Supplemental Immunization Activities (SIAs) Field Guide · 1 1. Introduction Measles is a highly infecous disease for which humans are the only reservoirs. Transmission is primarily

SupplementalImmunizationActivities(SIAs)FieldGuide

IntegratedMeaslesandPolioVaccinationCampaign

Follow up Campaign April 2014

2014

Supplemental Immunization Activities (SIAs) Field Guide


Integrated Measles andPolio Vaccination Campaign

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I

Table of content

1. Introduction ................................................................................................................................................. 2 2. 0 Measles, Polio and Vitamin A Campaign .......................................................................................................... 2

2.1 Oral Polio Vaccination .......................................................................................................................................................... 2 2.2 Vitamin A ............................................................................................................................................................................. 2 2.3 Objective of Integrated Measles, Polio vaccination and Vitamin A Campaign: .................................................................... 2

3. Strategies for Integrated Measles SIA ................................................................................................................ 3 4. Micro planning ............................................................................................................................................. 4

4. 1 Mapping .............................................................................................................................................................................. 4 4.2 Team composition and deployment ..................................................................................................................................... 4

5 Roles of Team members ................................................................................................................................. 5 Vaccinator for OPV and Vitamin A ............................................................................................................................................. 6 Recorder (preferably a teacher): ................................................................................................................................................ 6 Post mobilizer / Screener (crowd controllers): ........................................................................................................................... 6

6. Cold chain and logistics management ................................................................................................................ 8 6.1 The County Cold chain assistant ......................................................................................................................................... 8

6.1.1. Before the campaign ................................................................................................................................................ 8 6.1.2. During the campaign ................................................................................................................................................... 9 6.1.3. After the campaign ...................................................................................................................................................... 9

6.2 Payam or sub-county cold chain assistant ........................................................................................................................... 9 6.3. After the campaign .............................................................................................................................................................. 9

7. Vaccine Administration and handling ................................................................................................................ 10 7.1 Measles vaccine Dosage, reconstitution and administration ............................................................................................. 11

7.1.1 Steps to reconstitute (mix vaccine with diluent): ........................................................................................................ 11 7.1.2 Steps of administering and handling injections .......................................................................................................... 11

7.2 Polio Vaccine ..................................................................................................................................................................... 12 7.3 Vitamin A Administration .................................................................................................................................................... 12

8. Finger Marking ............................................................................................................................................ 13 9. Injection safety ............................................................................................................................................ 13 10. Waste disposal .......................................................................................................................................... 14 11. ADVERSE EVENTS ASSOCIATED WITH VACCINATION 14 12. SUPERVISION .......................................................................................................................................... 15

12.1 The Team Supervisor ...................................................................................................................................................... 16 12.1.1. Pre-campaign ........................................................................................................................................................ 17 12.1.2 During the campaign ............................................................................................................................................. 17 12.1.3 Post campaign ....................................................................................................................................................... 18

12.2 County and Payam supervisors ....................................................................................................................................... 18 12.3 Monitoring tools................................................................................................................................................................ 19

13. ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION ................................ .......................................... 19 13.1 Advocacy ......................................................................................................................................................................... 20 13.2 Planning for social mobilization ........................................................................................................................................ 20 13.3 Launching ceremony ........................................................................................................................................................ 20 13.4 Involve teachers, parents/children, community leaders (starting from micro planning) .................................................... 21 13.5 Schools (Teachers & Pupils)(involve during micro planning) ........................................................................................... 21 13.6 Leaders of religious & community organizations, chiefs & volunteers (involve during micro planning) ............................ 21 13.7 Social Mobilization for hard to reach populations ................................................................................................................. 21 13.8 Responsibilities of Social Mobilization Focal Persons (all levels) .......................................................................................... 21 13.9 Key messages about the campaign ............................................................................................................................ 22 13.10 Key messages on measles ............................................................................................................................................ 22 13.12. Key messages on polio ................................................................................................................................................. 23

13.13. Monitoring Adverse Event Following Immunization (AEFI) ............................................................................... 23 ANNEXES .................................................................................................................................................... 25

1

1. Introduction Measles is a highly infec�ous disease for which humans are the only reservoirs. Transmission is primarily person-to-person via aerosolized droplets like coughing, sneezing etc. It is characterized by a skin rash, fever, conjunctivi�s, coryza and cough. It may get one or more complica�ons like pneumonia, diarrhea, o��s media, laryngi�s, bronchi�s or encephali�s. Measles outbreaks have con�nued to affect children in all states of the Republic of South Sudan in the past 2 years. Since end of 2013 �ll Feb 2014, nearly 750 cases of Measles have been reported with nearly 80 deaths. Close epidemiologic analysis showed that 59% of the cases were in children less than 5 years of age of whom only 10% had been vaccinated. Thus, most measles cases have occurred in children with unclear vaccination status. The na�onal measles immuniza�on campaign will be integrated with OPV and Vitamin A to reach more children to avert avoidable risk of measles and poliomyeli�s. The current humanitarian crisis have called for maximiza�on of limited resources to save lives of children exposed to infec�ous disease such as measles and poliomyeli�s. The integra�on of measles may provide managerial, financial and logis�cs advantages in reaching high risks groups such as IDPs and to ensure improved herd immunity against measles and poliomyeli�s. 2. 0 Measles , Polio and Vitamin A Campaign

Measles Supplemental immuniza�on ac�vi�es (SIAs) is necessary to reach never-vaccinated children as well as providing an opportunity for an addi�onal dose of vaccine for children already covered. All children in the target age group of 6 months to 59 months will receive a dose of measles vaccine irrespec�ve of past immuniza�on history. An addi�onal dose of measles vaccine reduces the propor�on of suscep�ble in a given popula�on, prevents measles outbreaks and in the context of high rou�ne immuniza�on coverage, can help to eliminate indigenous measles transmission. 2.1 Oral Polio Vaccination Through good quality OPV SIAs, South Sudan has been able to interrupt the transmission of wild Polio virus in the country. To keep popula�on immunity high and prevent any Polio outbreaks, OPV vaccina�on is added to the Measles SIAs. All children in age group of 0-59 months would be eligible for receiving OPV irrespec�ve of previous immuniza�on history 2.2 Vitamin A Vitamin A deficiency is a well established risk factor for measles -related mortality. Trea�ng children with high –dose supplements during the course of a measles episode can reduce measles related deaths and complica�ons by about 66%: it is the standard of care for managing the disease as it helps develop immunity. In low income countries where food security are major concern the risk of measles due to Vita A deficiency are high. Among children under 5 years of age, the prevalence of malnutri�on is very high. Vitamin A will therefore be given to the children 6-59 months as part of the management of moderate to severe acute malnutri�on. 2.3 Objective of Integrated Measles, Polio vaccination and Vitamin A Campaign: To vaccinate >95% children in the target age group with Measles, OPV and Vitamin in a period of 7 days across the Na�on

Supplemental Immunization Activities(SIAs) Field Guide

Integrated measles and Polio Vaccination Campaign

Table1. Package of services during the Integrated Measles SIAs

Age Group Interven�on

0-5 months OPV

6-11 months Measles vaccine + OPV + Vitamin A 100,000IU (Blue capsule)

12-59 months Measles vaccine + OPV + Vitamin A 200,000IU (Red capsule)

Timing and dura�on: 21-28 April, 2014 for 7 days, from 9:00AM to 5:00PM daily Target: 100% coverage of children 6 -59m with Measles vaccine and Vitamin A 100% coverage of children 0-59 months with OPV Any Measles OPV campaign with <90% coverage is considered a poor quality campaign 3. Strategies for Integrated Measles SIA Supplementary immuniza�on ac�vity for measles, OPV and vitamin A supplementa�on will take place in

all coun�es from 21 to 28 April 2014. Due to the vastness of the country coupled with the difficult

nature in accessing communi�es in very sca�ered se�lements; there will be a combina�on of fixed post,

outreach and mobile strategies. There will be no house to house ac�vity and vaccina�on will take place

only at vaccina�on Posts

· Fixed Posts: Fixed posts will be set up at all health facili�es (Primary Health Care Units and

Centers), hospitals and community points close to the health facili�es. These points will not only

be vaccina�on points but will also serve as hubs for cold chain management, supplies, emergency

care and other campaign materials.

