Measles epidemiology and eradication
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Transcript of Measles epidemiology and eradication
MEASLES- EPIDEMIOLOGY AND ERADICATION
A Presentation By – Dr Murli Dhar Soni (CAS PG , PSM IInd Year)
SPMC Bikaner(Raj.)
13/09/2012
INTRODUCTION
Measles is one of the most infectious human diseases and can cause
serious illness, lifelong complications and death.
Prior to measles vaccine(1960), measles infected over 90% of children before 15 y. With the introduction of vaccine, measles infection has shifted to the teens in countries with an efficient programme.
These infections were estimated to cause >2 million deaths and between 15000-60000 cases of blindness annually worldwide .
In some developing countries, case-fatality rates for measles among young children may still reach 5–6%, but may run up to 10%-30% in certain localities.
In industrialized countries, approx 10–30% of measles cases require hospitalization, and one in a thousand of these cases among children results in death from measles complications.
It is unacceptable that every day 380 children still die from measles and 300 children still enter the world with the disabilities of CRS
Major causes of mortality among children of age < 5
years, 1990 vs 2008
Source: Van den Ent et al, J Infect
Dis Suppl July 2011, ppS18 - S23
20%Diarrhoea
21%Pneumon
ia
Measles 7%
Malaria, 5%
47%Other
15%Diarrhoea
18%Pneumonia
Measles,1%
Malaria,8%
58%Other
1990: 12.1 mil 2008: 8.8 mil
Measles accounts for ~23% of overall
decrease in child mortality
GLOBAL INCIDENCE 1980-2010 (DOWN BY 93%)
GLOBAL CASES
0102030405060708090100
0500,000
1,000,0001,500,0002,000,0002,500,0003,000,0003,500,0004,000,0004,500,0005,000,000
19
80
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imm
uniz
atio
n c
overa
ge (
%)
num
ber
of
case
s
Number of cases
Measles global annual reported cases and MCV coverage, 1980 to 2010
Campaigns
GLOBAL INCIDENCE, (WHO REGION WISE)1980-2010
Source: WHO/IVB database, August 2011 (Data for 2010)
193 WHO Member States. Date of slide: 4 August 2011
2015 Target
GLOBAL CASES, 2000 – 2010 *(DOWN BY 63%)
*Progress in global measles control, 2000–2010. WER 3 Feb 2012, vol. 87, 5 (pp 45–52)
REPORTED CASES –INDIA 1980-2010 (DOWN BY 75%)
Reported Cases of Diptheria, Measles, Polio and Pertussis: India 1980-2010
Source: WHO
DEATHS
2000 2010
Globally 5.35 lakh 1.39 lakh
India 85,600(16%) 65,500(47%)
0
200
400
600
800
100
0
Est
ima
ted
deat
hs,
thou
san
ds
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Year
Estimated mortality 95% confidence interval
Global estimated measles deaths down by
three - quarters, 2000 - 2010
2015 Target
74%
DEATHS DOWN 2000 TO 2010 (BY 74%)
74% 76% 79% 85%
90% 2010 reduction goal
78%
Source: WHO/IVB, November 2009
87% 100%
26%
Measles mortality was reduced by more than three-quarters in all WHO regions except the WHO southeast Asia Region. India accounted for 47% of estimated measles mortality in 2010, and the WHO African region accounted for 36%.
India in 2010 recorded nearly 30,000 new cases of measles, and recorded 65,500 deaths. (47% of the world)
Each year, between 60,000 and 100,000 children die of measles in India, which is the highest for any country in the world.
GLOBAL GOALS
Millennium Development Goal # 4: -Reduce child deaths by 2/3 by 2015 (vs. 1990)
-Measles immunization coverage indicator of access to care
Measles Mortality Reduction By 2015 Vaccination coverage: 90% national level and 80% in every district Reported incidence: < 5 cases of measles per million Mortality reduction: 95% (vs 2000)
Global Measles and Rubella Management Meeting
WHO, Geneva, March 20 - 21, 2012
MR INITIATIVE
MR Initiative (formerly, the Measles Initiative) was launched in 2001 to support technically and financially accelerated measles control activities.
