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Role of Schools - in Implementation of Measles catch-up campaigns

Role of Schools - in Implementation of Measles catch-up campaigns. Meeting of Principals of Pvt. Schools. Introduction. Measles is a leading cause of childhood mortality Infants and young children, especially those who are malnourished, are at highest risk of dying.

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Role of Schools - in Implementation of Measles catch-up campaigns

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  1. Role of Schools - in Implementation of Measles catch-up campaigns Meeting of Principals of Pvt. Schools

  2. 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. Disproportionate burden of measles mortality in India 67% India: 60,000-100,000 estimated Measles Deaths (2008) = 1000 death Dots are randomly distributed in countries Data source: WHO/IVB, November 2009

  4. Measles disease Measles case, Badaun district, Islamnagar block, Jan 2010 • An acute viral infection • Airborne transmission via respiratory secretions or aerosols • Classic manifestations: • Maculopapular rash • Fever • The “3Cs”: Cough, Coryza (runny nose), Conjunctivitis (red eyes) • Complications and mortality highest in children < 2 yrs and in adults

  5. Measles complications Corneal scarring causing blindness Vitamin A deficiency Older children, adults ≈ 0.1% of cases Chronic disability Pneumonia & diarrhea Encephalitis Diarrhea common in developing countries Pneumonia ~ 5-10% of cases, usually bacterial

  6. Global Context: Worldwide measles vaccination delivery strategies, mid-2010 Govt of India decision in 2010 to introduce MCV2 MCV1 & MCV2, no SIAs (40 member states or 21%) MCV1, MCV2 & one-time catch-up (36 member states or 19%) MCV1, MCV2 & regular SIAs (57 member states or 28%) MCV1 & regular SIAs (59 member states or 31%) Single dose (1 member state or 1%)

  7. Principles of control & rationale for second dose • Live attenuated vaccine gives long term immunity • Confers immunity to 85% children when given at 9-12 months of age • Confers 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.

  8. ….Benefit after measles vaccination • Bullet points • Bullet Points

  9. Measles SIA phasing plan, India As of date 24th July, 2012

  10. 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

  11. 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

  12. Why Schools are Important School Campaign in 1st week: “Make or Break” for rest of the campaign Since 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

  13. 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.)

  14. Planning • Enlist all schools in the PHC area, using Form-3 • Number 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.

  15. 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.

  16. 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)

  17. Role of Schools • Injection Safety & Waste management plan • Teams should not leave any waste at the school site. • AEFI Management • Assist the vaccination team in case of emergency • Provide transportation if required • Allay concerns of students and parents Team of Expert doctors for AEFI -120 with AEFI Kit Not a single case of serious AEFI from – 655921 injection in Patna District

  18. Impact

  19. Assessing the impact of campaigns

  20. Bihar: Signs of campaign impact MCUP phase 1 Dec 2010-Jan 2011 MCUP phase 2 Nov 2011-Feb 2012 • 2012 Surveillance results: • Lab confirmed measles outbreaks = 19 • Total cases = 1089; Deaths = 8 • 48% unvaccinated • 82% < 10 years of age N=(1089) 41% 36% 11% 7% 6% 19 Lab confirmed measles outbreaks 1 Lab confirmed rubella outbreaks 9 Lab confirmed outbreaks negative for both measles & rubella As on wk - 35

  21. Bihar: Signs of campaign impact MCUP phase 1 Dec 2010-Jan 2011 MCUP phase 2 Nov 2011-Feb 2012 • 2011 Surveillance results: • Lab confirmed measles outbreaks = 21 • Total cases = 2527; Deaths = 16 • 72% unvaccinated • 85% < 10 years of age N=(2527) 42% 37% 11% 6% 8% 21 Lab confirmed measles outbreaks 2 Lab confirmed rubella outbreaks 6 Lab confirmed outbreaks negative for both measles & rubella As on wk - 35

  22. Block Wise Achievement Report of Measles Campaign of Patna Rural (03.12.2012 - 16.12.2012)

  23. Block Wise Achievement Report of Measles Campaign of Patna Urban (03.12.2012 - 16.12.2012)

  24. Example of a well organized school campaign

  25. Queue with vaccination card

  26. Vaccination & Position of child by teachers/staff

  27. Make the measles campaign a big event in the district.

  28. Proper queuing for efficient time management

  29. Table 1: Well planned site. Note Immunization Cards on table

  30. Table 2 for Vaccination: Noting the time of reconstitution on the vial

  31. Table 2: Correct Procedure AD syringe / No touching of the needle or hub / 450 angle for subcutaneous injection

  32. Table 3: Waste Disposal

  33. Table 3: Hub Cutterin use

  34. Table 4: Filling up the Tally sheet

  35. Inj. Adrenaline Table 5: AEFI Kit

  36. Waiting at least 30 minutes after the injection.

  37. Everybody has an Immunization Card

  38. MCUP- Urban Schools Details

  39. 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 – addsmopatna@npsuindia.org

  40. Thanks

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