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Measles  epidemiology and eradication
 

Measles epidemiology and eradication

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Measles situation in India

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    Measles  epidemiology and eradication Measles epidemiology and eradication Presentation Transcript

    • MEASLES- EPIDEMIOLOGY A Presentation By – Dr Murli Dhar Soni SPMC Bikaner(Raj.) 13/09/2012 (CAS PG , PSM IInd Year) AND ERADICATION
    • INTRODUCTION Measles is one of the most infectious human diseases and can cause serious illness, lifelong complications and death.  Prior to measles vaccine(1960), measles infected over 90% of children before 15 y. With the introduction of vaccine, measles infection has shifted to the teens in countries with an efficient programme.  These infections were estimated to cause >2 million deaths and between 15000-60000 cases of blindness annually worldwide .  In some developing countries, case-fatality rates for measles among young children may still reach 5–6%, but may run up to 10%-30% in certain localities.  In industrialized countries, approx 10–30% of measles cases require hospitalization, and one in a thousand of these cases among children results in death from measles complications.  It is unacceptable that every day 380 children still die from measles and 300 children still enter the world with the disabilities of CRS 
    • Major causes of mortality among children of age < 5 years, 1990 vs 2008 Measles Malaria, 5 % 7% 21% Pneumon ia Measles accounts for ~23% of overall decrease in child mortality Malaria,8% Measles,1% 47% Other 58% Other 18% Pneumonia 20% Diarrhoea 15% Diarrhoea 1990: 12.1 mil Source: Van den Ent et al, J Infect 2008: 8.8 mil Dis Suppl July 2011, ppS18 - S23
    • GLOBAL INCIDENCE 1980-2010 (DOWN BY 93%)
    • GLOBAL CASES Measles global annual reported cases and MCV coverage, 1980 to 2010 Number of cases 100 90 80 70 60 50 40 30 20 10 0 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 number of cases 5,000,000 4,500,000 4,000,000 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 immunization coverage (%) Campaigns
    • GLOBAL INCIDENCE, (WHO REGION WISE)1980-2010 2015 Target Source: WHO/IVB database, August 2011 (Data for 2010) 193 WHO Member States. Date of slide: 4 August 2011
    • GLOBAL CASES, 2000 – 2010 *(DOWN BY 63%) *Progress in global measles control, 2000–2010. WER 3 Feb 2012, vol. 87, 5 (pp 45–52)
    • REPORTED CASES –INDIA 1980-2010 (DOWN BY 75%) Reported Cases of Diptheria, Measles, Polio and Pertussis: India 1980-2010 Source: WHO
    • DEATHS 2000 Globally 5.35 lakh India 2010 1.39 lakh 85,600(16%) 65,500(47%)
    • 600 800 1000 Global estimated measles deaths down by three - quarters, 2000 - 2010 0 200 400 74% 2015 Target 2000 2001 2002 2003 2004 Estimated mortality 2005 Year 2006 2007 2008 2009 95% confidence interval 2010
    • DEATHS DOWN 2000 TO 2010 (BY 74%) 26% 100% 87% 79% 85% 76% 74% 78% 90% 2010 reduction goal Source: WHO/IVB, November 2009
    •  Measles mortality was reduced by more than three-quarters in all WHO regions except the WHO southeast Asia Region. India accounted for 47% of estimated measles mortality in 2010, and the WHO African region accounted for 36%.  India in 2010 recorded nearly 30,000 new cases of measles, and recorded 65,500 deaths. (47% of the world)  Each year, between 60,000 and 100,000 children die of measles in India, which is the highest for any country in the world.
    • GLOBAL GOALS  Millennium Development Goal # 4: -Reduce child deaths by 2/3 by 2015 (vs. 1990) -Measles immunization coverage indicator of access to care  Measles Mortality Reduction By 2015 Vaccination coverage: 90% national level and 80% in every district  Reported incidence: < 5 cases of measles per million  Mortality reduction: 95% (vs 2000)  Global Measles and Rubella Management Meeting WHO, Geneva, March 20 - 21, 2012
    • MR INITIATIVE  MR Initiative (formerly, the Measles Initiative) was launched in 2001 to support technically and financially accelerated measles control activities.  As a result of its efforts, measles deaths dropped to approximately 139 000 per year in 2010, representing a 74% decrease compared with 2000, and a 23% decline in under-five deaths worldwide between 1990 and 2008 .
    • THE MEASLES AND RUBELLA INITIATIVE Provides financial plus following support to the five components of the Global Measles and Rubella- Strategic Plan 2012-2020 Strategy. • Advocacy to fully fund and implement the Strategic Plan, in close collaboration with child survival initiatives. • Technical support to priority countries: » to improve immunization coverage ; » to document and share best practices ; » to expand and enhance the quality of surveillance and the LabNet; » to provide appropriate measles case treatment. •Assistance to respond rapidly to measles outbreaks. •Support to operational research. •Monitoring and evaluation of progress in implementing the Plan and communication of progress and challenges to all stakeholders yearly. To date, the partnership has invested US$ 875 million in measles control activities, which supported the vaccination of more than one billion children in more than 80 countries.
