rationale for mr vaccine introduction · parents about ptm /interaction ( sms, whatsapp, e mails,...
TRANSCRIPT
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RATIONALE FOR MR VACCINE
INTRODUCTION
Training Workshop for Measles-Rubella Vaccination Campaigns 1
Presented by:-
Dr Ranjana Kakkar
District Immunization Officer
West District
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Rationale for MR Vaccination Campaign
• Widespread Measles & Rubella outbreaks in
country
• Inadequate population immunity to interrupt
transmission of Measles and Rubella
• Pockets of low Measles vaccination coverage
• Select states, urban municipalities and Indian Army
already providing Rubella vaccine
• IAP Immunization schedule includes Rubella
containing vaccine
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What are measles/rubella
diseases?
Measles is a highly infectious disease causing
illness and death due to complications in the
form of diarrhea, pneumonia .
Rubella is a mild yet highly contagious disease
that can cause crippling birth defects or the
death of the unborn child of an infected
pregnant woman.
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Measles disease
• An acute viral infection spread via
respiratory secretions or aerosols
• Classic manifestations:
– Maculopapular rash
– Fever +cough + coryza/conjuctivities
• Complications and mortality highest in
children < 2 yrs. and in adults
• Case Fatality Ratio (CFR):
– Ranges from (0.1 – 10) %
– Up to 30% in humanitarian
emergencies (A Measles case from Nagaland, District Mon
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What is congenital rubella syndrome
(CRS)?
• CRS is a set of serious congenital defects a
child may be born with when a pregnant
women gets rubella infection in her early
pregnancy (usually in the first trimester),
causing blindness, deafness, heart defects,
mental retardation, liver disorders etc.
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Measles mortality: due to complications
Corneal scarring
causing blindness
Vitamin A deficiency
Encephalitis
Older children, adults
≈ 0.1% of cases
Chronic disability
Pneumonia &
diarrhea
Diarrhea common in developing countries
Pneumonia ~ 5-10% of cases, usually bacterial
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• Measles is one of the leading cause of death among young children despite
availability of safe and cost-effective vaccine
• 2016 : 90,000 measles deaths globally – Nearly 247 deaths every day or 10
deaths every hour
• Measles vaccination has resulted in 84% drop in global measles deaths between
2000 and 2016 (preventing 2.04 crore deaths).
- This makes measles vaccine as one of the best buys in public health
• In 2000 Measles 1st dose coverage through routine immunization was 73% ,
which has increased to 85% in 2016
Facts on Measles
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NTAGI Recommendations-2014
• India along with other WHO SEAR countries in Sept 2013 resolved
to eliminate Measles and Control Rubella / CRS by 2020.
• WHO South East Asia Regional Strategic Plan 2014-20: Elimination of
Measles and control Rubella / Congenital Rubella Syndrome(CRS) by
2020.
• Accordingly, National Technical Advisory Group on Immunization (NTAGI)
recommended wide age range phased MR vaccination campaigns in all
states targeting children 9 months to < 15 years.
• All states introduce MR vaccine in it’s UIP schedule immediately after the
MR campaigns substituting both doses of measles vaccine with measles -
rubella vaccine.
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MR Campaign
• MR Vaccine is being introduced through a campaign in a phased manner across the country without sub phasing within the states.
• Primary purpose of MR campaign is to attain high levels of population immunity by reaching wide age group,including children missed under EI program.
• High quality campaigns with at least 95% coverage.
• Early planning and preparedness is the key to quality MR campaign.
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Planning the campaign
• Target age group: 9 months to <15 years
(regardless of prior immunization status or disease)
• Target to reach 100% eligible children
• Evaluated coverage more than 95 %
• Session site based approach – No House to
House vaccination.
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NTAGI Recommends
Wide age range MR vaccination campaign
• targeting children from 9 months to 15
years
• high coverage (to knock down MR
transmission completely / to low levels)
• before introduction of Rubella Containing
Vaccine (RCV) in routine immunization
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More than 13.43 crore* (134
million) children vaccinated safely in
28 states/UTs.
