Measles-rubella vaccine support

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Doubling impact in a single shot. Gavi’s support of measles-rubella vaccine is a game changer in the control of two deadly and disabling diseases

Rwanda was the first country in sub-Saharan Africa to introduce measles-rubella vaccine. Gavi plans to fund this effective combined vaccine in 49 countries this decade. Here is what these countries, and all of us, can learn from Rwanda.
Credit : Measles & Rubella Initiative

“Gavi’s support for rubella is a game changer in the control of a disease that causes serious, life-long disabilities in infants,” said Dr Susan Reef, Medical Epidemiologist, Centers for Disease Control and Prevention.

From 2013, developing countries will benefit from the catalytic support offered by Gavi for combined measles‑rubella vaccine.

 

In line with WHO recommendations, Gavi is providing support for large-scale catch up campaigns in measles‑rubella on the basis that countries self-finance the introduction of the vaccine in their routine immunisation programmes.

This is a major step in accelerating global progress in the control of two life-threatening diseases.

By 2020, over 700 million children in 49 countries between 9 months and 14 years of age are expected to be immunised against measles and rubella1 .

Rwanda

Rwanda was the first country to launch a measles‑rubella campaign with Gavi support. More than five million children were immunised between 12-15 March 2013.

The largest Gavi supported campaign to date was in Bangladesh in January 2014 where over 53 million boys and girls 9 months-14 years of age were vaccinated in a single nationwide campaign.


1Gavi SDF v6.0

Rubella infection occurring just before conception and early pregnancy may result in foetal death or birth defects - including blindness, deafness, and heart defects - known as Congenital Rubella Syndrome

Measles, a highly contagious and deadly disease, remains one of the top vaccine-preventable killers of children despite impressive drops in measles mortality around the world

Rubella is no longer the threat it once was in many countries thanks to widespread vaccination. But for millions of mothers and their children in poorer countries, rubella poses an on-going danger. Every year, an estimated 90,000 of the total 112,000 cases worldwide occur in Gavi-eligible countries.

Measles, a highly contagious and deadly disease, remains one of the top vaccine-preventable killers of children despite impressive drops in measles mortality around the world. Thanks to the introduction of measles vaccine, global measles deaths have dropped dramatically. However, progress has stalled and outbreaks continue in Africa and Europe.

Disease burden

Rubella usually affects children and young adults and is considered a mild illness, except for pregnant women who contract the virus. The unborn children of a woman who contracts rubella in the first trimester have up to an 85% chance of developing Congenital Rubella Syndrome (CRS). The risk increases to 90% if the woman contracts rubella in the first ten weeks of pregnancy.

Africa and South-East Asia are the regions with the highest number of estimated CRS cases and the lowest uptake of rubella-containing vaccine. Among WHO member states, more than one-third of countries, mostly in Africa, were not using rubella vaccine in the national immunisation schedule as of 2010. The human and economic toll of rubella is staggering.

WHO estimates that in 1996, 22,000 children were born with CRS in Africa, 46,000 in Southeast Asia and almost 13,000 in the Western Pacific. Few countries in these regions had introduced rubella-containing vaccine (RCV) by 2008 so current estimates are believed to be in line with these figures.

Measles kill an estimated 334 people every day. Before 2001, more than 750,000 children died every year from measles, whose symptoms include a high fever, severe skin rash, and a cough.

Since then, global measles deaths fell by 78% from an estimated 535,000 in 2000 to 122,000 in 2012, helped by the Measles & Rubella Initiative, a global partnership committed to ensuring no child dies from measles or is born with congenital rubella syndrome.

Recent experience shows that failure to vaccinate enough children and maintain high levels of herd immunity can result in serious outbreaks of measles. In 2011, more than 33,000 cases of measles were reported in Europe.

The vaccine

Rubella vaccine gives long-term protection. It is often given in combination with measles vaccine as measles‑rubella (MR) or measles‑mumps‑rubella (MMR) vaccine.

The MR vaccine is considered safe and cost-effective at around 50 cents per dose.

New WHO guidelines in 2011 supported a paradigm shift in vaccination strategy for the introduction of rubella-containing vaccines. Earlier thinking in the rubella disease community placed an emphasis on immunising adolescent girls and women of child-bearing age to decrease the risk of CRS. However, in many settings women were difficult to access resulting in limited vaccine coverage and the rubella virus continued to circulate.

When routine childhood coverage is low, rubella virus continues to circulate and children remain susceptible into adulthood. The new approach focuses on interrupting transmission of rubella virus, thereby eliminating rubella as well as CRS over the long term.

Gavi’s support for rubella, an underused vaccine, will benefit women’s and children’s health. The combined measles-rubella vaccine provides a 2-in-1 shot against two devastating diseases and will accelerate global efforts to control rubella and measles.

Sustaining impact

Rubella vaccine has been available since the 1970s but is underused in some regions, particularly Africa and South-East Asia.

The measles-rubella (MR) vaccine marks the first time Gavi is addressing the two diseases simultaneously and builds on efforts by the Measles & Rubella Initiative, a global partnership committed to ensuring no child dies from measles or is born with congenital rubella syndrome.

Gavi is investing more than $US 600 million in the fight against measles-rubella through large-scale catch up campaigns targeting children under 15 years of age, that aim to catalyse countries to self-finance the introduction of measles-rubella into routine immunisation programmes.

By July 2014, 5 countries, Rwanda, Senegal, Ghana, Cambodia and Bangladesh have conducted catchup campaigns using MR vaccine supported by Gavi. The campaigns targeted children aged 9 months to 14 years and ensure sustainability by embedding MR vaccine into routine immunisation programmes. This catalytic support will have a sustainable and positive impact on both rubella and measles control efforts.

By 2020, 49 countries are forecasted to introduce measles-rubella vaccines with Gavi support, immunising over 700 million children between 9 months and 14 years of age2.

Gavi’s new investment in measles-rubella vaccine builds on its earlier support of US $176 million to the Measles Initiative for measles campaigns, and Gavi’s support to countries for introduction of a second dose of measles into the routine immunisation programmes.

By helping countries to introduce MR vaccine, Gavi is leveraging existing platforms to accelerate the momentum in improving the health of mothers and children.


2Gavi SDF v6.0

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