Supplementary Immunization Activities

Quality, Coverage of high risk populations/ areas,

proposed plans for 2012 - 14

IEAG Meeting

15 March 2011

Outline of presentation

• SIAs – July 2011 to April 2012

• Quality of SIAs in high risk areas/populations

• Status of Emergency Preparedness & Response Plans

• Proposed SIA plans for 2012 - 2014

Areas/ Populations at highest risk of polio

Historic reservoir areas

Areas/ Populations at highest risk of polio

Areas with recent polio transmission

Historic reservoir areas

Areas/ Populations at highest risk of polio

Historic reservoir areas

Areas with recent polio transmission

Areas with high migrant populations

Polio SIAs , July to December 2011

SNID SNIDSNID

Aug Sep Nov

bOPV

Polio SIAs , January to April 2012

Jan Feb

Jan Feb

SNID

NID

bOPV

tOPV

Mar Apr

SNID

NID

Mar Apr

SIA quality in high risk areas/populations

Percent unvaccinated children – end of round survey

West UP

2009 2010 2011

Bihar

2009 2010 2011

~40,000 children checked for vaccination status each round in 107 high risk blocks

High polio vaccination coverage sustained in 107 highest risk blocks of UP and Bihar

66 HR blocks

41 HR blocks

2012

2012

Lot Quality Assurance Sampling (LQAS), Findings: HR blocks, UP

SNIDs: Aug 11 – Feb 12 # %

66 HR blocks

# lots accepted 260 85%

# lots cautioned 39 13%

# lots rejected 7 2%

Hypothesis: “The SIA coverage in this LOT is > 95%.”

N=54

Reasons for unvaccinated children

Child was not at home at time of team's visit

Refused immunization

Team failure

Non-resident child visiting house after team’s visit

Percent unimmunized children in field huts in Kosi riverine area

Source of data : NPSP monitoring

Coverage in field huts of Kosi area, Bihar

~ 3,000 children checked each round

• > 300,000 clusters of field huts (basas) visited by vaccination teams each round

• Intensive supervision and monitoring

Percent unvaccinated children: End-of-round surveyP

erc

en

t

N= 20,683 21,524 24,178 22,392 21,046 33,1497,805 8,989 9,271 10,430

West Bengal

Jharkhand

N= 2,945 3,213 9,779 8,398 4,163 5,509 6,151 5,242

Pe

rce

nt

3,422 4,981

Percent missed children < 5 yrs (average from Nov11, Jan12 & Feb12 SIAs), HR districts

Jharkhand

West Bengal

5,202

23,535

(Pakur & Sahibganj)

Malegaon Municipal Corporation – Resistance still an issue

# houses with reluctance to accept OPV, End-of-round

Num

ber

Maharashtra

Mapping and reaching migrants, India, 2011

Number of sites with migrants identified : ~162,000Number of children < 5 yrs in these sites : ~ 4.2 million

Number of sites identified by type

= 10 migrant sites

Coverage of migratory communities in states with large migratory population

Special vaccination drives at social-religious congregations:

~1 m children vaccinated in 2011

Historic reservoir areas: ~ 1 m migrant children vaccinated during SNID

Other states with large migratory population: ~2.5 m children vaccinated during SNID

Percent children < 5 yrs found unimmunized during end of the round survey

Punjab

Per

cent

Per

cent

N= 6,163 8,421 N= 8045,943

Gujarat

5,454 6,306 5345,988

Delhi

Per

cent

Per

cent

N= N= 6,0284,432

Gr. Mumbai

3,2146,189 8,490 9,366 5,297 5,32011,430 8,030 8,590 6,309 6,698

6,084 6,605 5,494 804 284 247

8,466

5,352

6,646

1,025

7,960

6,985 5,808

5,824

400 278 6757,570 6,105 3,054 3,725

959 1,367 2,608 1,201 2,269 2,377 2,712 2,785

SIA quality - Summary

• Historic reservoir areas of UP and Bihar sustaining high SIA coverage

• Areas with recent transmission

– West Bengal quality variable; pockets with gaps in quality remain

– Malegaon: reluctance to accept OPV continues; Need to study role of social networks in vaccine avoidance behaviour

• Quality of coverage of migrants improving, consistency of quality over rounds an issue

Status of Emergency Preparedness and Response Plans in India

Emergency Preparedness & Response Plans (EPRP)

• National Plan prepared

• Formation of State plans in process

• Key components of State plans

– Constitution of Emergency Preparedness and Response Groups

– Identification and training of Rapid Response Team members (RRTs)

– Identification of high risk districts, blocks and sub block areas/populations

– Plans to strengthen Routine Immunization & SIA quality

– Communication risk assessment and social mapping

– Preparedness of the state for undertaking urgent mop ups within 7-10 days of WPV isolation

EPRP : State Preparedness

• Emergency Preparedness & Response groups (EPRG) constituted

State EPRG constituted

31 blocks

Haryana Punjab

24 blocks

HR blocks being identified for intensification of SIAs & RI

• ~ 170 RRT members identified and trained

Identification of sub block High Risk Areas, India

~ 162,000 Migrant sites

Migrant sites High risk areas in settled population

~ 64,000 HR areas in settled population

= 10 Migrant sites = 10 HR sites

EPRP components that need strengthening in State plans

• Plans for overcoming staff vacancies in HR areas

• Systematic inclusion of high risk areas for RI strengthening

• Timeline for harmonization of SIA and RI microplans in high risk areas

• Assignment of HR districts to RRT members for regular review of RI and preparedness

• Assessment of communication risks and social mapping

• Identification of media spokesperson

• Plans for procurement of logistics and IEC materials for undertaking urgent mop ups

Proposed SIA plans for 2012 – 2014

Proposed SIA calendar, 2012

conducted planned

NID with tOPV SNID with bOPV

Proposed SIA scheduleNID with tOPV SNID with bOPV2013

2014

Questions for consideration of IEAG

• Is the proposed number and scope of SIAs from 2012 – 14 sufficient to maintain high population immunity?

• Which vaccine types and in what quantities should be maintained as buffer stocks?

Thank You