More than 40 crore (400 million) children to be vaccinated
during the MR Campaign
Completed - 21
Ongoing - 7
Planned - 8
RAJASTHAN
ODISHA
GUJARAT
MAHARASHTRA
MADHYA PRADESH
BIHAR
KARNATAKA
UTTAR PRADESH
JAMMU & KASHMIR
ASSAM
TAMIL NADU
TELANGANA
CHHATTISGARH
ANDHRA
PRADESH
PUNJAB
JHARKHAND
WEST BENGAL
ARUNACHAL PR.HARYANA
KERALA
UTTARAKHAND
HIMACHAL
PRADESH
MANIPUR
MIZORAM
MEGHALAYA
NAGALAND
TRIPURA
SIKKIM
GOA
A&N ISLANDS
D&N HAVELI
PONDICHERRY
LAKSHADWEEP
*As of 17th Nov 2018
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~ 55 Lakh (5.5 million) (9 months to 15 years)
Campaign starts from January 2019
Target for Delhi
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MR Vaccine Campaign: Implementation Strategy
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Schools Community Last week
sweeping in low performing areas
4-5 weeks activity 1 week sweeping
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School site vaccinations
Fixed in-facility sites Hospitals, PHCs, Dispensary, SC
Outreach session sites Villages, settlement,
colonies
Mobile sessions For far flung areas
Implementation of Session Sites
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Key for Successful Campaign
• Strong political commitment and ownership
• Crucial role for Education department – 85 % beneficiaries are in schools
• Timely Microplanning and training
• Creating MR visibility and awareness at all levels – Print and electronic media are important- reached
proactively.
• Best way to reach parents through teachers – Whats app, Facebook, parents teachers meeting/ messages
etc.
• Private pediatricians and leading practitioners are opinion makers for vaccination
• Clear financial guidelines from state to district and below
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Planning for school based MR Campaign
Education Department
Involvement
Training Workshop for Measles-Rubella Vaccination Campaigns 17
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Communication from Ministry of HRD Secretary Education (states/UTs)
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Strong engagement of schools (Public, Private and Catholic)
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Concerns of school
Vaccine safety & need for additional doses?
Is it a government program only?
What is the take of international agencies?
Quality of vaccine?
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Let us say hello to
Measles and Rubella vaccine
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Share stand of
WHO, Unicef, CDC, IAP, IMA, others
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• One new syringe for every child
• Health department across India is
using AD syringes in immunization
programme since 2005.
• Mechanism of AD syringe is such
that it can not used again for the
second time.
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Let us say hello to
Auto disabled (AD Syringe)
In phase I and ongoing phase II -2017 (12 states/UTs)
More than 6 crore children vaccinated successfully
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Role of Education Department
1. Share details & support planning
2. Training school and class lead
3. Awareness amongst parents
4. Engage students
5. Help on the day of vaccination
6. Support reporting & tracking of missed
children
Training Workshop for Measles-Rubella Vaccination Campaigns 23
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Format 1 – School Pre Campaign
• This format has been distributed by
respective DEOs/MOIC to all schools.
• Each school has to submit completed
Format 1 separately to Health Facility either
in Hard copy/Soft Copy by 24th Nov 2018.
• Format 1 – School Pre Campaign will be
submitted to Health department (Medical
Officer of Dispensary/Health Facilities.