· Temporary fixed Posts will be opened in coun�es where health facili�es will not extensively

cover many communities resul�ng in the community members walking long distances. This will

enable many children to be vaccinated. These posts can be set at churches, schools, homes of

religious or community leaders, village head man, NGO compounds or even under trees near

water holes. It can take 2-3 days at one site, two days in another one and so on. So, for a large

popula�on area, in addi�on to a fixed post, 2 to 3 addi�onal temporary posts can be set

· Outreach Posts: Due to the uneven distribu�on of health facili�es in South Sudan, many

communi�es – hard-to-reach areas - that are unable to access the health system, par�cularly the

immuniza�on program, will be provided with outreach services. Teams will be tran sported to the

communi�es with all the necessary logis�cs to vaccinate the children.

· Mobile Teams: South Sudan has a migra�ng (mobile) popula�on that is not reached by either

fixed or outreach services. Such communi�es and popula�ons have been iden� fied in each state

and a team of trained staff (with logis�cs) will move in a vehicle to cover such communi�es

during the campaign.

2 Supplemental Immunization Activities(SIAs) Field Guide


4. Micro planning Micro planning must start from the community level and must involve all stakeholders especially opinion leaders and group leaders. The micro plans should have key components such as; opera�onal map of the area/payam, target popula�on, cold chain requirements, number of teams necessary, vaccine carrier and icepack requirements, transport requirements, special plans to reach the un-reached. The micro plan should also entail communica�on plan detailing types of messages and announcements, number of sessions and mee�ngs with the community, quan�ty of IEC materials to be distributed (see Annex on Communica�on Plan). Micro plans should clearly indicate where the teams would going on what date. The vaccina�on team

members and supervisors must:

· List all the villages, se�lements, camps and any areas with popula�ons living.

· Get the best possible es�mates of target children

· List hard to reach areas with es�mated target children

· Agree on the type of vaccina�on post needed for each of areas-fixed site, fixed temporary,

outreach or mobile

· List possible sites to set up temporary fixed sites

· Develop a team deployment plan an example template is a�ached as annexure.

4. 1 Mapping

Teams should prepare a working map of the catchments area showing placement of vaccina�on

posts in the area on each day.

A sketch map of an area showing some informa�on is useful during micro planning and later during implementa�on of the campaign. Maps should be clear to understand and should contain as much informa�on as possible. An example of an opera�onal map showing the following informa�on is a useful tool.

villages, and health facility; the target popula�on of each village known hard-to-reach areas geographical landmarks (rivers, streams, mountains), roads, air strips es�mated distance from the health facility and accessibility

Using the map and other local informa�on mark, planning should iden�fy which areas and villages would be covered by the health facility, outreach or mobile teams, and the logis�cs need; number of teams, supplies and means of transport. Larger flip charts may be used for developing micro plans and sketching maps 4.2 Team composition and deployment

Each team will consists of

· Two vaccinators (one for measles and the other of OPV and Vitamin A)

· One recorder

3Supplemental Immunization Activities(SIAs) Field Guide


· One social mobilizers

Supervisors should try to iden�fy as many team members as possible from the communi�es in the catchments area of team. Team members should be selected with due considera�on to the following:

- Measles vaccinator: he/she must be a skilled health worker with ability to administer and handle measles vaccines and injec�ons effec�vely and safely. This is cri�cal to avert injec�on abscess and related complica�ons. He/she may come from the community depending on availability.

- OPV and Vitamin A vaccinator – He or she must come from the community and must have had good experience from previous NIDs.

- The recorder should be literate and able to enumerate effec�vely. - The social mobiliser must come from the community and should not only have good knowledge

about the culture of the people but also the en�re community. He/she shoul d preferably be a trusted personality in the community.

5. Roles of Team members Vaccinators: As earlier stated, there shall be two vaccinators in a team. One responsible for measles vaccina�on and the other administra�on of OPV and Vitamin A. Under the supervision of the county supervisor and vaccina�on team supervisor the measles vaccinator(s) will: . Be over all in charge of the post . Supervise the ac�vi�es of the recorder, screener and post mobilizer . Ensure adequate vaccine and diluents are packed in the vaccine carrier with frozen Ice packs . Ensure that a sterile packed AD syringe is used for each injec�on given and the same syringe is used to draw and to administer the vaccine . Use only one disposable syringe and needle (5ml) to re-cons�tute each vial of measles vaccine . Recons�tu�ng measles vaccines and ensuring that the vaccine is of the same temperature as the diluent at the �me of recons�tu�on and record used vials . Withdraw 0.5ml of the measles vaccine and giving it through the right route of administra�on- subcutaneous on right upper outer deltoid muscle to the children and adolescents . Ensure safe disposal of injec�on equipment and, eventually, safety boxes . Ensure that the recons�tuted measles vaccine is kept cool . Discard recons�tuted vaccine a�er six hours or at the end of a session, whichever comes first



Vaccinator for OPV and Vitamin A

. Ensure accurate storage and administra�on of OPV vaccines

. Monitor the VVM for potency of the vaccines

. Administer vaccines to all children 0 – 59mths

. Screen and administer requisite doses to children 6-11months and 12 – 59months Both Vaccinators will also: . Monitor and respond to parents/caretaker reac�ons by answering ques�ons and clarifica�ons from them whenever asked . Remind people of the importance of all vaccina�ons and providing informa�on on rou�ne immuniza�on services (loca�on, schedule) . In liaison with the team supervisor and Payam cold chain assistant ensure re -supplying the post . Reminding parent of importance of returning for rou�ne immuniza�on, as applicable. Gives health advice to the clients about measles and possible side effects and counsel them on AEFIs expected and what to do when they occur. Always ensure the measles vaccine vials and diluent are equal in numbers as issued by the sub stores. . Ensure that vaccines remaining a�er the end of the day is returned to the cold chain sub stores . Ensure that the vaccina�on areas remains safe and clean . Answer ques�ons and clarifica�ons from the people whenever asked Recorder (preferably a teacher): . Under the supervision of the team supervisor and vaccinator, the recorder will; . Tally every child that receives m easles and OPV and Vitamin A in the appropriate column . Ensuring tally sheets are available each day of the campaign . Completes the tally sheets by filling in data on doses administrated and vaccines consump�on data . Write the age of the child on the measles campaign card . Ensure that the daily tally sheets are filled and submi�ed to the team supervisor . Remind and give the parent/caretaker of the child under 9months of age the date for another

dose of measles vaccine . Thanks parents/caretaker/child and adolescent

Post mobilizer / Screener (crowd controllers): Under the supervision of the team supervisor and vaccinator, the screener will; . In liaison with the community leaders in the catchment area, remind parents of importance or returning for rou�ne immuniza�on, as appl icable . Where possible, answering ques�ons and clarifica�ons from the people whenever asked . Local social mobiliza�on in the neighboring areas around the post . Respond also to any rumor related to measles immuniza�ons . Makes house-to-house visit to mobilize the children through their parents / guardians

including adolescents.



. Welcome the parent/guardian/the child for coming . Screen for the right age group and refer them for vaccina�on . Use es�mate if the child’s birthday is unknown, by a�emp ting to use local or historical events

such as days of celebra�ons, seasons …. to es�mate age. . Ensuring efficient flow through the post . Tidying up the post . Maintaining order around the immuniza�on post . Inform the crow of any delays …… . Assist in the se�ng up of the vaccina�on point each day . Ensures a one-way-flow through the post . Gives health advice and thanks parents/guardian of the child

5.1. Organiza�on of a vaccina�on post

The crowd may be organized in queue by the social mobilizer outside the entrance of the vaccina�on area in case the post is too crowded. He/she then assists in crowd control, distribu�on of vaccina�on cards and direc�ng mothers to OPV table. In any case, each eligible child should be given Vaccina�on Card as soon as entering the Vaccina�on area.

First OPV will be given to all children 0 – 59months.

