Progress on SIAs and MCV2 introduction in India

Progress on SIAs and MCV2 introduction in India

Dr. Pradeep HaldarDeputy Commissioner (Immunization)

Ministry of Health & Family WelfareGovernment of India

Washington DC18-19 Sep 12

Measles Vaccination in India

• Measles vaccination was introduced under the National Universal Immunization Programme (UIP) in 1985 given to children at 9-12 months age

• Line listing of measles outbreak cases started in 2005 in selected states.

• In 2010, Government of India introduce 2nd dose of Measles under UIP through a two prong strategy.

Measles second opportunity – India

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2nd dose of Measles vaccine: State specific delivery strategies

MCV2: Coverage of Measles containing vaccine 2nd dose

per DLHS-3; CES-06 for Nagaland

National Technical Advisory Group on Immunization recommended second dose of measles vaccine for all states through state specific delivery strategies.

• 14 states with MCV1 <80%: Measles SIA (9 month to <10 years) followed 6 month later by MCV2 under RI

• 21 states with MCV1 > 80%: MCV2 under RI at 16 to 24 months of age


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MCUP: Basic considerations All children in target age-group (9 mo-<10 years) to

be vaccinated – Irrespective of previous doses of measles vaccine received– Irrespective of prior history of measles disease

In general, this age group constitutes around 18-25% of the total population– Target: ~135 million children– Expected coverage: More than 90% (evaluated coverage)

Massive public health undertaking with an injectable vaccine

Both safety and high coverage are critical

MOH&FW decided to take a phased approach


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MCUP: Basic operational strategy

All immunizations from static posts (no HTH immunization)

Regular routine immunization sessions will be conducted without interruption

– Two regular routine immunization clinics per week– Measles catch-up campaign in remaining four days

Average Campaign duration: 3 weeks = 12 working days

– 1st week: School based campaign (for 5-10 year children)– 2nd & 3rd weeks: Community based campaign for non-school going

children or children missed during school week

Training– Only trained persons (ANMs) will work as vaccinators– All ASHA/ AWW will be trained for beneficiary listing and Inter-personal communication– Doctors (including clinicians in pvt. sector) have been trained in managing rare adverse

events, if any


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MCUP: session sites and teams

Types of session sites– Session sites at Educational Institutes. – Outreach site (regular RI sites and additional sites in

village/urban mohalla)– Mobile/Special team– Facility based session site

Team composition– 1-2 Auxiliary Nurse Midwife (ANMs)– ASHA (Accredited Social Health Activist) – AWW (Anganwadi Worker)– Volunteer


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CHANDIGARH

D&N HAVELI

LAKSHADWEEP

DELHI

JAMMU & KASHMIR

HIMACHAL PRADESH

PUNJAB

HARYANA

JHARKHAND

SIKKIM

MANIPUR

MEGHALAYA

MIZORAMGUJARAT

CHHATTISGARH

ORISSA

ANDHRA PRADESH

GOA

PONDICHERRY

DAMAN & DIU

A&N ISLANDS

UTTARAKHAND

BIHARASSAM

TRIPURAWEST BENGAL

KARNATAKA

TAMIL NADU

KERALA

MAHARASHTRA

RAJASTHANUTTAR PRADESH

NAGALAND

ARUNACHAL PR.

MADHYA PRADESH

CHANDIGARH

D&N HAVELI

LAKSHADWEEP

DELHI

JAMMU & KASHMIR

HIMACHAL PRADESH

PUNJAB

HARYANA

JHARKHAND

SIKKIM

MANIPUR

MEGHALAYA

MIZORAMGUJARAT

CHHATTISGARH

ORISSA

ANDHRA PRADESH

GOA

PONDICHERRY

DAMAN & DIU

A&N ISLANDS

UTTARAKHAND

BIHARASSAM

TRIPURAWEST BENGAL

KARNATAKA

TAMIL NADU

KERALA

MAHARASHTRA


NAGALAND

ARUNACHAL PR.

