IEAG Meeting 15 March 2011

1. Supplementary Immunization ActivitiesQuality, Coverage of high risk populations/ areas, proposed plans for 2012 - 14 IEAG Meeting 15 March 2011

2. 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

3. Areas/ Populations at highest risk of polio Historic reservoir areas

4. Areas/ Populations at highest risk of polio Historic reservoir areas Areas with recent polio transmission

5. Areas/ Populations at highest risk of polio Historic reservoir areas Areas with recent polio transmission Areas with high migrant populations

6. Polio SIAs , July to December 2011 SNID SNID SNID Aug Sep Nov bOPV

7. bOPV tOPV Polio SIAs , January to April 2012 NID NID SNID SNID Mar Apr Jan Feb Mar Apr Jan Feb

8. SIA quality in high risk areas/populations

9. High polio vaccination coverage sustained in 107 highest risk blocks of UP and Bihar Percent unvaccinated children – end of round survey 66 HR blocks West UP ~40,000 children checked for vaccination status each round in 107 high risk blocks 2009 2010 2011 2012 Bihar 41 HR blocks 2009 2010 2011 2012

10. Lot Quality Assurance Sampling (LQAS), Findings: HR blocks, UP Reasons for unvaccinated children Team failure Refused immunization Non-resident child visiting house after team’s visit Child was not at home at time of team's visit N=54 Hypothesis: “The SIA coverage in this LOT is > 95%.”

11. Coverage in field huts of Kosi area, Bihar • > 300,000 clusters of field huts (basas) visited by vaccination teams each round • Intensive supervision and monitoring Percent unimmunized children in field huts in Kosi riverine area ~ 3,000 children checked each round Source of data : NPSP monitoring

12. Percent missed children < 5 yrs (average from Nov11, Jan12 & Feb12 SIAs), HR districts West Bengal Jharkhand Percent unvaccinated children: End-of-round survey West Bengal Percent N= 7,805 8,989 9,271 10,430 20,683 21,524 24,178 22,392 23,535 21,046 33,149 Jharkhand (Pakur & Sahibganj) Percent N= 2,945 3,213 9,779 8,398 4,163 5,509 6,151 5,242 5,202 3,422 4,981

13. Maharashtra Malegaon Municipal Corporation – Resistance still an issue # houses with reluctance to accept OPV, End-of-round Number

14. Mapping and reaching migrants, India, 2011 = 10 migrant sites Number of sites identified by type Number of sites with migrants identified : ~162,000 Number of children < 5 yrs in these sites : ~ 4.2 million

15. Coverage of migratory communities in states with large migratory population Historic reservoir areas: ~ 1 m migrant children vaccinated during SNID Other states with large migratory population: ~2.5 m children vaccinated during SNID Special vaccination drives at social-religious congregations: ~1 m children vaccinated in 2011

16. Percent children < 5 yrs found unimmunized during end of the round survey Delhi Gr. Mumbai Percent Percent N= 959 1,367 2,608 1,201 4,432 6,189 8,490 9,366 11,430 8,030 8,590 8,466 7,960 5,824 N= 2,269 2,377 2,712 2,785 3,214 6,028 5,297 5,320 6,309 6,698 6,646 Punjab Gujarat Percent Percent N= 7,570 6,105 3,054 3,725 6,163 8,421 5,943 5,988 6,084 6,605 5,494 5,352 6,985 N= 400 278 675 5,454 6,306 534 804 804 284 247 1,025 5,808

17. 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

18. Status of Emergency Preparedness and Response Plans in India

19. 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

20. EPRP : State Preparedness HR blocks being identified for intensification of SIAs & RI Punjab Haryana State EPRG constituted 31 blocks 24 blocks • Emergency Preparedness & Response groups (EPRG) constituted • ~ 170 RRT members identified and trained

21. Identification of sub block High Risk Areas, India = 10 Migrant sites = 10 HR sites High risk areas in settled population Migrant sites ~ 162,000 Migrant sites ~ 64,000 HR areas in settled population

22. 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

23. Proposed SIA plans for 2012 – 2014

24. planned Proposed SIA calendar, 2012 conducted NID with tOPV SNID with bOPV

25. 2014 Proposed SIA schedule 2013 NID with tOPV SNID with bOPV

26. 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?

27. Thank You