Update on implementation of measles 2 nd dose in India

1. Update on implementation of measles 2nd dose in India Global Measles and Rubella Management meeting 21 March 2012

2. Presentation outline • National measles control objective • MCV2 introduction: • Plans • Progress • Lessons learned • Measles surveillance • Summary

3. National objective and MCV2 introduction strategy National objective: To reduce measles mortality by 90% by 2013 compared to 2000 estimates • NTAGI recommendations: • Measles catch-up campaign: 14 states with < 80% MCV1 • Measles 2nd dose in RI: 21 states/union territories with > 80% MCV1

4. MCV2 introduction through RI • MCV2 introduced in UIP before NTAGI recommendation in 4 states – Delhi, Goa, Pondicherry and Sikkim • 17 additional states introduced MCV2 in UIP as per table • In SIA districts, MCV2 through UIP is being introduced 6 months following campaigns

5. MCV2 introduction through catch-up campaigns • Target population: • ~ 130 million children 9 months – 10 years of age • 361 districts in 14 states 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

6. Campaign results:Reported coverage vs. RCA monitoring 68 of 137 districts achieved >= 90% administrative coverage (50%) Data as of 14 March 2012: Number of areas visited for RCA monitoring = 33,212 Number of children verified = 638,660 Activity ongoing in AP, Assam, Gujarat, Rajasthan & Tripura RCA areas checked < 100 in AP, Manipur and Tripura

7. Campaign session monitoring N = number of campaign vaccination sessions monitored

8. Campaign awareness & source of information (in %) • Vast majority of those monitored were aware of the campaign • Session sites with visible IEC material – 82.6% • Sites where social mobilization was being done by house visits – 88.3% N= 638,660 children monitored

9. RCA monitoring:Reasons for non vaccination < 41% < 5% < 5% N = 80,437 unvaccinated children; analysis is first response provided

10. Presentation outline • National measles control objective • MCV2 introduction • Plans • Progress • Lessons learned • Measles surveillance • Summary and way forward

11. Expansion of laboratory supported measles surveillance Surveillance initiated 2006 2007 2009 2010 2011 • 11 states in the network each with state reference lab • Haryana and Chhattisgarh to be added in 2012 • Uttar Pradesh – late 2012, early 2013

12. Serologically confirmed measles, rubella and mixed outbreaks, 2011 • 209 outbreaks confirmed (180 measles, 16 rubella and 13 mixed) • 9,352 serologically and epi-confirmed measles cases (measles and mixed outbreaks • 84% cases < 10 years of age; 35% vaccinated

13. Assessing the impact of campaigns

14. Bihar: Signs of campaign impact MCUP phase 1 Dec 2010-Jan 2011 MCUP phase 2 Nov 2011-Feb 2012 Serologically confirmed outbreaks, Bihar • Surveillance results: • Lab confirmed outbreaks = 10 • Total cases = 947; Deaths = 3 • 80% unvaccinated • 91% < 10 years of age ● Lab confirmed outbreak Data as on 15/02/2012 Measles surveillance initiated in June 2011

15. Strengths and best practices • Strong central government ownership: • All logistic and operational costs borne by GoI • Regular feedback provided to Union MoHFW officials for action • AEFI management systems established: • AEFI response prompt and effective • Clear implications for routine immunization • Injection safety standards maintained • Logistics and cold chain: • Logistic issues solved very promptly from GoI and at state level • Cold chain equipment and management systems robust

16. Areas for improvement • Stewardship and coordination: • Variable state and district level engagement • Coordination: • Insufficient coordination between Health, Education and Women and Child development • Vaccination in schools, particularly in urban areas remains a challenge • Planning: • Lack of clarity regarding timeline of vaccine provision and state level vacillation on fixing campaign dates • Full scale engagement of Program Officers lacking in some districts • Coordination with schools especially in urban areas remains a challenge • Sharps waste disposal inadequate • Supervisory personnel require better training to be better provide supportive feedback

17. % Hub-Cutter Found Available, Uttar Pradesh January’11 – December’11 N= Source: RI monitoring data N = No. of session found held

18. Polio-free India Strengthening UIP is essential to maintain high levels of population immunity and maintain polio free status!!!

19. 2012-2013: Year of intensification of UIP

20. Summary • Lessons from Phases 1 and 2 must be consolidated to improve Phase 3 and strengthen routine immunization • Measles lab-supported surveillance to be improved and expanded • Introduction of rubella containing vaccine and CRS surveillance is on the agenda

21. Acknowledgments • Union and State governments • UNICEF • Measles Initiative • WHO HQ, SEARO

22. Thank you

23. RCA monitoring:% children not vaccinated

24. Current classification used