For any child below 6 months, he/she will be referred to the recorder.

The rest will further be screened and administered Vitamin A as follows:

6 – 11months the BLUE capsule, and

12 – 59months the RED capsule.

All children 6-59months will then be given measles containing vaccines

A�er, they are referred to the Recorder for tallying and finger marking.

social mobilizer



6. Cold chain and logistics management Measles and OPV being heat sensi�ve vaccines, require rigorous cold chain maintenance always keeping the temperature of vaccines at 4-8C. In addi�on teams would require daily supplies during the campaign. This is the responsibility of Cold chain assistant at Payam and county that all teams get their supplies along with cold chain equipment. The main requirements for a vaccina�on team would be:

· A copy of the microplans for all the days of SIAs

· A vaccine carrier and four hard frozen ice packs for each d ay of SIAs.

· The number of vials of measles vaccine and diluent needed to meet the daily target of the post. (Target popula�on x 1.20)

· AD syringes, disposable syringes and needles for recons�tu�on, (Ad Syringes = number of Measles doses, Diluent syringes = Measles vials x 1.1)

· Safety boxes = (Number of AD Syringes plus Diluent Syringes)/ 100 x 1.1

· Adeqaute capsules of Vitamin A, Blue and Red.

· Blue capsules =Number of 6-11 month children x 1.05

· Red capsule = Number of 12 months to 59 months children x 1.05

· The number of tally sheets needed to meet the daily target of the vaccina�on post. (Approximately 5 per day)

· Special marker pens to mark the fingers of immunized children = 4 per team in total

· AEFI case repor�ng forms and kits.

· T-shirts and Aprons for iden�fica�on of vaccina�on team members and supervisors

· Means of iden�fying vaccine site (poster, banner, megaphones etc).

· A bin or poly bag for non-biological, non-sharps waste.

· A steel bowl for water

· Two co�on roles per team in total.

· Mega phone (shared between 2-3 teams) All these supplies would be stored at sub-county and county cold chain hub/store.

These hubs would be managed by County and payam cold chain assistants. The main roles and responsibili�es of cold chain assistants are:

6.1 The County Cold chain assistant In consulta�on with the logis�cian, state logis�cs team and county supervisors the county cold chain assistant will; 6.1.1. Before the campaign

· Assist in the training of trainers at the county level

· Assist in the planning of appropriate cold chain at county and peripheral levels

· Receives and stores vaccines, injec�ons materials and supplies from State level and maintain an inventory using annexure 8

· Ensure that the refrigerators are maintaining temperature between 0 ᵒC and +8 ᵒC. twice daily temperature readings must be done.



· Maintains the cold chain at county level (ensures that vaccines at the sub -store are maintained at the right temperature)

· 7 days before campaign, starts freezing ice packs and store frozen ice packs in DF/ILR or cold boxes for supplying the cold chain hubs wherever needed

· Assist in the supervision of storage and distribu�on of vaccines, supplies and equipment to payam and sub stores

6.1.2. During the campaign

· Con�nue freezing ice packs to replenish used ice packs

· Issues out vaccine, injec�on materials, injec�on safety boxes, icepacks, and tally sheets at the distribu�on center

· Monitor the flow of vaccine, supplies, and equipment to ensure uninterrupted ac�vi�es of vaccina�on teams.

· Maintain the inventory and u�liza�on of vaccine and injec�on devices at the sub store

· Liaises with county/team supervisor for replenishment of supplies

· Ensure that all teams return unused vaccine and supplies and prepares them for return to Payam

6.1.3. After the campaign

· Assist with the backhauling of selected equipment from payams to the state level a�er the campaign

· Prepare an inventory of supplies used and returned unused including vaccine s and submit at state level

· Ensure safe keeping of backhauled supplies and Social mobiliza�on material

· Monitor to ensure appropriate disposal/ destruc�on of waste generated during the campaign with emphasis of burning used sharps

6.2 Payam or sub-county cold chain assistant In coordina�on with payam and team supervisors,

· Receive tally sheets from posts, returned vaccines and other logis�cs and maintain inventory using annexure 9

· Par�cipate in the training of the vaccinators, supervisors, and cold cha in assistants

· Receive/store/issue vaccines, injec�on materials, frozen icepacks, safety boxes, tally sheet etc

· Ensure that vaccine at the sub store are maintained at 2-4C

· Maintain the inventory and u�liza�on of vaccine and injec�on devices at the sub store

· Liaise with Payam supervisor for replenishment of supplies

· Ensure that all team returned used safety boxes and supervises the burning and buying of safety boxes

6.3. After the campaign

· Assist with the backhauling of selected equipment from payams to the county level a�er the campaign

· Prepare an inventory of supplies used and returned unused including vaccines and submit at county level

· Ensure safe keeping of hack hauled supplies and Social mobiliza�on material

· Monitor to ensure appropriate disposal/ destruc�on of waste generated during the campaign with emphasis of burning used sharps



7. Vaccine Administration and handling

Both Measles and OPV vaccines are heat sensi�ve vaccines. In addi�on, Measles is light sensi�ve as well. That is the reason why it is supplied in brown glass vials.

They loose potency if exposed to high temperature. That is the reason the vaccines must alwa ys be kept in vaccine carriers with ice packs and temperature maintained at 4 -8C

· The open vials in use should be kept in the foam pad of vaccine carrier to prevent exposure to heat

Foam pad vaccine carrier in use

· Avoid exposure of vaccine carriers to direct sun light. Keep in a shady place

· Always start the campaign with hard frozen 4 ice packs for each vaccine carriers

· Replace melted ice packs with fresh hard frozen ones every day

· The vaccine should always be kept at temperatures below 8oC. To monitor that the vaccine is kept safe, each vaccine vial is provided with a special indicator called”vaccine vial monitor” or in short, VVM. Both Measles and Polio vaccine vials have

How to read a vaccine vial monitor (VVM)



7.1 Measles vaccine Dosage, reconstitution and administration

· Measles vaccine is provided as a powder with diluents in a separate vial. The vaccine is safe and effec�ve. Two doses of vaccine provide life long immunity against Measles

· Diluents and recons�tuted measles vaccine should always be kept coo l and protected from sunlight.

· Only use the diluents provided with the vials, do not use any other diluents

· At recons�tu�on the diluents must have the same temperature as the vaccine (4-8C) so diluents are to be kept in vaccine carrier

· Once the vaccine is mixed with diluents, it should be used within 6 hours a�er which unused vaccine must be safely discarded.

· The dose of measles vaccine is 0.5 ml

· Route of administra�on (injec�on) is subcutaneous (SC)

· Site of injec�on is the le� upper arm.

7.1.1 Steps to reconstitute (mix vaccine with diluent):

1. Inspect the vaccine vial monitor (VVM) is right and Inspect the diluents vial or ampoule is intact. Boyh are cooled t a temp 4-8C

2. Draw diluent into a new mixing syringe; 5 ml disposable syringe and 18 gauge mixing needle.

· Use one new mixing syringe for every new vial.

3. Recons�tute the vaccine by inser�ng the syringe filled with diluents and emptying into the vial containing the vaccine.

4. Mix the diluents and vaccine by gently shaking or rolling in fingers

5. Put the recons�tuted vaccine on a foam pad of the vaccine carrier.

6. Put the mixing syringe and needle into a safety box provided

7.1.2 Steps of administering and handling injections

1. Posi�on the child sideways on mother’s lap with thewhole arm bare



2. Clean skin on injec�on site with co�on swab soaked in water. Do not use an�sep�c

3. Reach your fingers around the child’s arm from underneath squeezing up (li�ing) the skin with your fingers

4. Hold syringe barrel between thumb, index and middle finger of the other hand

5. Insert the needle smoothly into the li�ed up skin poin�ng towards the shoulder and push the plunger

6. Use thumb to push the plunger

7. Pull needle out quickly and smoothly

8. Ask the parent to press the injec�on site gently with clean co�on swab

9. Put the syringe with the needle on, into the safety box provided.

7.2 Polio Vaccine

Oral Polio vaccines come deep frozen and a�er thawing it appears as a pale liquid All children under 5 should receive 2 drops as per the drawing below.