MADHYA PRADESH

CHANDIGARH

D&N HAVELI

LAKSHADWEEP

DELHI

JAMMU & KASHMIR

HIMACHAL PRADESH

PUNJAB

HARYANA

JHARKHAND

SIKKIM

MANIPUR

MEGHALAYA

MIZORAMGUJARAT

CHHATTISGARH

ORISSA

ANDHRA PRADESH

GOA

PONDICHERRY

DAMAN & DIU

A&N ISLANDS

UTTARAKHAND

BIHARASSAM

TRIPURAWEST BENGAL

KARNATAKA

TAMIL NADU

KERALA

MAHARASHTRA


NAGALAND

ARUNACHAL PR.

MADHYA PRADESH

Phase 1 in 2010 -11; Phase 2 in 2011-12; Phase 3 in 2012-13 Starting Sep 12

Phase 2, 152 districts covered (~ 40 million

Phase 1, 45 districts covered (~ 13 million)

Phase 3, 167 districts planned (~ 81 million)

Overview of Measles SIA

Target population: ~ 135 million children 9

months – 10 years of age 365 districts in 14 states


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Measles catch-up campaign (MCUP)


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Measles SIA phasing plan, IndiaState Total number of

DistrictsDistricts covered in

Phase 1Districts covered in

Phase 2

Number of Districts for

Phase 3

ARUNACHAL PR. 16 1 15

ASSAM 26 1 25

BIHAR 38 5 15 18

CHHATTISGARH 18 9 9

GUJARAT 32 5 5 22

HARYANA 21 5 16

JHARKHAND 24 5 19

MADHYA PRADESH 50 5 13 32

MANIPUR 9 1 8

MEGHALAYA 7 1 6

NAGALAND 11 1 10

RAJASTHAN 33 5 5 23

TRIPURA 4 1 3

UTTAR PRADESH 75 3 72

Total 364 45 152 167

Target Population ~134,000,000 13,845,686 40,167,580 ~81,000,000

Coverage (% Achieved)

12,076,836 (87.2%)

36,102,564 (89.9%)


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Coverage achieved: Administrative and RCA monitoring (MCUP Phase 1

& 2)

48,179,400 of 54,013,266 vaccinated (89.2%)

98 of 197 districts with >= 90% coverage

Number of Childrenmonitored 2465 22438

287758 31462 49174

132343

140880

181299 160 3308 2175 41846 3280 27867


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Campaign awareness & source of information (in %)

94.9

83.7

16.4

7.7 5.31.4

0

10

20

30

40

50

60

70

80

90

100

Awarness for thecampaign

Health worker/ASHA/AWW

Teachers Family members/Community

Newspaper/Poster/ Banner

TV/Radio/Miking

N= 638,660 children monitored

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%


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Reasons for missing vaccination during Measles catch-up campaigns-

India (RCA)

4%

44%

52%

Social mobilisation

Operational

Others

Social mobilisation includes•Parents didn’t know of campaigns, •Didn’t know about Place/Date, •Didn't give Importance•Fear of Injection & AEFI

Operational• No vaccine/logistics • No vaccinator•Site too far, long queue

Others•Family travelling, sick child, •Gone to School etc

N - Total No of Unvaccinated children verified by RCA – (87,197)

(N – 87,197)


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All State Governments have issued orders

to include Measles 2nd dose under R

I in

campaign districts after 6

months


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Measles SIA timeline (3rd phase)

MADHYA PRADESH GUJARAT RAJASTHAN BIHAR UTTAR

PRADESHPeriod of campaign No. of Districts

Sep-12 12 (17 Sep) 22 (13 Sep) 9 (17 Sep) Oct-12 7 Nov-12 8 18 Dec-12 5 8 22Jan-13 6 Feb -13 16Mar -13 11Apr-13 23


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Partner support in measles 2nd dose

Key partners : WHO and UNICEF Areas of Support:

Support to steering committee and operational groups at national, state and district level.

