1 / 40

Supplementary Immunization Activities Quality, Risks and Risk Management

Supplementary Immunization Activities Quality, Risks and Risk Management. IEAG Meeting 13 July 2011. Supplementary Immunization Activities (SIAs) India, Jan to June 2011. Endemic & risk states. Endemic & risk states. Zone 1 UP/Bihar, Delhi & HR areas. Jan. Feb. Mar. Apr. May. Jun.

qiana
Download Presentation

Supplementary Immunization Activities Quality, Risks and Risk Management

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Supplementary Immunization ActivitiesQuality, Risks and Risk Management IEAG Meeting 13 July 2011

  2. Supplementary Immunization Activities (SIAs) India, Jan to June 2011 Endemic & risk states Endemic & risk states Zone 1 UP/Bihar, Delhi & HR areas Jan Feb Mar Apr May Jun NID SNID mop up in West Bengal / Jharkhand

  3. SIAs – India, January to February 2011 23 Jan 27 Feb 2nd week Feb mOPV1 mOPV3 bOPV tOPV

  4. bOPV tOPV SIAs – India, March to June 2011 March April May June

  5. Emergency Outbreak Response Howrah, West Bengal, 2011

  6. Key Immediate Actions that followed detection of case Mop up conducted Vaccine & other logistics reach blocks • National level partners meeting • Media plan operationalized • Vaccine arrived in district • State & District Task Force Meetings • 14 additional SMOs arrive in districts • IEC plan developed • Marker pens & other logistics procured • Field Investigation (NCDC/NPSP/UNICEF) • National Technical Group Meeting • Decision on mop up Chief Minister & Chief Secretary WB informed by GoI Wild Polio virus notified Day 0 Day5 Day 1 Day 2 Day 3 Day 4 Day 6 7 Feb 2011 13 Feb 2011

  7. Major Issues Identified • Microplanning • Missed Areas • High work load of vaccinators & supervisors • Composition of vaccination teams not appropriate • No revisits planned to ‘X’ houses • Training • Weak interpersonal communication skills of vaccinators • Untrained vaccinators working as team members • Non-acceptance of vaccine • High refusals (~ 47000 refusals in Howrah and 3 neighbouring districts) • Myths against vaccine safety

  8. Outbreak Response Actions(GoI/ GoWB, WHO-NPSP, UNICEF, Rotary, CORE) • Identification of 36 high risk blocks/municipalities & 222 high risk Gram Panchayats/wards to focus activities • Enhanced oversight & coordination by central and state officials, DMs, CMOs, Municipality/ Ward Officers, BDOs, BMOs

  9. Outbreak Response Actions (2)(GoI/ GoWB, WHO-NPSP, UNICEF, Rotary, CORE) • 25 experienced additional SMOs deployed to the outbreak area for 4 months to support • Improvements in microplans: ensure no missed areas, appropriate team composition and workload • Trainings: to improve skills & performance of vaccinators and supervisors • Intensive monitoring of preparedness & implementation in high risk areas

  10. Outbreak Response Actions (3)(GoI/ GoWB, WHO-NPSP, UNICEF, Rotary, CORE) • Scale up of IEC/ mobilization efforts • 1900 NGO mobilizers deployed • Additional IEC materials produced • Enhanced media support • Sensitization of Influencers/ religious leaders and local practitioners • Advocacy/ vaccination during community events • Health Camps • Vaccination at clinics of important practitioners • Mandatory revisits to ‘X’ marked houses accompanied by doctors/ local influencers

  11. Outbreak response, West Bengal WPV1 notified 07 Feb 2011 7 weeks 1 week 5 weeks 17 weeks WPV1 notified 12 Feb 2010 Howrah, 2011 7 6 WPV1 5 WPV3 Number of WPV 4 3 2 1 1 2 3 4 5 6 7 Murshidabad, 2010 bOPV mOPV1

  12. Summary – SIAs in 2011 • At least one SIA with tOPV conducted in all areas in the country – most areas got 2 tOPV rounds • 3 to 5 campaigns conducted with bOPV in high risk areas • Aggressive Emergency Outbreak Response conducted in West Bengal following detection of WPV type 1 in Howrah district in 2011

  13. SIA quality in high risk areas/populations

  14. Areas/ Populations at highest risk of polio Areas with recent polio transmission

  15. Areas/ Populations at highest risk of polio Areas with recent polio transmission Endemic areas

  16. Endemic areas Areas/ Populations at highest risk of polio Areas with recent polio transmission Areas with high migrant populations

  17. Areas with recent transmission West Bengal JharkhandMalegaon (Maharashtra)

  18. Northern districts, West Bengal Percent unvaccinated children End-of-round survey Percent N= 1,371 4,490 2,996 4,020 3,515 6,556 7,574 7,686 7,065 10,320 Southern districts, West Bengal Percent 7,525 6,665 8,193 11,933 11,027 11,787 N=

  19. Quality of SIAs in southern districts - West Bengal Percent unvaccinated children, End-of-round survey, 2011 Howrah Kolkata Percent Percent N= 1,451 2,220 2,674 3,995 3,629 3,393 1,423 N= 2,158 762 1,034 1,487 2,092 24-Parganas North 24-Parganas South Percent Percent N= 1,153 866 2,067 2,535 2,858 2,846 2,018 N= 2,405 2,347 1,998 2,341 2,847