As a result of its efforts, measles deaths dropped to approximately 139 000 per year in 2010, representing a 74% decrease compared with 2000, and a 23% decline in under-five deaths worldwide between 1990 and 2008 .
THE MEASLES AND RUBELLA INITIATIVE Provides financial plus following support to the five components of the Global
Measles and Rubella- Strategic Plan 2012-2020 Strategy.
• Advocacy to fully fund and implement the Strategic Plan, in close collaboration with child survival initiatives.
• Technical support to priority countries:
» to improve immunization coverage ;
» to document and share best practices ;
» to expand and enhance the quality of surveillance and the LabNet;
» to provide appropriate measles case treatment.
•Assistance to respond rapidly to measles outbreaks.
•Support to operational research.
•Monitoring and evaluation of progress in implementing the Plan and communication of progress and challenges to all stakeholders yearly.
To date, the partnership has invested US$ 875 million in measles control activities, which supported the vaccination of more than one billion children in more than 80 countries.
THE MR INITIATIVE WORKS WITH SEVERAL
KEY SUPPORTERS
the Anne Ray Charitable Trust,
BD,
the Bill & Melinda Gates Foundation,
the Canadian International Development Agency,
the Church of Jesus Christ of Latter-day Saints,
the United Kingdom Department for International Development,
the GAVI Alliance,
Herman and Katherine Peters Foundation,
the International Federation of Red Cross and Red Crescent Societies,
the International Financing Facility for Immunization,
the Japan International Cooperation Agency,
Lions Clubs International,
Merck Co. Foundation,
the Norwegian Ministry of Foreign Affairs, and
Vodafone Foundation.
Anne Ray Charitable Trust
Acknowledgements
THE GAVI ALLIANCE
The GAVI Alliance provides significant opportunities for improvements in funding to vaccination programmes in the developing world.
GAVI supports strengthening immunization and health systems; introduction of the measles second dose through routine services; introduction of rubella vaccine through wide age-range campaigns using MR vaccine; as well as performance-based support to increase on-time vaccination with the first dose of MCV.
The MR Initiative will work closely with the GAVI Alliance to help countries introduce MCV2 and MR vaccines, monitor and evaluate progress and recommend areas for new investment.
THE GAVI ALLIANCE PARTNERS
In addition to national governments and public health and
research institutions, the GAVI Alliance partners include
Bill & Melinda Gates Foundation,
International Federation of Pharmaceutical Manufacturers Associations,
Rockefeller Foundation,
UNICEF,
World Bank and
WHO.
GLOBAL MEASLES AND RUBELLA STRATEGIC
PLAN 2012-2020
This Strategic Plan 2012–2020 explains how countries, working together with the MR Initiative and its partners, will achieve a world without measles, rubella and congenital rubella syndrome (CRS).
THE STRATEGY FOCUSES ON THE
IMPLEMENTATION OF FIVE CORE COMPONENTS.
1. Achieve and maintain high levels of population immunity by providing high
vaccination coverage with 2 doses of MR vaccine.
2. Monitor disease using effective surveillance, and evaluate programmatic
efforts to ensure progress.
3. Develop and maintain outbreak preparedness, respond rapidly to
outbreaks and manage cases.
4. Communicate and engage to build public confidence and demand for
immunization.
5. Perform the research and development needed to support cost-
effective operations and improve vaccination and diagnostic tools.
PLAN‘S VISION, GOALS AND MILESTONES
VISION
Achieve and maintain a world without measles, rubella and
congenital rubella syndrome (CRS).
GOALS
By end 2015
o Reduce global measles mortality by at least 95% compared
with 2000 estimates.
Achieve regional measles and rubella/CRS elimination goals.
By end 2020
Achieve measles and rubella elimination in at least five WHO regions.
