Role of Schools - in Implementation of Measles catch-up campaigns
description
Transcript of Role of Schools - in Implementation of Measles catch-up campaigns
1
Training of Trainers for Measles SIAs
Role of Schools - in Implementation of
Measles catch-up campaigns
Meeting of Principals of Pvt. Schools
2
Training of Trainers for Measles SIAs
Introduction
Measles is a leading cause of childhood mortality
Infants and young children, especially those who are malnourished, are at highest risk of dying.
Measles outbreak surveillance data reveals that around 90% of the measles cases are in the age group of <10 years.
Review of Indian Literature: Median case fatality ratio (CFR) of measles 1.63%*
Because measles infection is so common, even with low CFR there are many deaths which are “preventable” with a vaccine.
The national coverage for measles vaccine is only 69% (DLHS 3)
At 85% vaccine efficacy, this means 41% (10.3 million) children are susceptible to Measles
3
Training of Trainers for Measles SIAs
Disproportionate burden of measles mortality in India
Data source: WHO/IVB, November 2009
India: 60,000-100,000 estimated Measles Deaths (2008)
67%
= 1000 deathDots are randomly distributed in countries
4
Training of Trainers for Measles SIAs
Measles disease
An acute viral infectionAirborne transmission via respiratory secretions or aerosolsClassic manifestations:
Maculopapular rashFeverThe “3Cs”: Cough, Coryza (runny nose), Conjunctivitis (red eyes)
Complications and mortality highest in children < 2 yrs and in adults
Measles case, Badaun district, Islamnagar block, Jan 2010
5
Training of Trainers for Measles SIAs
Measles complications
Corneal scarring causing blindnessVitamin A deficiency
Encephalitis
Older children, adults
≈ 0.1% of cases
Chronic disability
Pneumonia &diarrheaDiarrhea common in developing countries
Pneumonia ~ 5-10% of cases, usually bacterial
6
Training of Trainers for Measles SIAs
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
7
Training of Trainers for Measles SIAs
Principles of control & rationale for second dose
Live attenuated vaccine gives long term immunityConfers immunity to 85% children when given at 9-12 months of ageConfers immunity to 95% persons when given at >12 months of age
Persons who have failed to respond with first dose will almost always become immune with second dose
As coverage is never 100%, 1 dose schedule can never achieve 95% population immunity.
10
Training of Trainers for Measles SIAs
Bullet pointsBullet Points
….Benefit after measles vaccination
12
Training of Trainers for Measles SIAs
Measles SIA phasing plan, India
State Total number of Districts Districts covered in Phase 1 Districts covered in Phase 2Number of Districts for
Phase 3
ARUNACHAL PR. 16 1 15
ASSAM 27 1 26
BIHAR 38 5 15 18
CHHATTISGARH 18 9 9
GUJARAT 32 5 5 22
HARYANA 21 5 16
JHARKHAND 24 5 19
MADHYA PRADESH 50 5 13 32
MANIPUR 9 1 8
MEGHALAYA 7 1 6
NAGALAND 11 1 10
RAJASTHAN 33 5 5 23
TRIPURA 4 1 3
UTTAR PRADESH 75 3 72
Total 365 45 153 167
Target Population ~129,597,214 13,845,686 40,167,580 ~75,583,948
Coverage (% Achieved)
12,076,836 (87.2%)
36,001,191 (89.6%)
As of date 24th July, 2012
13
Training of Trainers for Measles SIAs
Catch-up campaign: Basic vaccination strategy … 1/2
Target age group: 9 months to <10 years (irrespective of their prior measles immunization status or disease history)
In general, this age group constitutes around 20-25% of the total population
Expected coverage: More than 90% (evaluated coverage)
Regular routine immunization sessions will be conducted without interruption
Two regular routine immunization clinics per week
Measles catch-up campaign in remaining four days
Average Campaign duration: 3 weeks = 12 working days
1st week: School based campaign (for 5-10 year children)
2nd & 3rd weeks: Community based campaign for non-school going children
14
Training of Trainers for Measles SIAs
Catch-up campaign: Basic vaccination strategy … 2/2
All immunizations from static posts (no HTH immunization)Types of session sites
Session sites at Educational Institutes: All types of schools where <10 years children attend will be used as vaccination sites. These sites will be covered in the first week of the campaign.
Outreach site (regular RI sites and additional sites in village/urban mohalla): Children who do not go to school or those left out during the vaccination week in schools will be covered from regular RI/UIP sites during the 2nd and 3rd weeks. Mobile/Special team: Street children and other high-risk populations in urban areas are most likely to have missed their routine dose in their infancy and may also miss the second opportunity.Facility based session site (Fixed sites): All health facilities at PHC level and above will function as session sites throughout the campaign duration
15
Training of Trainers for Measles SIAs
Why Schools are Important
School Campaign in 1st week: “Make or Break” for rest of the campaignSince schools will cover around half of the target children, the success of this campaign will depend largely on the full support, commitment and ownership of the education sector.
