Technical Consultation on Verification of Measles Elimination in the Western Pacific Region (15-16 June 2010) - Meeting Report
A Technical Consultation for the Verification of Measles Elimination in the Western Pacific Region was held at the Regional Office for the Western Pacific in Manila, Philippines on 15-16 June 2010. Financial support for the meeting was provided by the United States Centers for Disease Control and Prevention.The objectives of the consultation were:(1) to review and discuss existing regional poliomyelitis eradication certification processes and criteria and measles elimination verification processes and criteria of other WHO Regions;(2) to propose a verification process and criteria for measles elimination in the Western Pacific Region; and(3) to identify the next steps to implement the verification process and criteria for measles elimination in the Western Pacific Region, including how countries and areas may use measles elimination for accelerating the control of rubella and prevention of congenital rubella syndrome (CRS).During the course of the consultation, the participants agreed that verification should be carried out both for individual countries and for the Region as a whole. National Verification Committees (NVCs) may submit evidence of national elimination to the Regional Verification Commission (RVC) when they believe their respective countries or areas have achieved absence of endemic measles virus circulation for at least 12 months. However, regional elimination would require an absence of endemic measles cases throughout the Region for at least 36 months. The principle of independence for the RVC and NVC members was affirmed, recognizing that in some countries and areas the requirement for absolute independence from the national immunization programme may be waived on a case-by-case basis. Participants agreed that the Western Pacific Region should define the five components of verification criteria for measles elimination as follows:(1) high population immunity in birth cohorts at least since measles vaccine introduction;(2) incidence and epidemiologic analysis as far back as possible;(3) virologic analysis in as many chains of measles transmission as possible;(4) high-quality epidemiologic surveillance, using a defined set of indicators and targets; and(5) sustainability of measles elimination in the context of national immunization programme functions and that is included in a comprehensive multi-year plan or equivalent.Potential core and complementary indicators for the verification components were discussed. These indicators could form the basis for the documentation that NVCs will be required to prepare for submission to the RVC. It was also agreed that discretionary consideration should be given to countries unable to provide data satisfying the core and/or complementary indicators.Participants agreed that opportunities presented by measles elimination activities to accelerate rubella control and CRS prevention should be utilized with an aspirational target date of 2015, and that targets should be operationally established as reduction of rubella incidence to ≤ 10 per million population and reduction of CRS incidence to ≤ 10 per million live births in accordance with 2009 recommendations from the Technical Advisory Group for Vaccine Preventable Diseases in the Western Pacific Region (TAG). However, in view of some constraints in particular Member States, it was not considered appropriate to set a firm target date at this stage.Participants agreed that recommendations from this consultation may be referred to the TAG for endorsement at its next meeting in August 2010, and that TAG may further request the Regional Director to seek endorsement by the Regional Committee at its sixty-first session in October 2010.