PLAN’S MILESTONES
By end 2015
Reduce annual measles incidence to <5 cases/million & maintain that level.
Achieve at least 90% coverage with the MCV1 (or measles- rubella-containing vaccine) nationally, and exceed 80% vaccination coverage in every district or equivalent administrative unit.
Achieve at least 95% coverage with M, MR or MMR during SIAs in every district.
Establish a rubella/CRS elimination goal in at least three additional WHO regions.
Establish a target date for the global eradication of measles.
By end 2020
Sustain the achievement of the 2015 goals.
Achieve at least 95% coverage with both MCV1&2 (or measles- rubella-containing vaccine ) in each district and nationally.
Establish a target date for the global eradication of rubella and CRS.
CURRENT WHO GLOBAL AND REGIONAL
TARGETS
Among 6 WHO regions 5 have set target elimination dates.
The Americas achieved the goal - in 2002
The Western Pacific Region - by end of 2012
European and Eastern Mediterranean - by 2015.
The African Region -by 2020
The South-East Asia Region -under discussion
MEASLES AND RUBELLA ELIMINATION GOALS, FEB 2012
2015 2015
2015 2012
SEAR: 95% Measles Mortality Reduction by 2015
2020
2000 2010
GLOBAL CONTEXT MEASLES VACCINATION
In 2000, the World Health Assembly adopted a five-year strategic plan to
reduce global measles deaths by half compared with 1999 levels, from 2000–2005 through vaccination.
Then in 2006 MR Initiative supported a five-year strategic plan to reduce measles mortality by 90% by 2010 vs 2000 levels.
Except SEAR, all WHO regions have achieved 75% reduction.
The 90% goal was not achieved mainly due to delayed control activities in India and outbreaks in Africa.
According to WHO and UNICEF estimates, global routine coverage with MCV1 increased from 72% in 2000 to 85% in 2010.
By the end of 2010, the routine immunization schedules of 139 countries included 2 doses MCV, and in 2011, GAVI supported 11 more countries to introduce a routine MCV2.
HERD IMMUNITY Definition-The resistance of a population to attack by a disease to which a
large proportion of the members are immune.
For measles, this proportion is ~ 95%.
When ~ 95% of the population is immunized against measles:
Non-immunized individuals will remain susceptible, but may be indirectly protected by “herd immunity”.
If virus is reintroduced, the disease spread is limited (outbreaks are small).
Measles virus circulation may be interrupted.
Measles vaccine’s efficacy rate is only 85 per cent because the first dose of measles vaccine is given in India at the age of nine months .
At this age, infants have antibodies from the mother that makes the vaccine ineffective.
If given after one year of birth, the vaccine has efficacy of 95 per cent.
CHALLENGES
# 1: INDIA
RAJASTHAN
ORISSA
GUJARAT
MAHARASHTRA
MADHYA PRADESH
BIHAR
KARNATAKA
UTTAR PRADESH
ANDHRA PRADESH
JAMMU & KASHMIR
ASSAM
TAMIL NADU
CHHATTISGARH
PUNJAB
JHARKHAND
WEST BENGAL
ARUNACHAL PR.
HARYANA
KERALA
UTTARAKHAND
HIMACHAL PRADESH
MANIPUR
MIZORAM
MEGHALAYA
NAGALAND
TRIPURA
SIKKIM
GOA
A&N ISLANDS
D&N HAVELI
PONDICHERRY
LAKSHADWEEP
DELHI
CHANDIGARH
DAMAN & DIU
Phase 2 (157 districts)
Phase 1 (45 districts
covered)
Remaining (159
districts)
Source: Based on target population available with GoI
Target
pop
(millions)
Vaccinated
(millions)
Coverage
Phase-1 13.8 12.1 88%
Phase-2 42.9 28.6 67%*
Phase-3 72.7 Planned --
Total 129.4 40.7* --
* Phase-2 campaigns ongoing; data as on 23 Jan 2012.
