Update on implementation of measles 2 nd dose in india
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Update on implementation of measles 2 nd dose in India. Global Measles and Rubella Management meeting 21 March 2012. Presentation outline. National measles control objective MCV2 introduction: Plans Progress Lessons learned Measles surveillance Summary.

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Update on implementation of measles 2 nd dose in India

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Update on implementation of measles 2 nd dose in india

Update on implementation of measles 2nd dose in India

Global Measles and Rubella Management meeting

21 March 2012


Presentation outline

Presentation outline

  • National measles control objective

  • MCV2 introduction:

    • Plans

    • Progress

    • Lessons learned

  • Measles surveillance

  • Summary


National objective and mcv2 introduction strategy

National objective and MCV2 introduction strategy

National objective:

To reduce measles mortality by 90% by 2013 compared to 2000 estimates

  • NTAGI recommendations:

    • Measles catch-up campaign: 14 states with < 80% MCV1

    • Measles 2nd dose in RI: 21 states/union territories with > 80% MCV1


Mcv2 introduction through ri

MCV2 introduction through RI

  • MCV2 introduced in UIP before NTAGI recommendation in 4 states – Delhi, Goa, Pondicherry and Sikkim

  • 17 additional states introduced MCV2 in UIP as per table

  • In SIA districts, MCV2 through UIP is being introduced 6 months following campaigns


Mcv2 introduction through catch up campaigns

MCV2 introduction through catch-up campaigns

  • Target population:

  • ~ 130 million children 9 months – 10 years of age

  • 361 districts in 14 states

Source: Based on target population available with GoI

* Provisional data as of 1st week of March 2012; 6 districts have not yet started the campaign

** Phase 3 will be conducted during Fiscal Year 2012-2013


Campaign results reported coverage vs rca monitoring

Campaign results:Reported coverage vs. RCA monitoring

68 of 137 districts achieved

>= 90% administrative coverage (50%)

Data as of 14 March 2012:

Number of areas visited for RCA monitoring = 33,212

Number of children verified = 638,660

Activity ongoing in AP, Assam, Gujarat, Rajasthan & Tripura

RCA areas checked < 100 in AP, Manipur and Tripura


Campaign session monitoring

Campaign session monitoring

N = number of campaign vaccination sessions monitored


Campaign awareness source of information in

Campaign awareness & source of information (in %)

  • Vast majority of those monitored were aware of the campaign

  • Session sites with visible IEC material – 82.6%

  • Sites where social mobilization was being done by house visits – 88.3%

N= 638,660 children monitored


Rca monitoring reasons for non vaccination

RCA monitoring:Reasons for non vaccination

< 41%

< 5%

< 5%

N = 80,437 unvaccinated children; analysis is first response provided


Presentation outline1

Presentation outline

  • National measles control objective

  • MCV2 introduction

    • Plans

    • Progress

    • Lessons learned

  • Measles surveillance

  • Summary and way forward


Expansion of laboratory supported measles surveillance

Expansion of laboratory supported measles surveillance

Surveillance initiated

2006

2007

2009

2010

2011

  • 11 states in the network each with state reference lab

  • Haryana and Chhattisgarh to be added in 2012

  • Uttar Pradesh – late 2012, early 2013


Serologically confirmed measles rubella and mixed outbreaks 2011

Serologically confirmed measles, rubella and mixed outbreaks, 2011

  • 209 outbreaks confirmed (180 measles, 16 rubella and 13 mixed)

  • 9,352 serologically and epi-confirmed measles cases (measles and mixed outbreaks

  • 84% cases < 10 years of age; 35% vaccinated


Assessing the impact of campaigns

Assessing the impact of campaigns


Bihar signs of campaign impact

Bihar: Signs of campaign impact

MCUP phase 1 Dec 2010-Jan 2011

MCUP phase 2 Nov 2011-Feb 2012

Serologically confirmed outbreaks, Bihar

  • Surveillance results:

  • Lab confirmed outbreaks = 10

  • Total cases = 947; Deaths = 3

  • 80% unvaccinated

  • 91% < 10 years of age

● Lab confirmed outbreak

Data as on 15/02/2012

Measles surveillance initiated in June 2011


Strengths and best practices

Strengths and best practices

  • Strong central government ownership:

    • All logistic and operational costs borne by GoI

    • Regular feedback provided to Union MoHFW officials for action

  • AEFI management systems established:

    • AEFI response prompt and effective

    • Clear implications for routine immunization

  • Injection safety standards maintained

  • Logistics and cold chain:

    • Logistic issues solved very promptly from GoI and at state level

    • Cold chain equipment and management systems robust


Areas for improvement

Areas for improvement

  • Stewardship and coordination:

    • Variable state and district level engagement

  • Coordination:

    • Insufficient coordination between Health, Education and Women and Child development

    • Vaccination in schools, particularly in urban areas remains a challenge

  • Planning:

    • Lack of clarity regarding timeline of vaccine provision and state level vacillation on fixing campaign dates

    • Full scale engagement of Program Officers lacking in some districts

    • Coordination with schools especially in urban areas remains a challenge

  • Sharps waste disposal inadequate

  • Supervisory personnel require better training to be better provide supportive feedback


Hub cutter found available uttar pradesh january 11 december 11

% Hub-Cutter Found Available, Uttar Pradesh January’11 – December’11

N=

Source: RI monitoring data

N = No. of session found held


Polio free india

Polio-free India

Strengthening UIP is essential to maintain high levels of population immunity and maintain polio free status!!!


2012 2013 year of intensification of uip

2012-2013: Year of intensification of UIP


Summary

Summary

  • Lessons from Phases 1 and 2 must be consolidated to improve Phase 3 and strengthen routine immunization

  • Measles lab-supported surveillance to be improved and expanded

  • Introduction of rubella containing vaccine and CRS surveillance is on the agenda


Acknowledgments

Acknowledgments

  • Union and State governments

  • UNICEF

  • Measles Initiative

  • WHO HQ, SEARO


Thank you

Thank you


Rca monitoring children not vaccinated

RCA monitoring:% children not vaccinated


Current classification used

Current classification used


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