If the child spits the drop, a third drop should be given. Addi�onal drops are not harmful.

Opened vials with doses remaining at the end of the day , can be used the following day, as long as the VVM has not reached the discard point. Unused and par�ally used vials are to be kept in cold chain at 4-8C

7.3 Vitamin A Administration Vitamin A capsules come in two colors-Blue and Red

The Blue capsules contain 100,000 IU units of vitamin A. They are to be given to children 6months to 11 months

The Red capsules contain 200,000 IU of Vitamin and are meant for children 12 months to 59 months

· Nick the �p of Vitamin A capsule with a small scissors

· Squeeze the contents of the capsule inside the mouth of child while child is seated in mother's lap



· Ensure child swallows Vitamin A in your presence

· Do not repeat the dose if child spills some out or spits out as it may cause Vitamin A overdose

IMPORTANT: DO NOT GIVE RED CAPSULE VITAMIN A TO CHILDREN LESS THAN 12 MONTHS AS IT CAN CAUSE VITMIN A TOXICITY

8. Finger Marking

A�er the child has received the services due as per age group, the le� li�le finger of the child is to be marked by permanent marker.

The mark should cover the fingernail and skin of the li�le finger, always on the le� hand. A�er the mark is made, the vaccinator must wait a few seconds for it to dry. The child may wipe or lick it off.

A�er the mark has been placed on the finger, the marker should be recapped to prevent drying of marker

Finger marking in progress, cover the whole nail bed

· Avoid shaking the marker with the cap off as it may spill on your clothes and the ink may finish faster (Recap before shaking the marker)

· Recap the marker immediately after use to avoid drying.

9. Injection safety

Immuniza�on safety is challenging during integrated measles SIA because the number of vaccina�ons given per day is high and much ac�vity takes place away from health facili�es. To ensure the safety of injec�ons during the SIA, Auto Disable (AD) syringes must be used when conduc�ng the SIA and sufficient quan��es of AD syringes and safety boxes must be provided together with vaccine for every fixed or temporary post and every outreach team. Note that:

· A sterile packed AD syringe must be used for each injec�on for each child.

· Immediately a�er injec�ng the child, the AD syringe must be placed in injec�on safety box. DO NOT LEAVE the syringes on the table, or a tray a�er the injec�on.



· DO NOT ATTEMPT TO RECAP needles. This can lead to needle s�ck injuries.

· Do not use AD syringes that have damaged packaging, or have passed the manufacturers expiry date.

· A new mixing syringe should be used to recons�tute each vial of measles vaccine

· Health workers should monitor immuniza�on prac�ces by observing each other.

Supervisors must ensure that all vaccinators are observing safe injec�on prac�ces. Importantly, they should ensure that only AD syringes are used for all vaccina�ons

10. Waste disposal

All used syringes and needles (both AD and mixing syringes) must be disposed of immediately a�er use throughout the campaign by dropping them into the safety boxes provided in all vaccina�on posts. One box can hold 100 syringes and needles

·

·

Supervisors must ensure transporta�on of safety boxes and other waste to waste disposal sites usually locate at the cold chain hub, at the end of each day, from all immuniza�on posts.

· Contaminated sharps should be burned in a pit, drum or constructed hearth. Bury pits must be at least 1.5 meters in depth. The compound in which the incinera�on or burying takes place must be secure. Boxes must be kept in a secure store �ll they are burnt and burried. Burying should then be conducted as soon a�er the immuniza�on session as prac�cal.

· No other waste should be put into the safety boxes. Instead, other waste s hould be disposed of in a bin and burned regularly along with the safety boxes.

· Contaminated sharps must not be transferred from container to container, must not be le� in a public area of the post or health center.

11. Adverse events associated with vaccination

The goal of vaccina�on is to protect the child from measles and measles vaccine is known to be safe. In the process, however, a medical incident, known as adverse events (AEFI) may rarely occur even in the safest program environments. Approximately 5-10% of infants vaccinated with measles vaccine may develop low-grade fever and develop generalized rashes las�ng 1-3 days, beginning 3-7 days a�er vaccina�on. These reac�ons are generally mild and well tolerated. Risks associated with vaccine compared to the natural disease are shown in the following table.

Table 2: Comparison of AEFI associated with measles vaccine and natural disease

Adverse effect

Es�mated risk associated with

Measles vaccine Measles disease Fever ��39.4 °C 1 in 9 Always

Rash 1 in 10 Always Febrile convulsion 1 in 2500 -1 in 100 1 in 200 -1 in 100

Encephali�s & other neurological disorders

1/1,000,000-1/17,000 1/1,000



During mass campaigns, these events may appear exaggerated as vaccina�on takes place in large numbers in a short period of �me. Monitoring AEFI should focus in areas where events are likely to occur. Usually, adverse events follow minor errors, which are easily preventable. The following are few examples where problems might occur. 11.1 Program error

Adverse events resul�ng from vaccine prepara�on, handling & administra�on include: 1. giving excess (over dose) vaccine, 2. injec�ng in the wrong site (bu�ock), 3. using non-sterilized syringe or needle 4. using wrong vaccine or diluents

11.2 Vaccine reaction

· Local reac�on: mild reac�on leading to sore and redness at injec�on site.

· Systemic allergic reac�on (fever, malaise) shortly a�er vaccina�on

· Most reac�ons are mild and may well be tolerated. However, allergic reac�ons, though rare, may some�mes be life threatening.

11.3 Coincidental

· Events not related to the vaccine and its administra�on but that would have occurred even without the vaccina�on.

11.4 Unknown

· Events that could not be directly related to the vaccine.

11.5 Handling AEFI during the campaign

a) Assign focal persons: Focal persons who should assist in handling and inves�ga�ng reported AEFI should be designated and be known to vaccinators and health workers. The County supervisors or any trained qualified health worker is designated to inves�gate and manage the reported AEFI

b) Emergency kits: vaccina�on posts and health facili�es should have emergency kits consis�ng at least: adrenalin, hydrocor�sone, analgesics, an�- inflammatory agents, normal saline, and AEFI case inves�ga�on forms.

c) Treatment of AEFI: Mild symptoms such as fever can be treated at home or by health workers. While severe AEFI cases should be referred immediately to the nearest health facility for treatment. Cases of anaphylaxis should be treated at the immuniza�on site or at the closest health facility. (see annex)

d) Communica�on: The benefits and possible side effects of the vaccina�on should be part of IEC and social mobiliza�on ac�vi�es.

12. Supervision

Supervision is necessary to ensure the quality of planning and implementa�on.

The success of a campaign will largely depend on the work of mo�vated and hard-working supervisors who assist in the campaign prepara�ons, support training and who iden�fy and solve problems or refer issues to their managers during the campaign itself. The level of supervisors are as follows:



· Team Supervisors

· Payam Supervisors

· County Supervisors

· State Supervisors

· Regional Supervisors

· Na�onal Supervisors

12.1 The Team Supervisor

Among trained vaccinators, team supervisors should be selected from those who successfully completed the training and demonstrated interest and a mature leadership quality to be supervisors. On an average, there would one team supervisor for every 3 teams. Team supervisors must know:

· Under the supervision of County supervisors, the vaccination team supervisor will

· Facilitate in the elaboration of area micro-plans to identify and make strategies for the hard to reach

· Assist with the identification of strategic sites where teams will operate at the respective times · Support at least three vaccination team in the field · Ensure all the logistics i.e. vaccines, syringes and related supplies are in place and balances

of vaccines are returned to the storage center · Ensure all the safety boxes are collected and burnt and buried at the sites · Where possible, respond also to any rumor related to measles immunizations · Collect vaccination teams daily tally sheets, compile results 9including vaccines wastage), and

forward regular reports to Payam supervisor · Supervise and support daily activities of each of the vaccination teams assigned to him · Verify and support preparations of measles campaign activities in his assigned areas · Ensure the availability and timely distribution of vaccines, ice packs, tally sheets and supplies

needed daily by the vaccination teams · Collect vaccination team daily tally sheets, compile results (including vaccine wastage), and

forward regular reports to county supervisors · Ensure the daily collection and destruction of used safety boxes · To be accountable to all issued and used safety boxes, AD syringes, vaccines diluents and all

immunization equipment and ensure that they are back rolled to the county store · Activities of Payam coordination committees, and contribute technical inputs · Support vaccination team in the field, as per micro planning assessments · Train vaccinators and vaccination team members · Assist with the identification of strategic locations for vaccination posts, and the deployment of

cold chain equipment · Ensure the availability and timely distribution of vaccines, icepacks, tally sheets and supply

needed daily by the vaccination teams. Assist with the back rolling of selected equipment from the payams to the state hub after the campaign