If properly planned, large number of children can be vaccinated with lesser effort and duration than community campaign
16
Training of Trainers for Measles SIAs
School Sites & Teams
Vaccination sites at all educational institutes where <10 years children attend
Government and private schools, crèches, day-care centers, Madrassa
Complete the vaccination in a school in one day
Timing: As per school timing; match with school shifts.
Extra vaccinators for Urban wards as higher number of schools
Temporary skilled-vaccinators (nurses, intern doctors, private doctors, senior nursing students etc.)
17
Training of Trainers for Measles SIAs
Planning
Enlist all schools in the PHC area, using Form-3Number of vaccinators to cover a school in one day = Target population/200.Vaccination team: Generally a vaccination team will have 1 trained vaccinator (ANM / Others) * 1 ASHA /Link worker or similar staff (for urban areas) 1 AWW 1 volunteer
* In case the beneficiary load is 150-300 at one outreach site or 200-400 at one school site, the team will have two vaccinators.
18
Training of Trainers for Measles SIAs
Role of Schools
Organize measles vaccination centre inside the school
Identify a nodal person from the school who will Provide space in the school
Mobilize and control the flow of children.
Identify teachers as volunteers systematic queue management, mark tally sheets / marking fingers of children
Mobilize school teachers to support vaccination teams.
Send prior intimation to parents of school children regarding day of measles immunization at the school and
seek their cooperation.
19
Training of Trainers for Measles SIAs
Role of Schools
To train teachers to teach school children and parents about
Benefit of measles immunization in connection with child health
Inform about the date, time and place of vaccination.
To encourage children to educate/share information with their parents on
Importance of measles immunization
Date, time and vaccination site for younger siblings (children less than 5 years in the family)
20
Training of Trainers for Measles SIAs
Role of Schools
Injection Safety & Waste management planTeams should not leave any waste at the school site.
AEFI ManagementAssist the vaccination team in case of emergency
Provide transportation if required
Allay concerns of students and parents
Not a single case of serious AEFI from – 655921 injection in Patna District
Team of Expert doctors for AEFI -120 with AEFI Kit
21
Training of Trainers for Measles SIAs
Impact
22
Training of Trainers for Measles SIAs
Assessing the impact of campaigns
MCUP-States having measles surveillance
Phase -1 catch-up campaign dates
1 year pre Phase 1 MCUP* 1 year post Phase 1 MCUP
Total number confirmed measles
outbreaks
Total number of confirmed
measles cases
Total number of confirmed
measles outbreaks
Total number of confirmed
measles cases
Gujarat Mar 11-Jul 1118
6600
0
Madhya Pradesh Dec 10-Jan 118
6130
0
Rajasthan Nov 10-Dec 104
2112
54
Grand Total30
1,4842
54
Note: Surveillance not implemented until after the campaigns;Data updated as on 4th March 2012* Approximately 1 year before start of Phase 1 activity including the campaign months
23
Training of Trainers for Measles SIAs
19 Lab confirmed measles outbreaks 1 Lab confirmed rubella outbreaks 9 Lab confirmed outbreaks negative for both measles & rubella
2012 Surveillance results: Lab confirmed measles outbreaks = 19 Total cases = 1089; Deaths = 8 48% unvaccinated 82% < 10 years of age
MCUP phase 1 Dec 2010-Jan 2011
MCUP phase 2 Nov 2011-Feb 2012
Bihar: Signs of campaign impact
N=(1089)
6%
41%36%
11%7%
As on wk - 35
24
Training of Trainers for Measles SIAs
21 Lab confirmed measles outbreaks 2 Lab confirmed rubella outbreaks 6 Lab confirmed outbreaks negative for both measles & rubella
2011 Surveillance results: Lab confirmed measles outbreaks = 21 Total cases = 2527; Deaths = 16 72% unvaccinated 85% < 10 years of age
MCUP phase 1 Dec 2010-Jan 2011
MCUP phase 2 Nov 2011-Feb 2012
Bihar: Signs of campaign impact
N=(2527)
6%
42%
37%
11%8%
As on wk - 35
25
Training of Trainers for Measles SIAs
Sr. No.
