Strategies for Measles Control Progress and future plans

Principles of accelerated measles control strategies in India

1. Improve and sustain routine immunization coverage

2. Provide a second opportunity for measles immunization to all eligible children

3. Sensitive, laboratory supported measles outbreak surveillance for case/outbreak confirmation

4. Fully investigate all detected measles outbreaks and ensure appropriate case management

Disproportionate burden of measles mortality in India

Data source: WHO/IVB, November 2009

164,000 estimated Measles Deaths in 2008

67%

= 1000 death

Dots are randomly distributed in countries

Global Context: Worldwide measles vaccination delivery strategies, mid-

2010

MCV1 & MCV2, no SIAs (40 member states or 21%)

MCV1 & regular SIAs (59 member states or 31%)

MCV1, MCV2 & one-time catch-up (36 member states or 19%)

MCV1, MCV2 & regular SIAs (57 member states or 28%)

Single dose (1 member state or 1%)

Govt of India decision in 2010 to introduce MCV2

Enhanced AEFI surveillance during the Measles catch-up campaigns

304 minor AEFIs and 40 serious AEFIs reported

All serious AEFIs reported and correctly managed

NO DEATHS – VACCINE OR PROGRAMME RELATED

Lessons learned and areas for improvement

• Coordination and planning– Better coordination of the three primary department of Health,

Education and ICDS– Clear timelines of availability of logistics

• Communication and advocacy– IEC and interpersonal communication– IAP, IMA– Private schools

• Vaccination in urban areas• Injection waste management• Supervision needs to be improved at all levels

Presentation outline

• Global context• Introduction of MCV2

– Routine services– Catch-up campaigns

• Scale-up of laboratory measles surveillance• Summary and way forward

Scale-up of laboratory enhanced measles outbreak surveillance

2006

2007

2010

2009

2011

Serologically confirmed# measles, rubella and mixed outbreaks, India (Andhra Pradesh, Gujarat, Karnataka, Kerala, Madhya Pradesh, Rajasthan, Tamil Nadu and West Bengal)

216 outbreaksMeasles outbreaks confirmed

Rubella outbreaks confirmed

Mixed outbreaks confirmed

685641

196 16 4

2009 2010*

165 outbreaks

#Outbreak confirmation for Measles: 2009 ≥ 1 cases IgM positive for measles, Similarly for Rubella Outbreak confirmation for Measles: 2010 ≥ 2 cases IgM positive for measles, Similarly for Rubella

* data as on 15th Apr, 2011

0

500

1,000

1,500

2,000

2,500

3,000

3,500

< 1 year 1-4 years 5-9 years 10-14 years >= 15 years

Total cases: 8,956

Vaccinated Not Vaccinated Unknown Cases from serologically confirmed measles and mixed outbreaks* data as on 15th Apr, 2011

Vaccination status and age distribution of serologically confirmed measles cases 2010*, India

63 % no or unknown vax status

85 % < 10 yrs of age

Way forward• State review meetings and a national review

meeting to inform operational strategies• Starting coverage evaluation surveys in selected

states

• Expand laboratory supported measles surveillance to document the impact of the campaigns

• Initiate planning and preparation to cover remaining districts of phase 1 states and pilot districts of UP in phase II.

• Cover remaining districts of UP in the third phase, 2012

Thank you