17 states with MCV1 coverage ≥ 80% introduced
a routine second dose by August 2011.
14 states with MCV1 < 80%
are implementing measles
SIAs
# 2: RESURGENCE IN AFRICA
4-fold increase since 2008
Large outbreaks in Burkina
Faso (2009), S. Africa
(2010), and DRC (2011)
Outbreaks in drought
affected Horn of Africa
High case-fatality
0
100,000
200,000
300,000
400,000
500,000
600,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010‡
Year
No
. of
case
s (i
n t
ho
usa
nd
s)
0
10
20
30
40
50
60
70
80
90
100
MC
V1
cove
rage (%
)
Number of cases
WHO/UNICEF estimates
Administrative coverage
Weekly Epidemiological Record
(2011) 86:129-135
# 3: WEAK IMMUNIZATION SYSTEMS
1st dose:
67 Countries have
MCV1 coverage < 90%
2nd dose ( routine ):
54 countries do not
have routine 2nd dose
Campaigns:
Variable quality
Delayed
Measles 1st dose coverage among infants, 2010
80-89% (24 countries or 12 %)
50-79% (41 countries or 21%)
>=90% (126 countries or 66%)
<50% (2 countries or 1%)
# 4: FINANCING IS LATE AND UNPREDICTABLE
Lack of multi-year funding
Countries not committing
50% of the operational costs
of SIAs
Outbreak response not
budgeted for
$ 32 million funding gap for
2012
Annual Donations 2001 - 2011 & Financial Resource
Requirements, Projections, Funding Gap 2012
*Excluding country contributions
0
20
40
60
80
100
120
140
160
180
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
$ U
S M
illi
on
Donations Projected Donations Funding Gap
SINCE 2000, 1ST DOSE COVERAGE UP BY 13%
Source: WHO/UNICEF coverage estimates,
2011 revision. Date of slide: 29 July 2011
2015 Target
SCALING-UP 2ND DOSE STRATEGIES
0
50
100
150
200
250
300
350
400
450
500
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Nu
mb
er
of
MC
V d
oses (
in m
illi
on
s)
1st routine dose 2nd routine dose SIA
Number of doses of measles vaccine administered,
by delivery strategy, 2000-2010
Measles Initiative
1st routine dose: WHO/UNICEF coverage estimates, The World Population Prospects New York, 2011. 2nd routine dose: WHO/UNICEF Joint reporting
form, (not all countries report 2nd dose). SIA dose;: WHO SIA database, July 2011 (Provisional data)
1 billion vaccinated
as of July 2011
INDIA
Measles vaccine coverage in India, under the routine immunization program, was only 69 % in 2007-2008, according to the DLHFS III and 14 states had <80% coverage.
The nation-wide coverage rose to 74% in 2009,(Global – 84%, Rajasthan 65.6%) according to UNICEF.
COVERAGE WITH MCV1 AMONG CHILDREN AGED 12--23 MONTHS, BY DISTRICT ---
INDIA, 2007--2008*
* Data are from the District Level Household and Facility Survey 2007--2008.
COVERAGE WITH MCV1 AMONG CHILDREN AGED 12--23 MONTHS, BY STATE ---
INDIA, 2007--2008*
* Data are from the District Level Household and Facility Survey 2007--2008 for all states except
Nagaland, for which data are from the UNICEF 2006 Coverage Evaluation Survey.
LABORATORY-CONFIRMED MEASLES AND RUBELLA OUTBREAKS IN STATES
CONDUCTING MEASLES OUTBREAK SURVEILLANCE --- INDIA, 2010*
* Data are from the National Polio Surveillance Project measles surveillance database, 2010.
MCV2 IN INDIA
In 2008, the Indian National Technical Advisory Group on Immunization (NTAGI) recommended introduction of a MCV2 at the age of 16-24 months.
States/UTs with >80% Measles coverage (21 States) have introduced MCV2 in their Routine Immunization Program by Aug 2011.