· Ensure collection and destruction of safety boxes · Assist in the evaluation of vaccination coverage at each phase of the campaign · Verify and compile data recorded by all vaccination teams at the end of each immunization

day



12.1.1. Pre-Campaign In coordina�on with team members, community leaders, partner NGOs and local popula�on:

· Iden�fy villages, IDPs or any areas inhabi�ng popula�on and enlist them. Divide all such areas among teams assigning each team well defined areas to be covered

· Get Best possible es�mates of target popula�on for each area

· Depending upon the nature and access of area, decide whether to place a fixed site, outreach or mobile vaccina�on post

· Iden�fy resources needed to establish vaccina�on posts and convey to manager well in advance

· Iden�fy the sites where to place vaccina�on post

· Calculate the dura�on a vaccina�on post needs to be opera�on and develop a team movement plan

· Compile team micro plans to develop Supervisor micro plan

· Coordinate with NGOs and map available resources like transport, trained human resource etc.

· Structured visits to hubs, health facili�es and vaccina�on posts will help not only to solve last minute problems but also mo�vate field staff.

· Social mobiliza�on ac�vi�es should be given a priority by conduc�ng "spot check" households to verify their knowledge on dates, target popula�on, loca�on and nearest posts.

· Develop a team and supervisory micro plans

12.1.2 During the campaign Using team deployment micro plans, each supervisor will set a schedule to visit all posts at least twice a day.

Addi�onal visit will depend on distance between posts and availability of transport.

Ini�al visit is to ensure that all vaccina�on posts are in opera�on on �me. In case one or more members of the team are absent (except vaccinators), iden�fy l ocally any person who can be trained and given the role of a recorder or a social mobilizers.

The final visit to team is

· to collect the coverage data, compare to the target and ensure teams complete their catchments area before moving to next loca�on

· take stock of logis�c

· iden�fy needs for the next day

At each vaccina�on post visited, central supervisors/observers will:

· Complete a supervision checklist

· Completed checklists should be reviewed immediately by the next level to address problems that have been iden�fied.

· Verify that the tally sheets are being completed correctly.

· Check strategies to reach special popula�ons, transport needs and problems.

· Iden�fy constraints and work with the county supervisors and the local community to overcome them.

· Ensure that the cold chain is working and that the vaccine is stored properly.



· Ensure that the vaccina�on post is aware of safe waste disposal.

· Encourage vaccina�on posts doing well to maintain the quality of service.

· Correct any necessary ac�ons at vaccina�on posts that are not performing well.

12.1.3 Post campaign

· Ensure all the catchments areas have been covered. If any missed areas are discovered, in consulta�on with county supervisor, extend the ac�vity of the team by one day

· Collect and collate the coverage data and transmit to county supervisor

· Ensure all teams deposit the cold chain equipments and le� over supplies to the cold chain store/hub

· Preserve the micro plans for upda�ng and use in subsequent rounds

12.2 County and Payam supervisors

Under the supervision of the state campaign coordinator the county supervisor with the support of Payam supervisor will;

· Be the overall supervisor and coordinator of the measles campaign ac�vi�es at the county and Payam level

· To lead all team within his/her Payam

· Support data collec�on/analysis in the elabora�on of county micro plans

· Support ac�vi�es of the county/payam coordina�ng commi�ees, and contribute technical inputs

· Par�cipate in review and valida�on of county/payam micro plans incorp ora�ng team micro plan and finalize the county micro plan

· Assist with the planning of appropriate cold chain

· Assist in the supervision of recep�on storage and distribu�on of vaccines, supplies and equipment to county and sub-county cold chain stores/hubs

· Monitor the flow of vaccines, supplies and equipment to ensure uninterrupted ac�vi�es of vaccina�on teams.

· Assist with the backhauling of selected equipment from the Payam to the state level a�er the campaign.

· Monitor the implementa�on of the county social mobiliza�on strategy

· Track, treat and follow up AEFIs cases reported by vaccina�on teams and supervisors

· Assist in the training of trainers at the county level. train vaccinators and vaccina�on team members at county and Payam levels

· Support of Payams Coordina�on Commi�ee to ensure smooth and coordinated implementa�on of the integrated measles campaign ac�vi�es

· Collect report from team/Payam supervisor and summarized them

· Report �mely on constraint/ bo�lenecks, and take appropriate ini�a �ves to resolve emergency field situa�ons

· Monitor to ensure appropriate disposal/ destruc�on of waste generated during the campaign with emphasis of burning and buying used sharps

· Work with the team supervisors to ensure that all the filled up safety bo xes are collected burnt and buried at the designated places



12.3 Monitoring tools

The following monitoring tools would be used to record campaign cover age and repor�ng at all level:

Level Tool/Responsible person Objec�ve

Vaccina�on Post

Tally sheet and Vaccina�on Card (Annex 6) -Recorder

AEFI repor�ng form -Annex 7 Supervisor/ Vaccinator/Medical officer

To record daily the number of vaccinated children by age group.

To record usage and/or wastage of vaccines and, injec�on equipment .

To report adverse events and ensure appropriate ac�on by the health worker.

Payam

Supervisory checklist

Annexure-8, Supervisors

Daily summary sheet -

Annexure 9, Team Supervisors

Payam Summary -Sheet Annexure 11

District Supervisor

To monitor the quality of implementa�on of the campaign at the vaccina�on post.

To document daily the coverage by vaccina�on post.

To monitor coverage in a Payam To monitor usage/wastage of

vaccine and syringes by post, compiled by team

County

Supervisory checklist Supervisor Daily Summary sheet –Annexure 10 County Sup./County Coordinator AEFI case Invt. form County Supervisor/Medical Officer

To monitor the quality of the campaign at the vaccina�on posts and teams. To document any AEFI case reported and ensure appropriate ac�on is taken. To document coverage by payam. To monitor usage and wastage of vaccine and syringes by payams at the end of the campaign.

13. ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION This being an integrated Measles and OPV campaign adop�ng a post based strategy, communica�on and social mobiliza�on play an important part to encourage parents to bring children to vaccina�on posts. At Na�onal level several ini�a�ves are being taken to ensure good quality campaign with >95 coverage. These include:

· Advocacy with implementa�on partners, NGOs and other Government departments

· Developing communica�on and Social Mobiliza�on strategy

· Preparing and broadcas�ng Radio jingles

· Prin�ng of banners, s�ckers, posters, etc.

· Procuring Measles, OPV, T-shirts and aprons for team member and supervisors to give them recogni�on and visibility to the program



· Megaphones would be provided to social mobilizers to announce Measles, OPV campaign dates and venue to communi�es

13.1 Advocacy Advocacy ac�vi�es are key in securing community acceptance and support. Various leaders of the community could be targeted. Elected and appointed authori�es, religious leaders, leaders of donor agencies, and community opinion leaders are good targets. Experience from ongoing program ac�vi�es such as NIDs, and previous campaigns could be capitalized. The following data will be useful in conduc�ng advocacy mee�ngs:

· Briefs on the burden of the disease in the community and the impact of the campaign on morbidity/mortality reduc�on and success stories from other countries

· Social and economic benefits of measles elimina�on · The safety of the vaccines and the injec�on during vaccina�on

13.2 Planning for social mobilization Planning should be done well in advance, as part of the overall micro-planning ac�vity. A work plan with objec�ves, ac�vi�es, responsible persons and budget should be prepared. Planning for social mobiliza�on should answer the following ques�ons: -

· Who should be involved?