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M.O to check information gathered by education department & by health workers to consolidate list of
schools for microplanning
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Format 2-A– School Pre Campaign (School Principal to ensure this information reaches MO I/C in time)
Block Village / Urban Area:
School name & address:
School vehicle available yes / no
Govt/ Private Co-ed/ Boys only / Girls only (Encircle)
School team leaders Principal name Landline Cell Board ICSE/CBSE/State/Others
School nodal person MR Campaign vaccination (Name & Tel number):
Total Students under 15 year : Total classes with children under 15 Total rooms in school
Class leads training planned on DD/MM/YYYY
Class leaders with Students details (up to 15 years ) Class/
class
section
Total
students
Name &
Mobile number of class lead (teacher)
PTM
date
planned
for MR
PTM
date
planned
for MR
Student –teacher interaction date planned
dd/mm/yy
yy
dd/mm/yy
yy 1st interaction
2nd interaction
dd/mm/yy
yy
dd/mm/yy
yy 1st interaction 2nd interaction
dd/mm/yy
yy
dd/mm/yy
yy 1st interaction 2nd interaction
dd/mm/yy
yy
dd/mm/yy
yy 1st interaction 2nd interaction
dd/mm/yy
yy
dd/mm/yy
yy 1st interaction 2nd interaction
Signature
Principal
Nursery 20 Ms Sonia 99XX55XX34XX
KG (A) 30 Ms Seema 95XX37XX39XX
KG (B) 25 Mr Pradeep 81XX24XX56XX39
Class1 (A) 30 Ms Roohi 95XX34XX89XX50
Signature
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Role of Education Department
1. Share details & support planning
2. Training school and class lead
3. Awareness amongst parents
4. Engage students
5. Help on the day of vaccination
6. Support reporting & tracking of missed
children
Training Workshop for Measles-Rubella Vaccination Campaigns 26
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• School team leaders : 2 per school
– School Principal + one additional nodal officer for campaign from every school
(Govt, Private, Aided, Madrasas , pre nursery schools, Kindergarten, others
including schools for special, orphanages, others)
– Will be trained by Health Department/ WHO will monitor the training
• Class leader – class/ section teacher : 1 per class / per section
– Will be trained by School team leaders
• Class MR Warriors and Class wise Captains for MR Campaigns
(students) : 3-5 per class / section.
– Support teachers in MR activities
– Motivate cheer friends on vaccination day.
– Be part of team to hoist the “ We just did it …Measles Freedom flag”
– Will be trained by Class leader – class/ section teacher
Key Officials Education department in MR Campaign
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The process…
Greet child Before going in the
vaccination room Class lead
(teacher) cross ticks the name in the
attendance register give child a
vaccination card , fill details except
date of vaccination child goes to
vaccination team
Class to Registration desk (location:
Inside or outside the vaccination room)
From vaccination room Direct child to join friends in observation
room / area observe for 30 min children may leave
From Vaccination Site to observation room/ area
Vaccinators greet child Take the card
given to child at registration desk
child is asked to sit Vaccinate child
Congratulate the child for defeating
Measles and Rubella Mark the left
thumb finger with indelible marker pen
Fill date of vaccination
From Registration desk
vaccination room
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Role of Class Teacher/ MR warrior
On Day Of Vaccination
• Identifying a suitable room/place for registration of kids
• Identify a room where children can be comfortably
vaccinated
• If possible mark an area and depute people for
observing children after vaccination ( keep under
observation for 30 minutes)
• Arranging for logistics like curtains, drinking water etc.
• Make Missed out children list same day evening
(format 9 B)
• Contribute in painting display in vaccination room
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• Do include the doctors on
call / visiting doctors/
medical room staff in
school to attend the
training program
• Ensure that they are part
of the trainings with their
school leaders.
Doctors/ medical staff attached to schools
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Role of Education Department
1. Share details & support planning
2. Training school and class lead
3. Awareness amongst parents
4. Engage students
5. Help on the day of vaccination
6. Support reporting & tracking of missed
children
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Communication to parents
• Use available communication channel to inform
parents about PTM /interaction ( SMS, Whatsapp,
e mails, Student diary message, school website
• Provide links to key information
• Promotion message stickers with school names
• Play school children: Parents must be asked to
come to school on the given day/date
• For bigger classes the options are left to school.