States/UTs with <80% coverage (14 states) are first covering all children b/w 9m -10y age through a Measles SIA as Catch-up campaigns in a phase-wise manner followed by introduction of 2nd dose under their routine immunisation programme.
CATCH-UP CAMPAIGNS The campaign is divided in four
phases. First phase of the campaign held from Nov 2010 to May 2011
The campaign runs in each district for three weeks. One week in schools ,Next two weeks at the community-level.
States covered in the first phase of the campaign were: Assam, Arunachal Pradesh, Haryana, Manipur, Rajasthan, Madhya Pradesh, Bihar, Chhattisgarh, Gujarat, Jharkhand, Tripura, Nagaland and Meghalaya.
Target population:
~ 130 million children 9 months – 10 years of age
361 districts in 14 states
RAJASTHAN
ORISSA
GUJARAT
MAHARASHTRA
MADHYA PRADESH
BIHAR
KARNATAKA
UTTAR PRADESH
ANDHRA PRADESH
JAMMU & KASHMIR
ASSAM
TAMIL NADU
CHHATTISGARH
PUNJAB
JHARKHAND
WEST BENGAL
ARUNACHAL PR.
HARYANA
KERALA
UTTARAKHAND
HIMACHAL PRADESH
MANIPUR
MIZORAM
MEGHALAYANAGALAND
TRIPURA
SIKKIM
GOA
A&N ISLANDS
D&N HAVELI
PONDICHERRY
LAKSHADWEEP
DELHI
CHANDIGARH
DAMAN & DIU
RAJASTHAN
ORISSA
GUJARAT
MAHARASHTRA
MADHYA PRADESH
BIHAR
KARNATAKA
UTTAR PRADESH
ANDHRA PRADESH
JAMMU & KASHMIR
ASSAM
TAMIL NADU
CHHATTISGARH
PUNJAB
JHARKHAND
WEST BENGAL
ARUNACHAL PR.
HARYANA
KERALA
UTTARAKHAND
HIMACHAL PRADESH
MANIPUR
MIZORAM
MEGHALAYANAGALAND
TRIPURA
SIKKIM
GOA
A&N ISLANDS
D&N HAVELI
PONDICHERRY
LAKSHADWEEP
DELHI
CHANDIGARH
DAMAN & DIU
RAJASTHAN
ORISSA
GUJARAT
MAHARASHTRA
MADHYA PRADESH
BIHAR
KARNATAKA
UTTAR PRADESH
ANDHRA PRADESH
JAMMU & KASHMIR
ASSAM
TAMIL NADU
CHHATTISGARH
PUNJAB
JHARKHAND
WEST BENGAL
ARUNACHAL PR.
HARYANA
KERALA
UTTARAKHAND
HIMACHAL PRADESH
MANIPUR
MIZORAM
MEGHALAYANAGALAND
TRIPURA
SIKKIM
GOA
A&N ISLANDS
D&N HAVELI
PONDICHERRY
LAKSHADWEEP
DELHI
CHANDIGARH
DAMAN & DIU
RAJASTHAN
ORISSA
GUJARAT
MAHARASHTRA
MADHYA PRADESH
BIHAR
KARNATAKA
UTTAR PRADESH
ANDHRA PRADESH
JAMMU & KASHMIR
ASSAM
TAMIL NADU
CHHATTISGARH
PUNJAB
JHARKHAND
WEST BENGAL
ARUNACHAL PR.
HARYANA
KERALA
UTTARAKHAND
HIMACHAL PRADESH
MANIPUR
MIZORAM
MEGHALAYANAGALAND
TRIPURA
SIKKIM
GOA
A&N ISLANDS
D&N HAVELI
PONDICHERRY
LAKSHADWEEP
DELHI
CHANDIGARH
DAMAN & DIU
INDIA: PHASED CATCH-UP CAMPAIGNS 2010-2013
Phase No. of
State
No. of
Distt
Target Pop
(9 m - 10
yrs)
%
Cover
age
P 1 13 45 13,845,686 87.2
P 2 14 157 42,931,906 82.9*
P 3** 15 159 ~ 73,000,000
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
RAJASTHAN
In Rajastan, five districts—Ajmer, Bhilwara, Nagaur, Rajsamand and Tonk—were selected for the first phase of the campaign that started on November 29, 2010.