  20. Pakur & Sahibganj Percent 2,945 3,213 5,904 9,779 8,398 6,088 4,163 5,568 5,509 6,197 6,151 N= High coverage achieved in high risk areas of Jharkhand Percent unvaccinated children, End-of-round survey Jharkhand West Bengal

  21. Jharkhand West Bengal Lot Quality Assurance Sampling (LQAS) West Bengal & Jharkhand – Feb to June 2011 Hypothesis:“The SIA coverage in this LOT is > 90%.” Only 1 of 46 lots rejected in North Bengal/Jharkhand during last 5 SIAs LQAS findings validate monitoring findings from end-of-round surveys

  22. Malegaon Municipal Corporation Percent unvaccinated children, End-of-round survey Percent 1,989 4,424 4,193 3,151 3,844 3,946 3,115 3,155 3,798 N= # houses with reluctance to accept OPV, End-of-round Number

  23. Summary – Areas with recent transmission • West Bengal (Northern districts): Improvement in SIA quality since September 2010 - sustained over last 9 months – a few pockets of low coverage persist • West Bengal (Southern districts): Rapid improvement in SIA quality during past 4 months, however quality variable in districts; pockets with gaps in quality remain – require immediate addressal • Jharkhand: Sustained good quality campaigns over last 9 months • Malegaon (Maharashtra): Large proportion of unvaccinated children during multiple rounds – recent worsening of quality

  24. Endemic Areas Western UPCentral Bihar

  25. Continued intensive focus on vaccination in field huts - Kosi area, Bihar • > 280,000 clusters of field huts (basas) visited by vaccination teams each round • Intensive supervision and monitoring Percent unvaccinated children detected in field huts (basas) ~ 3,000 children checked per round

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

  27. Lot Quality Assurance Sampling (LQAS), 66 highest risk blocks, West UP, June 2011 – A Pilot Hypothesis:“The SIA coverage in this LOT is > 95%.” HR blocks in which LQAS done

  28. Zinc distribution to children with diarrhea 107 highest risk blocks of UP and Bihar Percent households having a child with diarrhea that had received Zinc tablets, June 2011 1% 22% Households checked =2,115 Household checked =1,444 Source: NPSP SIA monitoring data

  29. Summary – Endemic Areas • Intensive series of SIAs conducted with bOPV in endemic areas in first half of 2011 • High coverage during polio SIAs being sustained in the high risk areas of UP and Bihar • Implementation of certain components of 107 high risk block plan remain a challenge

  30. Areas with high migrants / mobile populations Migrant populations vaccinated 5-6 times (Jan to June 2011) # children: 0.8 mn in each round # children: 0.7 mn in each round # children: 0.5 mn in each round # children: 1.1 mn in each round Delhi, Mumbai, Punjab, Haryana, Gujarat, Uttarakhand, West Bengal

  31. Percent unvaccinated children, End-of-round survey Delhi Gr. Mumbai Percent Percent 2,608 1,201 2,681 2,802 4,432 6,189 8,490 9,366 9,715 11,430 2,218 2,640 2,631 2,611 3,214 6,028 5,297 5,320 5,503 N= N= Punjab Gujarat Percent Percent 3,054 3,725 6,163 8,421 5,943 5,988 6,084 537 650 5,454 6,306 534 804 804 N= N=

  32. Continuous vaccination along Indo-Nepal border NEPAL Uttar Pradesh INDIA Bihar Vaccination post Blocks with vaccination post 81 vaccination posts ~314,000 children vaccinated (April to June 2011)

  33. Coverage during major religious congregations/ population movement • Ajmer Urs (Rajasthan) • 22 May to 14 June 2011 ~ 300,000 children vaccinated 2. Piran Kaliyar (Uttarkhand):Feb 2011:~60,000 children vaccinated 3. Holi - returnee migrants (West Bengal, UP, Bihar): March 2011: ~245,000 children vaccinated 4. Planned activity: Shrawani Mela (Bihar & Jharkhand): July – August 2011: ~300,000 children expected to be vaccinated

  34. = 10 migrant sites Migrants sites identification, India – June 2011 Number of sites identified by type Number of sites with migrants identified : 150,000 Number of children < 5 yrs in these sites : ~ 4.2 million

  35. Summary – Coverage of migrants • Intensive SIAs to vaccinate migrants in high risk states during first half of 2011 • Quality of coverage of migrants variable in different states • Additional opportunities to vaccinate migrants at congregations, borders being utilized • National data base of migrant families being prepared

  36. Conclusions • Number and scope of SIAs during first half of 2011 conducted as recommended by last IEAG • Aggressive outbreak response conducted in West Bengal in early 2011 • Endemic areas sustaining high SIA coverage • Strategy to cover migrants in high risk states and other areas being optimized • Overall SIA quality in areas with recent transmission improved in 2011, however certain pockets remain a matter of concern

  37. Questions for consideration of IEAG • What is the optimum number, timing and scope of SIAs between July and December 2011? • What should be the scope and number of SIAs during early 2012? • What types of polio vaccines should be used in the SIAs?

  38. Proposed SIAs – India, July to December 2011 (As recommended by Nov 2010 IEAG) SNID SNID Jul Aug Sep Oct Nov Dec Sep Nov bOPV

  39. Monthly incidence of WPV1 cases, 2005-2011 25 Planned SNID Most recent SNID conducted 20 Planned SNID 15 10 5 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

  40. Thank You

More Related