Download - Measles Control and AEFI
Strategies for Measles Control Progress and future plans
Principles of accelerated measles control strategies in India
1. Improve and sustain routine immunization coverage
2. Provide a second opportunity for measles immunization to all eligible children
3. Sensitive, laboratory supported measles outbreak surveillance for case/outbreak confirmation
4. Fully investigate all detected measles outbreaks and ensure appropriate case management
Disproportionate burden of measles mortality in India
Data source: WHO/IVB, November 2009
164,000 estimated Measles Deaths in 2008
67%
= 1000 death
Dots are randomly distributed in countries
Global Context: Worldwide measles vaccination delivery strategies, mid-
2010
MCV1 & MCV2, no SIAs (40 member states or 21%)
MCV1 & regular SIAs (59 member states or 31%)
MCV1, MCV2 & one-time catch-up (36 member states or 19%)
MCV1, MCV2 & regular SIAs (57 member states or 28%)
Single dose (1 member state or 1%)
Govt of India decision in 2010 to introduce MCV2
Enhanced AEFI surveillance during the Measles catch-up campaigns
304 minor AEFIs and 40 serious AEFIs reported
All serious AEFIs reported and correctly managed
NO DEATHS – VACCINE OR PROGRAMME RELATED
Lessons learned and areas for improvement
• Coordination and planning– Better coordination of the three primary department of Health,
Education and ICDS– Clear timelines of availability of logistics
• Communication and advocacy– IEC and interpersonal communication– IAP, IMA– Private schools
• Vaccination in urban areas• Injection waste management• Supervision needs to be improved at all levels
Presentation outline
• Global context• Introduction of MCV2
– Routine services– Catch-up campaigns
• Scale-up of laboratory measles surveillance• Summary and way forward
Scale-up of laboratory enhanced measles outbreak surveillance
2006
2007
2010
2009
2011
Serologically confirmed# measles, rubella and mixed outbreaks, India (Andhra Pradesh, Gujarat, Karnataka, Kerala, Madhya Pradesh, Rajasthan, Tamil Nadu and West Bengal)
216 outbreaksMeasles outbreaks confirmed
Rubella outbreaks confirmed
Mixed outbreaks confirmed
685641
196 16 4
2009 2010*
165 outbreaks
#Outbreak confirmation for Measles: 2009 ≥ 1 cases IgM positive for measles, Similarly for Rubella Outbreak confirmation for Measles: 2010 ≥ 2 cases IgM positive for measles, Similarly for Rubella
* data as on 15th Apr, 2011
0
500
1,000
1,500
2,000
2,500
3,000
3,500
< 1 year 1-4 years 5-9 years 10-14 years >= 15 years
Total cases: 8,956
Vaccinated Not Vaccinated Unknown Cases from serologically confirmed measles and mixed outbreaks* data as on 15th Apr, 2011
Vaccination status and age distribution of serologically confirmed measles cases 2010*, India
63 % no or unknown vax status
85 % < 10 yrs of age
Way forward• State review meetings and a national review
meeting to inform operational strategies• Starting coverage evaluation surveys in selected
states
• Expand laboratory supported measles surveillance to document the impact of the campaigns
• Initiate planning and preparation to cover remaining districts of phase 1 states and pilot districts of UP in phase II.
• Cover remaining districts of UP in the third phase, 2012
Thank you