In 2010, before the start of the campaign, there were four measles outbreak episodes in these five districts. In 2011, the outbreak incidents in these districts dipped to two.
MEASLES OUTBREAK SURVEILLANCE
Laboratory-supported measles outbreak surveillance was initiated in 2006 and, by 2010, was operational in eight states (Andhra Pradesh, Gujarat, Karnataka, Kerala, Madhya Pradesh, Rajasthan, Tamil Nadu, and West Bengal).
An outbreak is considered confirmed if measles immunoglobulin M (IgM) is detected in serum from at least two suspected cases. Sera are tested by a network of eight laboratories accredited by the World Health Organization. All samples testing negative for measles IgM are tested for rubella IgM.
During 2010, a total of 242 suspected outbreaks were investigated, and 198 (82%) were laboratory-confirmed as measles (Figure 3).
Among 8,984 measles patients from laboratory-confirmed outbreaks, 7% were aged <1 year, 41% were aged 1--4 years, 37% were aged 5--9 years, and 15% were aged ≥10 years.
GUIDING PRINCIPLES TO ELIMINATE
MEASLES, RUBELLA AND CRS
1. Country Ownership And Sustainability
2. Routine Immunization And Health Systems Strengthening
3. Equity
4. Linkages
With polio eradication
With new vaccines
With other proven child survival interventions
Surveillance activities
CHALLENGES IN INDIA
Need for
1) increasing the number of trained staff at all levels,
2) increasing public demand for and confidence in vaccines,
3) improving vaccine stock and cold chain management, and
4) developing a strong reporting and management system for
adverse events after vaccination.
Also challenges in planning and implementation, including obtaining
strong state-level leadership and coordination, timely
determination of campaign dates, reaching populations with the
campaign messages, and reaching children in urban areas.
GLOBAL MEASLES SUMMARY
Achievements 1st dose coverage up to 85%
1 billion doses delivered in campaigns
2 / 3 reduction in cases
3 / 4 reduction in deaths
Challenges Catch - up in India, outbreaks in Africa, weak systems, unpredictable
funding
New Strategic Plan, 2012 - 2020 Addition of rubella as a “ game changer "
MEASLES CONTROL IN INDIA
Strategies and Operational Plans
Dr Pradeep Haldar
Assistant Commissioner
(Immunization)
Government of India
For 26 & 27th July 2010
TARGET POPULATION AND VACCINE
DOSES REQUIRED
SIA in 14 states
Target population (9 mo-10 years): 134 million
Vaccine doses +AD: 147 million
Mixing syringe : 29.5 million
Operational cost as per JE norms
MCV2 in RI in 17 states: Annual targets
1-2 year population: 9.36 million
Vaccine doses: 11.23 million
SIA PHASING
Will be in three phase
First phase – 40 districts from 14 states
one district from each of the North-East states, (6 states
excluding Mizoram & Sikkim)
2 districts from each of the UP and Bihar (2 States)
5 districts from each of the remaining states (6 States)
Planned for 40 districts in late 2010
Second and third phase will be built-upon the first
phase and will be in 2011.
