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

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

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