TERMS OF REFERENCE FOR MEASLES AND PNEUMOCOCCAL CONJUGATE VACCINE (PCV) SEROSURVEY

Background

1.1  Measles

Measles is a highly contagious viral disease, which affects mostly children can cause severe complications and death. High population immunity is required to interrupt the transmission. The first Measles vaccine was licensed for public use in 1963, and measles was among the first diseases targeted by the World Health Organization (WHO) in 1974, when the Expanded Programme on Immunization (EPI) was established. The widespread of measles vaccine utilization reduced drastically the number of measles cases and deaths. Coordinated efforts including the accelerated immunization activities by countries, Member States support from WHO, the Measles and Rubella Partnership and other international partners successfully prevented an estimated 60 million deaths between 2000–2023. Globally, the incidence of Measles has reduced by 88.6% (from 144.6 to 16.4 per 1 million population) from 2000 to 2021. The disruption of routine immunization due to COVI-19 pandemic resulted in resurgence of Measles cases for which incidence increased from 16.4 to 91 per million population from 2022-2023.[1]

The Rwanda EPI was established in 1980 and became operational in 1984, with six antigens including Measles Containing Vaccine (MCV). In 2014, the second dose of MCV in combination of Rubella vaccine (MR vaccine) was introduced in routine immunization, and coverage monitoring efforts are being deployed to ensure that all districts meet the coverage of ≥95% and incidence reduced and maintained to less than 1/1000,000 for at least three consecutive years. These indicators are required for the country   to be certified for Measles elimination.  

1.2  Pneumococcal Disease

Pneumococcal Disease caused by Streptococcus pneumoniae (the pneumococcus) are a major public health problem worldwide. In the developing world young children and the elderly are most affected; it is estimated that about one million children die of pneumococcal disease every year.   On average, about 75% of Invasive Pneumococcal Disease (IPD) cases and 83% of pneumococcal meningitis occur in children aged less than two years.  For pneumonia, between 8.7% and 52.4% of cases occur in infants aged <6 months.

In 2007, Rwanda introduced the 7-valent pneumococcal conjugate vaccine (PCV7) into the routine immunization to reduce child mortality by protecting against pneumococcal diseases, which are leading causes of death among children under five. The PCV7 was later replaced by 13-valent Pneumococcal Conjugate Vaccine (PCV13), to expand the protection against additional pneumococcal strains, therefore enhance the vaccine's effectiveness. Although the incidence has drastically reduced, the pneumonia remains among the top five leading cause of morbidity among under five children.   

Rationale for serosurvey

Rwanda immunization program achieved high coverage for almost all the antigens at national level. The surveillance system is well performing and highly sensitive to detect measles cases and passive surveillance is done for pneumonia and meningitis.

In the context of the ongoing circulation of measles viruses and the pneumococcal strains, serologic assessments are important to provide a direct measure of population immunity derived from both immunization and natural disease.   

In the framework of Measles elimination and IPD control, monitoring the presence of pathogen-specific IgG antibodies is critical to complement the coverage and epidemiological data, for more understanding on population-level immunity and disease burden.

The routine surveillance and outbreaks data show that 50-70% of Measles cases are aged below 15 years and an estimate of 30% report to have received two doses of MCV. 

Though the pneumonia cases decreased after the introduction of PCV13, low respiratory tract infections (LRTI) remain among the top five causes of deaths among under five children. This highlights the need of serosurvey to identify gaps in population immunity and assess the protection of the population against Measles and Pneumonia. A well-designed serological study is expected to respond to this need. The findings will inform on the effectiveness of immunization program, policy and strategies.

Objectives

The main objective of Measles and PCV13 serosurvey is to provide information on   the population immunity for Measles and pneumonia strains included in PCV13. Specifically, the serosurvey aim to:  

1. Estimate the proportion of children aged 5 to 14 years who is immune to Measles and PCV13
2. identify geographic or demographic areas with low immunity, where there may be a high risk of measles and pneumonia transmission
3. appraise the effectiveness of vaccination programs by determining the proportion of immune individuals

Work assignment

 The consultant or firm will be requested to conduct the following activities:

1. Design the protocol for the assessment and assessment questionnaire
2. Submit the assessment protocol for ethic approval
3. Organize and facilitate the orientation workshop for data collection and supervision
4. Organize and supervise the field activities for data collection
5. Perform laboratory testing, data entry, cleaning and analysis and draft the preliminary report
6. Organize and facilitate meeting to present the preliminary findings
7. Elaborate the final report and facilitate the dissemination workshop

Deliverables

1. Submission of inception report which include the methodology and timelines for the implementation of the study
2. Preliminary report drafted and findings review meeting organized  
3. Final report submitted

Scope of work

The work will be performed in collaboration with the Maternal Child and Community Health (MCCH)/Vaccine Preventable Diseases Program Unit. The RBC will provide necessary support to the consultant agency such as facilitating communication with relevant stakeholders for a smooth implementation of the activities.

Qualification

The consultancy agency should:

• have extensive research experience including design and implementation of nationwide surveys and clinical trials
• prove human resources capacity including a professional team able to undertake the research. This is evidenced by detailed CVs of key staff with expertise in designing  and implementing   surveys   
• have good understanding of the Rwanda health and immunization system

Proposal documents and submission

The consultancy agency will submit proposal which comprises the technical and financial details. The technical proposal should be a narrative which includes the proposed approach, methodology and timeframe for each deliverable. Staffing structure, including staff CVs with completion certificates of research activities undertaken in the past, details of days per team member articulated against a workplan of activities should be also included. The financial proposal includes activities and budget details. Interested agencies shall submit their proposals with their full address to afwcorwbids@who.int

The deadline for submission of proposal is 5^th May 2025

Selection and contract signing

After analysis of proposals and interviews, WHO will notify the winner in writing and call for discussion followed by contract signing if fully agree. The work is expected to start immediately after contract signing.

WHO Rwanda reserves the right to cancel any or all the proposal without assigning any reason thereof.

[1] Progress Toward Measles Elimination — Worldwide, 2000–2023