KEY VACCINATION STRATEGIES
Target group: 9 m to 10 yrs (irrespective of measles immunization status) This age group constitutes ~ 20-25% of total population Target population (9 mo-10 years): 134 million
Regular RI sessions will be conducted without interruption Measles catch-up campaign in remaining days
Immunization will be at fixed posts to ensure safe injection practices All sites used for routine immunization sessions Additional sites to cover all villages Schools with children under 10 years Special plans for hard to reach areas and/or underserved populations
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 remaining children
STRATEGIC PLANS FOR IMMUNIZATION
Training of all staff followed by development of micro-plan
Complete measles immunization in one day in a village or an urban area
(Mohalla) or in a school
1 team = 1-2 vaccinator + 1 ASHA/AWW + 1-2 volunteers (1 vaccinator in
NE/ other sparsely populated area)
One vaccinator will be able to vaccinate in a day
Approx. 125-150 children in community based booths
Approx. 200 children in a school booth
Children will be finger marked with indelible ink
Catch-up campaign card for each immunized child
ROLES IN IMMUNIZATION SITE
Immunization session will be conducted from 8-2 pm and there after the worker will do the routine activity till 4 pm.
Rapid assessment of coverage by Supervisors & independent monitors on a daily basis: Missed children will be immunized in areas found to have
<90% coverage
ASHA/AWW will bring in subsequent weekly RI session in village
Waste disposal: per National guidelines
AEFI MANAGEMENT
Medical Officers will carry Emergency Medicines –
Mobile Supervisory cum Medical Units
AEFI training/ reporting and management: All government centre will work as AEFI management centres Additional sites at private sector clinics, if required Involvement of professional bodies like IAP, IAPSM, IPHA AEFI kits will be available at all these sites Daily monitoring
VHSCs/plans for transport serious AEFI cases
Pro-active media plan with designated spokesperson
PLANNING & COORDINATION
Committees at central and state levels Steering committee
To mobilize resources and coordinate planning and implementation activities with other departments
Broad based including relevant departments, civil society organization, professional bodies, opinion leaders
Chairperson: Secretary Health
Working Group Smaller group for day-to-day monitoring of campaign planning and
implementation
State Control room during the campaign
District Task Force (DTF) To supervise, support, monitor and ensure implementation of the
highest quality measles campaign in the district.
Chairperson: District Collector/ Magistrate
A measles catch-up control room at District level
KEY LOGISTIC NEED FOR SESSIONS
Vaccine doses required = Target population X 1.1 (WMF)
Vaccine vials required = Vaccine doses / 5 (for 5 dose vials)
Diluent vials required = Vaccine vials required
Auto disable syringes = Target population X 1.1 (WMF)
Reconstitution syringes (5 ml) = Vaccine vials X 1.1 (WMF)
Hub cutters = Number of teams
Red plastic bags = 1 per 50 syringes
Black plastic bags = 2 per session site
Ensure adequate cold chain space
1. Various depts at the state/district level (edu, rural devpt)
2. Educational institutions, mainly schools (teachers body)
3. Professional medical/ pediatrics associations
4. Local NGOs and community-based organizations
5. Influential individuals within communities/religious
groups
6. Media
Advocacy activities planned/underway
1. Seminars, workshops , group discussions
2. Powerpoints and outreach materials with targeted
messaging for each group
ADVOCACY TO GAIN AND SUPPORT TO THE
CAMPAIGN
PLANNING FORMATS – PHC / BLOCK LEVEL S Level Who will fill Name of format
1 Subcenter ANM Village List / School List / H2R
List
2 Subcenter ASHA/AWW/ANM/Volunt
eers
Beneficiary Due List
3 PHC / Block ANM + Supervisor Microplan
4 PHC / Block ANM + Supervisor Educational Facility Plan
5 PHC / Block ANM + Supervisor + MO H2R Plan
