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Measles / MMR Vaccine Developments last 6 months

Measles / MMR Vaccine Developments last 6 months. Dr.Sanjay Srirampur sanjaysrirampur@yahoo.com. Agenda. Measles Surveillance Measles/MMR Vaccine Second Dose of vaccine Vaccine Delivery - Status Update. NTAGI recommendations 2009: Surveillance and CFR estimates. Surveillance:

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Measles / MMR Vaccine Developments last 6 months

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  1. Measles / MMR Vaccine Developments last 6 months Dr.Sanjay Srirampur sanjaysrirampur@yahoo.com IAPCOI Measles/MMR - Dec 2011

  2. Agenda Measles Surveillance Measles/MMR Vaccine Second Dose of vaccine Vaccine Delivery - Status Update IAPCOI Measles/MMR - Dec 2011

  3. IAPCOI Measles/MMR - Dec 2011

  4. NTAGI recommendations 2009: Surveillance and CFR estimates • Surveillance: • Serve the data needs of the immunization programs • IDSP-lead role with technical support from WHO-NPSP and other partners • Geographic expansion in consultation with the states: • Preceding the phased implementation of measles SIAs • 2009-2010: Rajasthan, Madhya Pradesh and Orissa • 2010-2011: Bihar, Chhattisgarh, Jharkhand, Uttar Pradesh (UP) and Assam • Estimates of case fatality ratio (CFR): • Through outbreak surveillance system in one high burden state • Technical support from partners IAPCOI Measles/MMR - Dec 2011 Source: National Technical Advisory Group on Immunization (NTAGI); 3 August 2009

  5. Measles Surveillance India: Current Status and Future Plans Surveillance Initiated 2006 2007 2009 Surveillance Planned 2009-10 2010-11 2011 IAPCOI Measles/MMR - Dec 2011

  6. IAPCOI Measles/MMR - Dec 2011

  7. Serologically confirmed measles, rubella and mixed outbreaks 2008 2009 - 2010* 58 52 38 111 36 39 186 outbreaks 148 outbreaks IAPCOI Measles/MMR - Dec 2011 * data as on 15th Jan, 2010

  8. Measles / MMR Vaccine Update IAPCOI Measles/MMR - Dec 2011

  9. IAPCOI Measles/MMR - Dec 2011

  10. IAPCOI Measles/MMR - Dec 2011

  11. IAPCOI Measles/MMR - Dec 2011

  12. Second Dose of Measles Vaccine Rationale IAPCOI Measles/MMR - Dec 2011

  13. Immune response to second dose of MMR vaccine in Indian childrenSunil Gomber1, Shilpa Khanna Arora1, Shukla Das2, VG Ramachandran21 Department of Pediatrics, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India2 Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India Year : 2011  |  Volume : 134  |  Issue : 3  |  Page : 302-306 IAPCOI Measles/MMR - Dec 2011

  14. Response to second dose of Measles Vaccine • Gomber et al after 2 year vaccination 20% had detectable antibody • Multicentric study 100% antibody conversion on 2nd dose • Single dose Mumbai – 93%, Pune – 82%, Indore – 50% • Effect of 3rd dose ??? – 65% ? IAP Gomber S, Arora SK, Das S, Ramachandran VG. Immune response to second dose of MMR vaccine in Indian children. Indian J Med Res. 2011;134:302–6 Bhargava I, Chapparwal BC, Phadke MA, Irani SF, Chapparwal D, Dhorje S, et al. Imunogenicity and reactogenicity of indigenously produced MMR vaccine. Indian Pediatr. 1995;32:983–8 IAPCOI Measles/MMR - Dec 2011

  15. Vaccine Delivery Status Update IAPCOI Measles/MMR - Dec 2011

  16. Measles Coverage (DLHS-3) IAPCOI Measles/MMR - Dec 2011

  17. Background • MYP for Universal Immunization Program (UIP) in India • Goal 2005-10: 67% reduction of measles related mortality by 2010 • Goal 2010-17: 90% reduction in measles related mortality by 2013 • Widely disparate MCV1 performance through RI in 35 states and UTs • 99% in Goa vs. 47% in Uttar Pradesh* • Variable improvement in MCV1 coverage through RI • Bihar: MCV1, 46% (2006) to 54% (2008) • Uttar Pradesh has remained static at 47% Proposed and under consideration IAPCOI Measles/MMR - Dec 2011 Source: DLHS 3 (2007-08)

  18. India national immunization programmeintroduced second dose of measles in 2010 Global Context: Worldwide measles vaccination delivery strategies, mid-2010 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%) IAPCOI Measles/MMR - Dec 2011 Data source: WHO/IVB measles database as of 26 January 2010

  19. NTAGI recommendations, 2009:MCV2 delivery strategies • MCV2 delivery strategies for states with low MCV1 coverage (< 80%) • SIA targeting children 9 month to 10 years • 2009-10: Rajasthan and Madhya Pradesh • 2010-11: Bihar, Chhattisgarh, Jharkhand, UP and Assam • MCV2 delivery strategies for states with high MCV1 coverage (>= 80%) • 18 states and union territories identified • MCV2 offered through UIP at 16-24 months of age IAPCOI Measles/MMR - Dec 2011 Source: National Technical Advisory Group on Immunization (NTAGI); 3 August 2009

  20. NTAGI 2009: introduce MCV2 MCV2 in UIP MCV2 through Measles SIA Delivery mechanism: UIP Delivery mechanism: SIAs 2009-2010 >= 80% MCV1 CES 2006 2010-2011 IAPCOI Measles/MMR - Dec 2011 2011

  21. SIA: MCV1 <80%: 14 states RI: MCV1 > 80%: 21 states MCV2 introduction: State-specific delivery strategies • SIA in 14 states: • Target population (9 mo-10 years): 134 million • Vaccine doses and AD syringes: 147 million • Mixing syringe : 29.5 million • MCV2 in routine immunization in 21 states: • Annual targets • 1-2 year population: ~10 million • Vaccine doses: ~12 million IAPCOI Measles/MMR - Dec 2011

  22. MCV2 introduction through catch-up vaccination campaign (MCUP) Phase 1 • In three phases • Target: 134 million in 351 districts • Phase 1: • 45 districts from 13 states with ~13 million target children • 9 district from Chhattisgarh • 5 districts from each of the 6 states (Bihar, Jharkhand, Rajasthan, Madhya Pradesh, Gujarat & Haryana) • 1 district from each of the North-East states • Phase 2 to take place from September 2011 • Phase 3 in 2012 IAPCOI Measles/MMR - Dec 2011

  23. Administrative coverage achieved in MCUP1@ 10.2 million children vaccinated so far (92% coverage) in 39 districts across 11 states State (No. of Districts covered in phase 1) IAPCOI Measles/MMR - Dec 2011 * Provisional data @ From 39 districts where campaign completed

  24. Thank You IAPCOI Measles/MMR - Dec 2011

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