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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

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
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!!!

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
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