6 PHC / Block PHC / Block Cold Chain
Handler
PHC and Block Logistics Plan
7 PHC / Block PHC / Block Cold Chain
Handler
Vaccine Distribution Plan
8 PHC / Block Supervisor Supervisor Plan
9 PHC / Block Cold Chain Handler + MO Waste Management +
Contingency Plan
1
0
PHC / Block Supervisor + MO + ANM Communication Plan
PLANNING FORMATS – DISTRICT LEVEL S
No
Level Who will fill Name of format When
1 District District Cold Chain
Officer + DIO
District Vaccine & Logistics
Planning Format
2 District District Cold Chain
Officer + DIO
District Cold Chain Planning
Format
3 District District Cold Chain
Officer
District Contingency Plan
4 District DIO and Other
Program Managers
District Supervision Plan
* Fund Distribution Plan will also be developed at the
district once financial norms have been finalized
REPORTING FORMATS – PHC / BLOCK LEVEL
S
N
o
Level Who will fill Name of
format
When
1 Session
Site
Vaccinator (ANM) / AWW Immunization
Card
2 Session
Site
Vaccinator (ANM) Tally Sheet
3 Sector Supervisor Supervisor
Checklist
4 PHC Supervisor Supervisor
Compilation
report
5 Block Block Data Handler (IO /
Computer / HS etc)
Block
Compilation
Report
REPORTING FORMATS – DISTRICT / STATE
LEVEL
S
No
Level Who will fill Name of
format
When
1 District District Computer
Assistant / Data Handler /
Statistical Officer
District
Compilation
Report format
2 State State CA State
Compilation
Report format
REPORTING FORMATS – NATIONAL LEVEL
Sl
No
Level Who will fill Name of format When
1 Village /
Session
site
National / Independent
Observers
Rapid Assessment
Format
TIMELINE.. S.No Activity Timeline
1 Develop Action Plan (Core group) Mar 2010
2 Estimate Budget and operational costs for SIA Mar 2010
3 Logistics timeline /Costs etc. For SIA Mar 2010
4 Raising current indent for the vaccine Apr-10
5 Initiating process for procurement of additional vaccines
6 Expected availability of vaccine Aug-10
7 AD Syringes Apr-10
8 Initiating process for emergency procurement of additional AD
syringes Apr-10
9 Training and Operational Guidelines including AEFI
guidelines Draft by Apr-10
10 Training Plans
11 Communication Package and Branding for SIA May 2010
12 Vaccinator guidelines Draft by May-10
13 Training guide Draft by May-10
TIMELINE..(2) S.No Activity Timeline
14 Key messages Draft by May-10
15 Do's and don'ts Draft by May-10
16 Print and Distribute National guidelines Jun-10
17 National Workshop Jun 2010
18 State level workshops Jun 2010
19 Develop communication materials Jul-10
20 Training of vaccinators and ASHA/AWW Aug-10
21 District level workshops Aug-10
22 Prepare micro-plans Aug-10
23 Review micro-plans Aug-10
24 Review of cold chain systems at district/sub-district levels Jun-10
25 Flow of funds for Ops costs to state Aug-10
26 Flow of funds for Ops costs from state to district Aug-10
TIMELINE.. (3)
S.No Activity Timeline
27 District level coordination meetings Before campaign/ During campaign for mid-
course correction/After SIA to identify gaps
28 Distribution of Vaccines to state Aug-10
29 Distribution of other logistics to state Aug-10
30 SIA Implementation Stage Sep 2010
31 Pre-campaign monitoring end August
32 Campaign monitoring Concurrent - Sept 2010
33 Post-campaign evaluation Oct 2010; results finalized by end Oct
34 Post campaign review at state level Nov-10
REFFERENCES
Hoekstra_Measles technical update
Moss_Research Agenda
INDIAN PEDIATRICS, Vol.49__May 16, 2012
ANNUAL REPORT to the People on Health Government of India, Ministry of Health and Family Welfare September 2010
Epidemiology of Measles,Prof. Ashry Gad Mohd Prof. of Epidemiology
Global eradication of measles, WHO EXECUTIVE BOARD, 126th Session Provisional agenda item 4.14, EB126/17, 26 November 2009
GLOBAL MEASLES AND RUBELLA, Strategic Plan 2012- 2020
MILLENNIUM DEVELOPMENT GOALS INDIA, COUNTRY REPORT 2011, Central Statistical Organization, Ministry of Statistics and Programme Implementation, Government of India, www.mospi.nic.in
MMWR Weekly / Vol. 60 / No. 38 September 30, 2011