Name of Block Target Coverage Percentage
1 Athmalgola 19936 13258 672 Bakhtiyarpur 49453 33904 693 Barh 31603 24216 774 Belchhi 12867 9577 745 Bihta 55513 32574 596 Bikram 37145 23776 647 Danapur 54642 30903 578 Daniyawan 18367 13124 719 Dhanarua 46845 32914 70
10 Dulhin Bazar 27005 15649 5811 Fathua 41079 22397 5512 Ghoswari 15559 13733 8813 Khusrupur 21397 13777 6414 Maner 54282 22384 4115 Masaurhi 52835 24517 4616 Mokama 44987 25869 5817 Naubatpur 45014 25038 5618 Paliganj 57137 32724 5719 Pandarak 33187 22456 6820 Patna Sadar 45744 36288 7921 Phulwarishriff 48944 16641 3422 Punpun 33659 17925 5323 Sampatchak 24546 19354 79
871745 522998 601252828 655921 52
Patna Rural
District Total
Block Wise Achievement Report of Measles Campaign of Patna Rural(03.12.2012 - 16.12.2012)
26
Training of Trainers for Measles SIAs
Sr. No.
Name of Block Target Coverage Percentage
24 SDH Barh 11801 9043 77
25 SDH Danapur 33234 14768 44
26 SDH Masaurhi 11801 8730 74
27 Urban Gardanibagh Hos 48271 15623 32
28 Urban Guljar bagh Hos. 16832 6208 37
29 Urban Guru gobind singh Hos 42267 13900 33
30 Urban Jai prabha Hos 29861 8121 27
31 Urban Kankarbagh Hos. 26809 7119 27
32 Urban Maroofganj Hos 20980 13844 66
33 Urban NGRH 26667 11722 44
34 Urban Rajbanshi Nagar Hos. 61561 12149 20
35 Urban Rajendra nagar Hos. 51000 11502 23
36 Kurji Holy Family 194381084 132923 35
1252828 655921 52District Total
Patna Urban
Block Wise Achievement Report of Measles Campaign of Patna Urban(03.12.2012 - 16.12.2012)
27
Training of Trainers for Measles SIAs
Example of a well organized school campaign
28
Training of Trainers for Measles SIAs
Queue with vaccination card
29
Training of Trainers for Measles SIAs
Vaccination & Position of child by teachers/staff
30
Training of Trainers for Measles SIAs
Make the measles campaign a big event in the district.
31
Training of Trainers for Measles SIAs
Proper queuing for efficient time management
32
Training of Trainers for Measles SIAs
Table 1: Well planned site. Note Immunization Cards on table
33
Training of Trainers for Measles SIAs
Table 2 for Vaccination: Noting the time of reconstitution on the vial
34
Training of Trainers for Measles SIAs
Table 2: Correct Procedure AD syringe / No touching of the needle or hub / 450 angle for subcutaneous injection
35
Training of Trainers for Measles SIAs
Table 3: Waste Disposal
36
Training of Trainers for Measles SIAs
Table 3: Hub Cutter in use
37
Training of Trainers for Measles SIAs
Table 4: Filling up the Tally sheet
38
Training of Trainers for Measles SIAs
Table 5: AEFI Kit
Inj. Adrenaline
39
Training of Trainers for Measles SIAs
Waiting at least 30 minutes after the injection.
40
Training of Trainers for Measles SIAs
Everybody has an Immunization Card
41
Training of Trainers for Measles SIAs
Urban Planning UnitsNo of
Schools
No of Schools activity done
No of Schools
given time
No of Schools
not given time
PTN_DANAPUR SDH 157 119 15 23
PTN_SADAR 238 193 28 17
PTN_URBAN GARDANIBAGH 167 137 0 30
PTN_URBAN GULJARBAGH HOSPITAL 79 59 0 20
PTN_URBAN JAI PRABHA HOSPITAL 88 48 12 28
PTN_URBAN KANKARBAGH 160 91 25 44
PTN_URBAN MAROOFGANJ HOSPITAL 126 109 13 4
PTN_URBAN NEW GARDINER ROAD 85 69 6 10
PTN_URBAN PATNA CITY 133 93 24 16
PTN_URBAN RAJBANSHI NAGAR 200 85 63 52
PTN_URBAN RAJENDRA NAGAR 190 116 14 60
Patna Urban Total 1623 1119 200 304
MCUP- Urban Schools Details
42
Training of Trainers for Measles SIAs
For Any Quarry / Support
Please contact to :-
1- Dr. Lakhinder Prasad,
Civil Surgeon - Patna
(Mob.-09470003600)
2- Dr. S.P. Vinayak,
District Immunization Officer - Patna
(Mob.-09470003548)
3- Dr. Rajesh Kumar Verma
SMO, Patna, Mobile – 09771496458
email – [email protected]
43
Training of Trainers for Measles SIAs
Thanks