· What informa�on or messages need to be given to the various groups?

· What are available and most effec�ve channels of communica�on?

· What ac�vi�es should be planned for?

· What should be the roles of the various actors?

· What will it cost? It is also important to consider other issues such as:

· Who are the hard to reach popula�ons?

· Are there likely to be any resistant groups?

· Ac�vi�es to be included in the plan include advocacy ac�vi�es, the launching (opening) ceremony, social mobiliza�on, communica�on for behavior change, and the budget. These are outlined below.

13.3 Launching ceremony The launching (opening) ceremony can be an important occasion if a�ended by eminent personali�es. It is therefore crucial that any launching ceremony should be planned in advance and conducted extremely well by the State and County Social Mobiliza�on Commi�ees. Key public figures should be contacted well in advance to ensure their par�cipa�on. In view of injec�on safety precau�ons, measles injec�on should be administered only by a trained health worker during launching ceremonies. However, eminent personali�es invited could give Vitamin A or Polio if they are interested. In speeches that are made, all par�cipa�ng groups and individuals should be acknowledged. The event should be well covered by the media. The launching ceremony should also be used as an informa�onal opportunity and simple ‘take away’ fliers with key informa�on should be distributed



13.4 Involve teachers, parents/children, community leaders (starting from micro planning)

A campaign is successful whenever mass organiza�ons are persuaded to ac�vely par�cipate in areas where each will be effec�ve. Teachers, parents and children are usually very effec�ve in seeking out eligible children in their communi�es and mobilizing them to be immunized during campaigns. Plans should target: 13.5 Schools (Teachers & Pupils) (involve during micro planning)

· Make an announcement of campaign dates, �mes, venues, and age cohorts during school assembly ahead and during the campaign.

· Explain benefits of the Integrated Measles Polio and Vitamin A campaign and send pupils to remind their parents

· Agree for school premises to be used as vaccina�on posts. · Ensure children below 5 yrs. are vaccinated and check that they have finger marks. · Train pupils to volunteer as child -tracers to ensure that no child is le� out.

13.6 Leaders of religious & community organizations, chiefs & volunteers

(involve during micro planning)

· Involve chiefs, religious and community leaders, to mobilize their people · Make an announcement of campaign dates, �mes, venues, and age cohorts before and during the

campaign in church and mosques and market places · Record the names and phone numbers for coordina�on during campaign · Organize various mee�ngs covering all communi�es. · Display the communica�on materials; poster and banners and explain the messages to

ensure it is properly communicated to parents. Agree on appropriate loca�ons for vaccina�on posts e.g. churches, house of Boma chief etc.

· Request to accommodate vaccina�on teams if to stay overnight or for few days · Help to combat rumors

13.7 Social Mobiliza�on for hard to reach popula�ons

· For nomadic groups; determine the dates for entry and exist points and loca�ons where they will gather in large numbers. U�lize members of these communi�es as mobilizers and vaccinators Prepare and use mobile teams.

· In border area, carry out planning and coordina�on ac�ons with the neighboring jurisdic�on.

· Ethnic or other minority groups; Visit site with someone from the community and brief tradi�onal leaders to enlist their support. Put in place a team with local mobilizers to work in the community Families that fear contact with government e.g. may not have proper documents: Visit with the local and let them know that the government is not asking for their papers

· Groups with difficult geographical access: Ensure transport beforehand to reach these groups and visit with local from the community.

13.8 Responsibili�es of Social Mobiliza�on Focal Persons (all levels)

· Ensure Payam/County social mobiliza�on commi�ee is formed/re-ac�vated; ascertain their func�onality such as mee�ngs, to plan ac�vi�es (involve during micro planning).

· Selects and train focal person for each community/village in the district,



· Ensure distribu�on and use of IEC materials such as posters, banners etc.

· Mobilizes/assembles/distributes all needed logis�cs for social mobiliza�on.

· Undertake supervision and monitoring visits to the communi�es and posts.

· Ensures that accurate announcements are made in church, school, market, villages.

· Recruit, orient and deploy more volunteers and mobilize those in hard-to-reach areas. 13.9 Key messages about the campaign

· A na�onal integrated vaccina�on campaign against measles and polio will take place 21 -28 April 2014.

· Parents and caretakers should bring their children 0 - 59 months to the nearest health facility, hospital, or outreach point.

· Measles vaccine and Vitamin A will be given to all children aged 6 - 59 months.

· Polio vaccine will also be given to children under 5 years of age (0 – 59).

· Even if a child has been vaccinated before, they should s�ll bring him/her for a second dose of vaccine.

· Vaccina�on is free of charge.

·

A vaccina�on card will be given a�er vaccina�on and kept safely .

13.10 Key messages on measles

· Measles is a disease caused by a germ (the measles virus). The signs include a rash over the whole body, fever and a runny nose or red eyes or cough.

· Measles kills most children less than 5years; and may result in complica�ons including deafness, blindness, pneumonia, severe malnutri�on etc.

· In rou�ne services, all children should be vaccinated at age 9 months or soon a�erwards.

· Addi�onal dose for a child will boost his/her immunity against the disease and give opportunity to reduce the number of people at risk of the diseases. When a high percentage of the children are vaccinated, the likelihood of an outbreak will be minimal and many children will be saved from the complica�ons and deaths from measles.

· During the campaign, all children ages 6-59 months should be immunized against measles, even if they were already vaccinated or had measles disease.

· Children should s�ll receive their rou�ne measles vaccina�on dose.

· There are no reasons for a child not to receive measles vaccina�on, even if the child is sick.

13.11 . Key messages on vitamin A

· Vitamin A protects your child's health. Without it, your child may become ill more easily and stay ill for longer periods.

· Vitamin A strength ens your child's resistance to infec�ous diseases, like measles.

· Lack of vitamin A can make your child blind.

· Giving vitamin A su pplements to all children ages 6-59 months every 6 months can prevent vitamin A deficiency.

· The measles campaign is an opportunity to give vitamin A supplements to the same children who will receive measles vaccina�on.



13.12 . Key messages on polio

· Polio i s a dangerous disease that cripples children for life.

· Polio a�acks suddenly, and begins like a cold with fever

· It weakens the muscles of the body, legs and arms, and can cause permanent lameness.There is no treatment.

· Polio can be easily be avoided by a safe vaccine that is given by drops in the mouth.

· Parents and caretakers should take their children under age 5 years to vaccina�on post in their respec�ve areas to get the polio vaccine.

· Even children who are up-to-date with their polio vaccina�on should s�ll receive the vaccine.

· There are no reasons not to receive the polio vaccine. Even sick children can get vaccinated.

· The dose of polio received during the campaign does not replace the rou�ne immuniza�on doses. 13.13. Monitoring Adverse Event Following Immuniza�on (AEFI)

What are AEFI?

· The goal of immuniza�on is to protect both individuals and the community from vaccine preventable diseases. Although vaccines are safe, no vaccine is en�rely without risks. An adverse event following immuniza�on (AEFI) is any adverse event follows immuniza�on that is believed to be caused by the immuniza�on. Serious AEFI’s are very rare. However, since a large number of children will be vaccinated in a short �me during measles vaccina�on, there is a greater possibility of observing AEFI’s. Why monitor for AEFI?

· Even though most reac�ons to vaccina�ons are mild, any reac�ons (especially rare serious ones) can undermine the community's confidence in immuniza�ons. False rumors can spread about the effects of a vaccine. Health workers who monitor for more serious reac�ons can respond quickly and poten�ally save a child's lif e. How do you respond to a case of AEFI?

· Treatment must always be the first response to an AEFI. All severe AEFI cases should be referred immediately to the nearest health center or hospital for treatment. The case inves�ga�on form must be quickly fill ed in as far as possible and accompany the pa�ent being referred, otherwise the inves�ga�on may not be followed up. Case inves�ga�on forms should be complete for every case of a severe AEFI. How do you report an AEFI?

