province < 15 pop 2013 (week 1-36) 2014 (week 1-36) No of AFP reported Non Polio AFP Rate % Stool Adequacy < 15 pop No of AFP reported Non Polio AFP Rate % Stool Adequacy Bahr Elghazal , Batha , Borkou , Chari Baguirmi , Dar Sila , Ennedi , Guera , Hadjer Lamis , Kanem , Lac , Logone Occidental , Logone Oriental , Mandoul , Mayo Kebbi Est , Mayo Kebbi Ouest , Moyen Chari , N'Djamena , Ouaddai , Salamat , Tandjile , Wadi Fira , National 6,609, ,612,

33 AFP Surveillance Indicators in DRC 2013 vs 2014 as of week 36 DRC Province < 15 pop 2013 (week 1-36) 2014 (week 1-36) No of AFP reported Non Polio AFP Rate % Stool Adequacy < 15 pop No of AFP reported Non Polio AFP Rate % Stool Adequacy Bandundu 3,870, ,128, Bas-congo 1,672, ,722, Equateur 4,328, ,036, Kasai-Occidental 3,619, ,080, Kasai-Oriental 4,583, ,706, Katanga 5,631, ,194, Kinshasa 3,557, ,006, Maniema 1,007, ,111, Nord-Kivu 3,595, ,596, Orientale 4,758, ,164, Sud-Kivu 2,451, ,994, National

34 Results for Environmental Surveillance Site Name Vala do Golf 2 (Kilamba Kiaxi) Rio Cambamba Bairro (Cazenga) Antigo Control Samba (Amostra mixturada) Rio Seco (Maianga) in Angola Preliminary Results - Luanda, Angola - Epidemiological Week WPV1 WPV1 + cvdpv2 Negative for WPV WPV3 Referred for sequencing X Scheduled but sample not collected cvdpv2 Result pending Sampling not scheduled - No WPV identified - In Rio Seco (Maianga) Sabin 2 was identified

35 End Red List Additional slides

36 Equatorial Guinea Additional Slides

37 BACKGROUND In 2014, Equatorial Guinea was re-infected by WPV imported from Cameroon 5 WPV1 cases, all of them were in zero dose children The 5 th polio case is due to an internal WPV1 circulation WPV1 was found in March in Sao Paolo sewer, Brazil, linked to Equatorial Guinea Non-polio AFP rate of 0 in 2013 to 4.8 to today's date Weak AFP active surveillance. AFP case detection mainly based on search during SIA No vaccination campaigns in campaigns in 2014 (4 of them addressed to children < 15) OPV3 Coverage remains low (30%) and surveillance depends on the active search of cases carried out during campaigns The outbreak in Central Africa threatens the goal of a polio-free Africa by the end of 2014

38 WPV1 CASES EPIDEMILOGICAL LINK. EQUATORIAL GUINEA, EQG-BIN-MAL EQG-LIT-BAT EQG-CES-NIE EQG-KIN-EBE EQG-LIT-BAT

39 STRATEGIES AND ACTION LINES IMPLEMENTATION OF QUALITY VACCINATION CAMPAIGNS STRENGTHENING OF AFP SURVEILLANCE ACELERATION OF ROUTINE VACCINATION ADVOCACY TO MAINTAIN LEADERSHIP AND POLITICAL SUPPORT COMMUNICATION AND SOCIAL MOBILIZATION TECHNICAL SUPPORT COORDINATION AND PLAN FOLLOW-UP IMPACT ASSESSMENT OF RESPONSE ACTIONS

40

41 ROUTINE IMMUNIZATION INDICATORS ROUTINE IMMUNIZATION PROGRA, OPV3 COVERAGE EQUATORIAL GUINEA, JANUARY - JUNE % 90% 80% 70% 60% 71% 56% 73% 50% 40% 30% 20% 10% 0% 27% 29% 6% 3% 6% 17% 24% 31% 3% 24% 20% 40% 15% 30% 20% 39%

42 NATIONAL AFP SURVEILLANCE PERFORMANCE EQUATORIAL GUINEA, UP TO WEEK 37, 2014 DISTRICT TARGET POPULACION <15 YEAR AFP RATE (2/100mil) NP AFP RATE ADEQUACY RATE SURV_INDEX INVEST CAISE (<48h) Malabo ,0 50,0 1,02 100,0 Baney ,0 #DIV/0! #DIV/0! #DIV/0! Luba ,0 #DIV/0! #DIV/0! #DIV/0! Riaba ,0 #DIV/0! #DIV/0! #DIV/0! Annobón ,0 #DIV/0! #DIV/0! #DIV/0! Bata ,4 25,0 4,60 100,0 Mbini ,0 #DIV/0! #DIV/0! #DIV/0! Kogo ,0 #DIV/0! #DIV/0! #DIV/0! Niefang ,8 50,0 2,40 100,0 Evinayong ,1 100,0 6,15 100,0 Acurenam ,0 #DIV/0! #DIV/0! #DIV/0! Aconibe ,0 #DIV/0! #DIV/0! #DIV/0! Mongomo ,0 #DIV/0! #DIV/0! #DIV/0! Añisok ,8 0,0 0,00 100,0 Nsork ,0 #DIV/0! #DIV/0! #DIV/0! Ebebiyín ,9 50,0 1,44 100,0 Nsok-Nsomo ,0 #DIV/0! #DIV/0! #DIV/0! Micomiseng ,0 #DIV/0! #DIV/0! #DIV/0! NATIONAL ,8 35,0 1,70 100,0

43 End Equatorial Guinea Additional slides