• All children will have to wait for half an hour after
vaccination
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What Parents need to know in PTMs (refer training material)
More than 6 crore children vaccinated in 5 southern states India heading for elimination of
measles
MR Vaccination – one shot campaign, Why the need, how will it help their child,
Additional dose irrespective of previous doses received or not
What is Measles and Rubella – the threat , disease, complications and how it will protect their children
MR Vaccine is WHO prequalified, one syringe one child, Vaccination will be provided
under medical supervision
Children should have had something to eat in morning. Severely ill children will not be vaccinated
Process of vaccination in schools from class to vaccination room, teacher escort, from vaccination room to observation room for 30 min)
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Focused attention on Parent-Teacher meeting at
schools
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MR campaign - Interaction of health department with
students, especially large private schools
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School to parents messages
Rubber stamps design
Every child is special , every parent is a winner !!
Let us beat Measles and Rubella with MR Vaccination
One dose MR Vaccination campaign scheduled on ___________ day _________at_______am
Let us make our school proud by achieving more than 95% coverage and hoisting the flag - ‘WE JUST DID IT’
An effort towards making a healthier and disease free India
Holy Angels Holy Mother School, Hyderabad
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Car/ Bike sticker -a few samples
War against Measles and Rubella Disease
My child will win, We will Win
Holy Angelian Mother
War against Measles and Rubella Disease
My child is a MR Vaccine Captain
Holy Angelian mother
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War against Measles and Rubella Disease
My child is a MR Warrior
Holy Angelian mother
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Role of Education Department
1. Share details & support planning
2. Training school and class lead
3. Awareness amongst parents
4. Engage students
5. Help on the day of vaccination
6. Support reporting & tracking of missed
children
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Improving children participation: Drawings, painting
competitions
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Improving children participation: Drawings, painting
competitions
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Schools innovations team for MR Campaign
• 5 best activities in district : Following MR Campaign – best recorded activities to be judged by panel –WHO/UNICEF/ DIO/Lions club Other Partners and recommended for district awards – DM to award the winners
• Best district activities for state level award ( not more than 5 per district). Panel: WHO/UNICEF/Health deptt/Lions club partners will judge and recommend best 25 activities received from district for state level award. Principal Secretary, HM may do the honors .
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Class teacher, Art teacher, Music teacher , SUPW teacher, IT Teacher
to support innovative activities
• 5 best activities of school for MR advocacy may be recorded and
sent by whats app/ others to …………………….
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Role of Education Department
1. Share details & support planning
2. Training school and class lead
3. Awareness amongst parents
4. Engage students
5. Help on the day of vaccination
6. Support reporting & tracking of missed
children
Training Workshop for Measles-Rubella Vaccination Campaigns 43
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Role of Class Teacher/ MR warrior On Day Of Vaccination
• Ensuring children are informed to not come empty stomach
• Contribute in painting display in vaccination room
• Ensure filling name based post campaign format for missed
children and forwarding it to school lead
• Identify a room where children are asked to move after
vaccination.
• If possible mark an area for observing children after
vaccination ( keep under observation for 30 minutes)
• Make Left out children list same day evening (refer to format2-B)
Training Workshop for Measles-Rubella Vaccination Campaigns 45
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Role of School team leaders / Class leads On Day Of Vaccination
Follow the simple strategy of taking
one child at a time in vaccination
room Ensure there is a place to wait before the child gets into
vaccination room
Training Workshop for Measles-Rubella Vaccination Campaigns 46
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Motivating students
• The vaccinated children have to be observed for at least
30 minutes
• Ensure that every class greets
their first 5-7 children going
for vaccination with an
applause (claps). This boosts
confidence.