· Report by phone and in wri�ng (using the form) within 48 hours to your district or regional coordinator, and to the EPI Office in Windhoek. If available, also try to include the following informa�on

· Vaccine manufacturer and lot number and expiry date

· Diluent: Was the diluent used the same provided with the vaccine and from the same manufacturer – or was it accidentally replaced with another drug stored with the vaccine; or was non-sterile diluent or another substance used as diluent?



· Route and site of administra�on

· Name of vaccinator and supervisor

· Outcome (pa�ent recovered? Died?) How can you minimize AEFIs?

· Recons�tute measles vaccine only with the diluent supplied by the manufacturer.

· Discard recons�tuted vaccines at the end of each immuniza�on session (and a�er 6 hours) and NEVER retain them for use in subsequent sessions.

· Do not store other drugs or substances in the refrigerator beside the vaccines and diluent- these poten�ally dangerous items can be taken by mistake.



ANNEXES Annex 1: TALLY SHEET

Tally sheet (Back)

State _____________________________ County _____________________________ Payam _____________________________

Post Name _____________________________ Post Coordinator's Names: ________________________________ Date: ____________

Mark the strategy used: FIXED PERMANENT FIXED TEMPORARY MOBILE IDP CAMPS ( √�TICK )

O O O O O O O O O O O O O O OO O O O O O O O O O O O O O OO O O O O O O O O O O O O O OO O O O O O O O O O O O O O OO O O O O O O O O O O O O O O

O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OO O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OO O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OO O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OO O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OO O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OO O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OO O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

Total 6 - 11 months Total 6 - 11 months

O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OO O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OO O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OO O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OO O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OO O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OO O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OO O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OO O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O OTotal 0 - 59 months Total 12- 59 months Total 12 - 59 months

Vials of Measles vaccine and diluent received Vials of Measles vaccine and diluent used

No. of A-D syringe & needle received No.of A-D syringe & needle used

No. of mixing syringe & needle received No. of mixing syringe & needle used

Number of Safety boxes received No. of Safety boxes with used syringes returned for burning

Number of Vials of OPV received Number of Vials of OPV used

Number of Vit A capsule 100,000 iu received Number of Vit A capsules 100,000 iu used

Number of Vit A capsule 200,000 iu received Number of Vit A capsules 200,000 iu used

* Please LIST DETAILED ADDRESS OF ANY VACCINEE WITH ADVERSE EVENT FOLLOWING IMMUNIZATION (AEFI) AND/OR ACUTE FLACCID PARALYSIS (AFP) at the Back

PLEASE REMEMBER TO DISCARD ANY RECONSTITUTED VIAL AT THE END OF THE SESSION OR AFTER 6 HOURS – WHICHEVER COMES FIRST

CH

ILD

RE

N A

GE

D 6

to

59

Mo

nth

s

MINISTRY OF HEALTH Republic of South Sudan

TALLY SHEET FOR INTEGRATED MEASLES AND POLIO SIA

OPV (0 - 59 months) Measles Vaccine (6 - 59 months) Vitamin A (6 - 59 months)

CH

ILD

RE

N A

GE

D 0

to

59

Mo

nth

s

DO NOT GIVE MEASLES VACCINE TO CHILDREN UNDER 6 MONTHS

DO NOT GIVE VITAMIN A TO CHILDREN UNDER 6 MONTHS

CH

ILD

RE

N A

GE

D 6

to

11M

on

ths

Name of the Child with symptoms of AEFI Age Name of Mother/Father

Contact Details (Physical Address including Tel No. etc)

Name of the patient with symptoms of AFP Age Name of Mother/Father

Contact Details (Physical Address including Tel No. etc)

* Please LIST DETAILED ADDRESS OF ANY VACCINEE WITH ADVERSE EVENT FOLLOWING IMMUNIZATION (AEFI) AND/OR ACUTE FLACCID PARALYSIS (AFP)

AFP SURVEILLANCE

AEFI SURVEILLANCE



Annex 2: Daily Activity Summary Sheet

Health Facility_______________ County________________ State_______________

OPV MEASLES0 - 59 m 6 - 59 m 6 - 11 m 12 - 59 m Total Vit A

TOTAL

AFP Cases


DAILY SUMMARY SHEET

Vials of Measles vaccine

and diluent received

No. of A-D syringe &

needle received

No. of mixing

syringe & needle

received

Number of Safety boxes

received

Number of Vials of

OPV received

Number of Vit A

capsule 100,000 iu received

Name of Vaccination Posts, Payams, or IDPs Camps

VITAMIN A

Number of Vit A


AEFI Cases

Annex 3: Summary Payam sheet

Payam_______________ County________________ State_______________

OPV MEASLES0 - 59 m 6 - 59 m 6 - 11 m 12 - 59 m Total Vit A

TOTAL

Number of Vit A

capsule

100,000 iu received

Number of Vit A

capsule

200,000 iu received

AEFI Cases

AFP Cases


PAYAM DAILY SUMMARY SHEET

Name of Vaccination Posts, Boma, or IDPs Camps

VITAMIN A

Vials of Measles vaccine



needle received

No. of mixing

syringe &

needle received

Number of Safety

boxes received

Number of Vials of

OPV received



Annex 4: Summary county sheet

Health Facility_______________ County________________ State_______________

OPV MEASLES

0 - 59 m 6 - 59 m 6 - 11 m 12 - 59 m Total Vit A

TOTAL

AEFI Cases

AFP Cases


DAILY COUNTY SUMMARY SHEET

NAME OF PAYAM

VITAMIN A Vials of Measles vaccine



needle received

No. of mixing

syringe & needle

received


received

Number of Vials of

OPV received

Number of Vit A


Number of Vit A


Annex 5: State Summary sheets

PAYAM_______________ County________________ State_______________

OPV MEASLES

0 - 59 m 6 - 59 m 6 - 11 m 12 - 59 m Total Vit A

TOTAL


needle received

No. of mixing

syringe & needle

received


received

Number of Vials of

OPV received

Number of Vit A


Number of Vit A


AEFI Cases

AFP Cases


DAILY STATE SUMMARY SHEET

NAME OF COUNTY

VITAMIN A Vials of Measles vaccine




Annex 6: Vaccina�on card

Annex 7:Communication Micro planning Tool

No

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Interpersonal Communication Plan

Inegrated Measles, Polio and Vitamin A Supplemental Immunization Activities - Communication Micro - Payam Name____________________________

Sr. No. Payam

Name of

Vaccoination

site

Names of

Bomas/villages/hamlet

to be covered

IEC Materials and Plans Public Announcements Plan



ANNEX 8: AEFI Report Form

Demographic details

Father`s name in full:

First name: Date of birth day____month____ Year___________

Sex: M F

Address: Region: County: Payam:

Boma Health facility:

Report Prepared by:(Name): _________________________________

Measles Vaccine* Lot number Manufacturer Expiry date

Vaccine

Other

Date immunized Date AEFI started Onset interval Date of report

Tick box(es) and describe event: Toxic shock syndrome

Sepsis

Abscess: sterile or bacterial

tannel

Severe local reac�on: >3 days, beyond nearest joint, or hospitalized

Vaccine reac�on on list (state):

Other AEFI (state):

Past medical history (including history of similar reac�on or other allergies) and any other relevant informa�on (e.g., other cases):

How was the child/woman treated/what measures were taken?

Others (specify) _____________________________________

Recovered: Yes / No / ? Hospitalized: Yes / No / ?

Died: Yes / No / ?

Regional Level:

Date report received: / / Checked by:

Inves�ga�on needed: Yes / No / ? If yes, date started:

Inves�gator: AEFI inves�ga�on ID:

Causality assessment: Certainty:

Certain / Probable / Possible



Annex 9: OBSERVATION CHECKLIST FOR SUPERVISORS

OBSERVATION CHECKLIST FOR SUPERVISORS DURING April 2014 MEASLES – OPV CAMPAIGN

Date of visit: Observer: Region: District: Vaccination post: Post supervisor: Yes No Comments Social Mobilization and Patient Services

Population aware of campaign dates, purpose and post locations? Hard-to-reach populations/areas identified and targeted for special strategies?

Post clearly identified by poster or banner? Health workers or volunteers actively searching for unvaccinated children and directing them to vaccination post?