Development of strategic guidelines, tools and IEC prototypes

Program implementation support to states incl. capacity building and supportive supervision

Media sensitization at national, state and district levels Surveillance in 11 states Strengthening cold chain through assessment, supply and

capacity building Micro-planning, training, and social mobilization using polio

resources (SMOs and SMNet) Campaign monitoring Data analysis and dissemination incl. quarterly newsletter


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Summary of measles 2nd dose

Measles 2nd dose under RI at 16-24 months introduced in 21 States/UTs in 2010

Measles SIA completed in 197 districts in 14 states with coverage of 90% in two phases.

In 9 states out of 14 completed measles SIA in all districts. 2nd dose of measles under RI started 6 month after

measles SIA Remaining 167 districts in 5 states planned/ on going

measles SIA during 2012-13 with target of 81 million children (UP, MP, BI, RAJ, GUJ)

Case based surveillance, expansion of laboratory network, Rubella vaccination refer to sub committee of NTAGI on

strategy ie vaccinate children or adolescent group or both.

MEASLES 2ND DOSE WILL BE UNIVERASLIZED IN THE ENTIRE COUNTRY BY 2014


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Impact on measles transmission

[Data as on August 2012]


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SIA and RI Plans Line listing of measles surveillance

States with MCV2 through MCUP

States with MCV2 in RI

2006

2007

2010

2009

2011

Surveillance initiated

2012*

* State workshops conducted in Haryana, March 2012

MCUP: Measles catch-up campaign

MCV2: Measles containing vaccine, 2nd dose


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State

MCUP Phase & (No. of districts

covered)

Pre-MCUP Surveillance data from MCUP districts* MCUP

activity completed

by

MM-YYYY

Post-MCUP Surveillance data from MCUP districts #

Reference period (From)

MM-YYYY

Total number

confirmed measles

outbreaks

Total number of confirmed measles

cases

Reference period (until)

MM-YYYY


outbreaks


cases

Assam 1 (1) NA NA 12-2010 12-2011 0 0

2 (26) 07-2011 7 353 06-2012 08-2012 0 0

Bihar 1 (5) NA NA 01-2011 01-2012 0 0

2 (15) 06-2011 2 82 02-2012 08-2012 0 0

Gujarat 1 (5) 07-2010 14 546 07-2011 07-2012 0 0

2 (5) 03-2011 1 15 03-2012 08-2012 0 0

Jharkhand 1 (5) NA NA 03-2011 03-2012 0 0

2 (19) 07-2011 7 238 03-2012 08-2012 0 0

Madhya Pradesh

1 (5) 07-2010 5 354 01-2011 01-2012 0 0

2 (13) 01-2011 8 492 01-2012 08-2012 0 0

Rajasthan 1 (5) 12-2009 4 211 12-2010 12-2011 2 54

2 (5) 03-2011 3 60 03-2012 08-2012 0 0

Grand Total

1 ( 26) 23 1111 2 54

2 (83) 28 1240 0 0

Measles cases and outbreaks in districts completed catch-up campaigns and lab supported measles surveillance before and after start of MCUP

Data as on 13/08/2012


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Summary Of 14 states implementing measles SIA, 6 states (Assam,

Bihar, Gujarat, Jharkhand, MP & Rajasthan) have lab supported measles surveillance data to make before-after comparisons– The ‘post-’ window for phase-2 activity is <1 year (Range: 1-7 months) for

all states– Surveillance sensitivity is variable across states and should be taken into

account while interpreting results– Quality of MCUP activities have also varied among states

Overall, in phase 1 & 2 districts

Overall the MCUP strategy has been effective in reducing measles transmission

In measles 2nd dose states the size and frequency of measles outbreak reduced

SIA Outbreaks Measles cases

Upto 1 yr before SIA 51 2351

Upto 1 yr after SIA 2 54


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Thank-You

Documents

Progress on SIAs and MCV2 introduction in India