Training Workshop for Measles-Rubella
Vaccination Campaigns 47
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Role of Education Department
1. Share details & support planning
2. Training school and class lead
3. Awareness amongst parents
4. Engage students
5. Help on the day of vaccination
6. Support reporting & tracking of missed
children
Training Workshop for Measles-Rubella Vaccination Campaigns 48
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Sr
No
Day of
vaccinationClass
Total Target
Children in school
No of Children
vaccinatedActivity Status
Day -1 Completed/Ongoing
Day -2 Completed/Ongoing
Day -3 Completed/Ongoing
Day -4 Completed/Ongoing
* In case the activity is >1 day planned in school then the data reporting officer should mention day/date wise report till activity compilation
Signature Principal
School nodal person for MR Campaign vaccination (Name & Tel number): _________________________
School name: __________________________________________
Address (Village/Urban area): ______________________________________________ Encircle: Govt/ Private/ Aided
School fills this up and shares with Planning unit / Block level
Date of vaccination % achieved
Total
Board of school: ICSC/CBSC/State board/other (specify)
Total no days activity planned in school: 1/2/3/4/5/6
Class wise School MR Campaign Coverage Report
Principal name & Telephone number: ______________________
State: ____________ District: __________________ Block/urban area: ________________ Planning unit: ________________
MR Campaign FORM - 2E
Daily Class wise coverage to Principal
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Planning unit: ________________
Sr
NoName of school
Total Target
Children in schools
No of Children
vaccinated
%
achieved
No days activity
planned in
school
Activity Status
Completed/Ongoing
Signature of MO
in charge
Date
Total no of school in block/Area: ______________________
School wise Block/Planning unit MR Campaign Coverage ReportMO incharge of Planning unit / Block level fills this up and send it to district MR Campaign FORM - 2F
State: ____________ District: __________________ Block/urban area: ________________________
TotalDaily school wise coverage
to planning unit/ Block MO incharge
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Sr
NoBlock Name No of Schools
Total Target
Children in schools
No of Children
vaccinatedActivity Status
Completed/Ongoing
Signature of DIO
Date % achieved
Block wise district level MR Campaign Coverage ReportDistrict DIO will fill this and share with state MR Campaign FORM - 2G
State: ____________ District: __________________ No of blocks/planning units: ____________
Total no of school in district:
Total
Daily planning unit/Block wise
coverage to District (Immunization
officer)
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Sr
NoDistrict Name No Of Schools
Total Target
Children in schools
No of Children
vaccinatedActivity Status
Completed/Ongoing
Signature of SEPIO
Date % achieved
District wise state level MR Campaign Coverage ReportDistrict will fill this and share with state MR Campaign FORM - 2H
State: ______________________________ No of districts ____________ Total no of school in State: __________________________
Total
Daily District wise coverage to
District (Immunization officer)
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After Vaccination is completed
Training Workshop for Measles-Rubella Vaccination Campaigns 53
• The school and class leads should immediately
calculate the vaccination coverage in school
– Before vaccination session finishes Class teachers to make list
of only those students who could not be vaccinated on that day
along with the reason (refer form ) for follow up of students
More than 95 % coverage
Less than 95% coverage
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Collecting list of all
schools/madrasas/
nurseries/play schools/
educational institutions
Collect school-wise
number of children of
target age group / class &
section wise(Submission
of Format 1 by school to
HF)
School engagement during preparations
Principals/Heads orientation
(+ 1 nodal teacher)
Principal & Nodal teacher to orient
all class teachers / subject teachers
Each class teacher will orient /
sensitize students & write in
blackboard / diaries / share MR
information card
School will organize Parents-
teachers meeting (PTM) &
sensitize the parents
Preparation of School
Microplan by ANM/Health
Facility
Planing Sensitization/Advocacy
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Support Requested from Schools
• Sharing of Information and details by school authority to Health Facility.
• Submission of completed Format 1 by School to HF.
• Identification of One Nodal person for MR campaign.
• Orientation of All Class leads on MR campaign
• Sensitization of Parents and conducting PTM for MR Campaign.
• Sensitization and orientation of students on MR campaign.
• Support in Microplaning of School sessions in consultation with MOICs/ANM.
• Deployment of adequate staff on the day of MR vaccination(3 teachers+1 Nodal Teachers).
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Waiting for vaccination…….
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Improved communication of health delivery staff & education
staff pre, during & post vaccination
(Starts & ends with smiles)
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Delighted after vaccination
Madarasa
Monastery Convent school
Play school
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If your school
records above 95%
coverage the MR
Captains and
warriors and class
teachers should
hoist the flag the
same day/ next day
until the campaign
period ends.
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Thankyou