Health workers explain to parents what vaccine is being given? And what disease it prevents?

Health workers explain to caretakers about the vaccine, side effects? Parents reminded that routine immunization should continue? And oriented on routine schedule/number of visits etc.?

Parents/children mobilized to seek other unvaccinated children? Cold Chain Vaccines stored in vaccine carriers with at least 2 frozen ice packs? Refrigerator temperature 2-8oC with up-to-date temperature monitoring form?

Is the diluent kept cold in the same place with the vaccine before reconstituting?

Availability of Vaccines and Supplies Sufficient measles vaccine and diluent? Sufficient OPV and droppers? Sufficient Vitamin A? Vaccines bundled with enough reconstitution and AD syringes and needles?

Enough cold boxes, vaccine carriers? Adequate tally sheets and summary sheet? Post Organization Post well organized, with good client flow? Sufficient workers (at least four)? Every child vaccinated is tallied properly? Tally sheets being used correctly?

Immunization Safety Practices Are there sufficient syringes and needles? Were syringes pre-filled and waiting before administration? Reconstituted vaccine is kept inside the vaccine carrier? Measles injection given correctly? Used syringes discarded into safety boxes without recapping? Reconstituted vaccine discarded after 6 hours? AEFI procedures understood, reporting forms in place? Is the VVM on the OPV vial at stage I or II? Waste Management Practices Is there a designated person or site for incineration of used safety boxes?



ANNEX 10: Interpersonal Communica�on (IPC)- Guidelines for Social Mobiliza�on

1. GREET

1.� Introduce yourself. Example- I am (your full name). I am a social mobilizer/Vaccinator

working for the welfare of the community. My main role is dissemina�ng informa�on about the up-coming Measles, Polio and Vitamin A campaign and making sure that all children of target age get vaccinated.

2.� Stress upon the 'emo�onal' factor of the campaign. Example- by administering this vaccine

and drops, we are protec�ng and saving children from life threatening diseases like measles

and polio (refer to messages in the field guide on measles, polio and vitamin A). Measles kills

most children under five and may result in complica�ons leading to deafness, blindness,

pneumonia, severe malnutri�on etc. Polio can cripple a child for life and lack of Vitamin A

deficiency can lead to blindness. In the past many more children were being affected by

measles and polio resul�ng in serious health complica�ons, death and o�en disability for

life. This campaign will ensure that thousands of lives are saved and children are protected

from measles and the disability caused by polio.

Note: Please ensure you are familiar on the key messages on Measles, Polio and Vitamin A

included in the field guide

REMEMBER

· Be informal during conversa�on

· Do not sit with an open register. The community might mistake you as a surveyor, etc.

2. ASKING

� A�er gree�ng and introduc�on, this is the moment to allow the parents to talk. Do not jump

into Measles/Polio discussion because this is not what they are thinking about at that

moment. A�er they have opened up enough, you can become specific on child health,

immuniza�on and Polio. It is important for you to know - children's general health, age,

vaccina�on status, number of children below 5 years of age etc.

- LISTENING IS A SKILL

Listening is a skill. Listening means- encouraging others to talk, Listening means- giving

others space to express what they feel. Listening means- winning the heart and soul of

someone whom you want to make a healthy decision.

1.� Do not compel them to give informa�on, if they are not willing at that par�cular �me.

2. Do not impose informa�on upon par�cipants.

Whenever you visit a household, greet everyone as far as possible according to local tradi�on.

Introduce yourself and your purpose.



3. Body language should be posi�ve

- Sit at the level of the person you are talking to. If s/he is si�ng on the floor, you

should also sit there. S/he should feel relaxed.

- Pay a�en�on. While speaking, keep your eyes on the person, not on your register

or diary.

- If there is any interrup�on/obstacle, remove it immediately. Copy

� and pencils can be a source of distrac�on.

- Give �me. Do not hurry (Or look at your watch repeatedly).

4.� Ask open-ended ques�ons – Because, the open ended ques�ons allow him/her to share

informa�on in detail. The close ended ques�ons do the opposite. The open-ended ques�ons

start with- What, why, where, how, when and who.

Example of Open ended ques�on:

What do you know about this measles and polio disease?

Why you did not vaccinate your baby?

Example of Close-ended ques�on (only allows an answer in yes or no)

X Have you immunized your child or not?

X Do you know that vaccine is safe?

5.� Match the emo�ons your response should be full with sympathy and empathy.

6.� Do not negate what the other person says, just because you feel that they may not be based

on facts. Respect their opinions. At �mes you might have to conduct a prolonged

conversa�on in order to elicit the informa�on you are seeking. The persons you normally talk

to will not structure what they want to convey or the narra�on may go very long. But, you

should not lose pa�ence. Give a�en�on to every li�le detail they are presen�ng.

3. TELLING

Telling should take in to account the following;

Frame your answer keeping in view-

What they already know about the subject.

What they want to know?

What specific fear or myth they have about the subject?

Useful �ps-

Do not pretend to know everything. If not confident about some informa�on, tell

clearly that you will return and answer a�er consul�ng your seniors.



4. HELPING, FACILITATING, ENCOURAGING:

� In order that the parents change their decision (in favor of measles/polio vaccina�on), they

need – in addi�on to factual informa�on- support and encouragement from the all- around

social environment.

This means helping them to –

1. Overcome their personal fear or belief (many parents refuse to vaccinate a sick

child under the instruc�on of the local doctor. (The potent solu�on will be to

make the local doctors talk about it with parents to get rid of their fears).

2. Overcome their religious and social belief (many parents refuse to vaccinate

finding the vaccina�on drive as foul play by Govt. authority. The solu�on- Engage

religious leaders, local clerics, doctors belonging to their own community).

5. EXPLAIN:

� Remember-

Use educa�on/ informa�on materials. Choose appropriate one.

Pictorial-based materials be�er explain and have higher reten�on value. A popular

evalua�on of various media says- we recall 10 % of the things that we hear, we recall 50 % if

we hear and see, we recall 90 % if we hear, see and DO. This means, the SM needs to be fully

ready with visual materials before a mee�ng etc.

Use local exemples, simple langage, folklores etc.

6. REPEAT YOUR VISIT:

Repeated visits win trust. Repeatedly meet the reluctant/ resistant families, at least 2 �mes before the vaccina�on day. Pay special visits to earlier families a�er they have received doses. Ask about their children's health etc.



ANNEX 11: TECHNICAL REPORT FORMAT

MINISTRY OF HEALTH

MEASLES CAMPAIGN, April 2014, TECHNICAL REPORT

NIDs Dates

Target population OPV:

Vit. A:

Measles:

Total Number of children vaccinated OPV:

Vit. A:

Measles:

% of children immunized by Fixed strategy:

Mobile strategy:

House-House:

TVP:

Number of vaccination teams

Number of health workers

Number of volunteers

Number of drivers

Number of lunch packs

Vaccine wastage

Vaccine quality

Icepacks in cold box: Yes/No

How many, Please indicate No.

Vaccine carriers Yes/No

How many

Expiry dates of vaccines

OPV

Measles

Vit. A

Thermometers in vaccine carriers

Icepacks monitored during process

High level commitment at regional/district level

Yes/No

If yes, Please indicate who



If no, Please explain

Hard-reach-children immunized:

Yes/No

If Yes: Which strategies were used e.g.:

If No: Please explain, why not?

Number of vehicles used MoHSS:

Line Ministries:

NGOs/UN Agencies:

Private cars:

GRN Garage:

Hired vehicles:

NIDs used to improve routine immunization

YES/NO

If yes, please explain how

If no, why not?

Any information shared on routine EPI services during NIDs

Yes/No

Please elaborate

Number of children immunized with zero doses

Cost/child immunized

Major national/local partners involved

Please list

3 Major problems

3 Major achievements

3 Major lessons learnt



IntegratedMeaslesandPolioVaccinationCampaign

SupplementalImmunizationActivities(SIAs)FieldGuide

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Documents

Supplemental Immunization Activities (SIAs) Field Guide · 1 1. Introduction Measles is a highly infecous disease for which humans are the only reservoirs. Transmission is primarily