    • THE MR INITIATIVE WORKS WITH SEVERAL KEY SUPPORTERS                the Anne Ray Charitable Trust, BD, the Bill & Melinda Gates Foundation, the Canadian International Development Agency, the Church of Jesus Christ of Latter-day Saints, the United Kingdom Department for International Development, the GAVI Alliance, Herman and Katherine Peters Foundation, the International Federation of Red Cross and Red Crescent Societies, the International Financing Facility for Immunization, the Japan International Cooperation Agency, Lions Clubs International, Merck Co. Foundation, the Norwegian Ministry of Foreign Affairs, and Vodafone Foundation.
    • Acknowledgements Anne Ray Charitable Trust
    • THE GAVI ALLIANCE  The GAVI Alliance provides significant opportunities for improvements in funding to vaccination programmes in the developing world.  GAVI supports strengthening immunization and health systems; introduction of the measles second dose through routine services; introduction of rubella vaccine through wide age-range campaigns using MR vaccine; as well as performance-based support to increase on-time vaccination with the first dose of MCV.  The MR Initiative will work closely with the GAVI Alliance to help countries introduce MCV2 and MR vaccines, monitor and evaluate progress and recommend areas for new investment.
    • THE GAVI ALLIANCE PARTNERS In addition to national governments and public health and research institutions, the GAVI Alliance partners include  Bill & Melinda Gates Foundation,  International Federation of Pharmaceutical Manufacturers Associations,  Rockefeller Foundation,  UNICEF,  World Bank and  WHO.
    • GLOBAL MEASLES AND RUBELLA STRATEGIC PLAN 2012-2020  This Strategic Plan 2012–2020 explains how countries, working together with the MR Initiative and its partners, will achieve a world without measles, rubella and congenital rubella syndrome (CRS).
    • THE STRATEGY FOCUSES ON THE IMPLEMENTATION OF FIVE CORE COMPONENTS. 1. Achieve and maintain high levels of population immunity by providing high vaccination coverage with 2 doses of MR vaccine. 2. Monitor disease using effective surveillance, and evaluate programmatic efforts to ensure progress. 3. Develop and maintain outbreak preparedness, respond rapidly to outbreaks and manage cases. 4. Communicate and engage to build public confidence and demand for immunization. 5. Perform the research and development needed to support costeffective operations and improve vaccination and diagnostic tools.
    • PLAN‘S VISION, GOALS AND MILESTONES VISION  Achieve and maintain a world without measles, rubella and congenital rubella syndrome (CRS). GOALS By end 2015 o Reduce global measles mortality by at least 95% compared with 2000 estimates.  Achieve regional measles and rubella/CRS elimination goals. By end 2020  Achieve measles and rubella elimination in at least five WHO regions.
    • PLAN’S MILESTONES By end 2015  Reduce annual measles incidence to <5 cases/million & maintain that level.  Achieve at least 90% coverage with the MCV1 (or measles- rubellacontaining vaccine) nationally, and exceed 80% vaccination coverage in every district or equivalent administrative unit.  Achieve at least 95% coverage with M, MR or MMR during SIAs in every district.  Establish a rubella/CRS elimination goal in at least three additional WHO regions.  Establish a target date for the global eradication of measles. By end 2020  Sustain the achievement of the 2015 goals.  Achieve at least 95% coverage with both MCV1&2 (or measles- rubellacontaining vaccine ) in each district and nationally.  Establish a target date for the global eradication of rubella and CRS.
    • CURRENT WHO GLOBAL AND REGIONAL TARGETS Among 6 WHO regions 5 have set target elimination dates.  The Americas achieved the goal - in 2002  The Western Pacific Region - by end of 2012  European and Eastern Mediterranean - by 2015.  The African Region -by 2020  The South-East Asia Region -under discussion
    • MEASLES AND RUBELLA ELIMINATION GOALS, FEB 2012 2015 2015 2000 2010 2015 2020 SEAR: 95% Measles Mortality Reduction by 2015 2012
    • GLOBAL CONTEXT MEASLES VACCINATION  In 2000, the World Health Assembly adopted a five-year strategic plan to reduce global measles deaths by half compared with 1999 levels, from 2000– 2005 through vaccination.  Then in 2006 MR Initiative supported a five-year strategic plan to reduce measles mortality by 90% by 2010 vs 2000 levels.  Except SEAR, all WHO regions have achieved 75% reduction.  The 90% goal was not achieved mainly due to delayed control activities in India and outbreaks in Africa.  According to WHO and UNICEF estimates, global routine coverage with MCV1 increased from 72% in 2000 to 85% in 2010.  By the end of 2010, the routine immunization schedules of 139 countries included 2 doses MCV, and in 2011, GAVI supported 11 more countries to introduce a routine MCV2.
    • HERD IMMUNITY  Definition-The resistance of a population to attack by a disease to which a large proportion of the members are immune.  For measles, this proportion is ~ 95%.  When ~ 95% of the population is immunized against measles:  Non-immunized individuals will remain susceptible, but may be indirectly protected by “herd immunity”.  If virus is reintroduced, the disease spread is limited (outbreaks are small).  Measles virus circulation may be interrupted.  Measles vaccine’s efficacy rate is only 85 per cent because the first dose of measles vaccine is given in India at the age of nine months .  At this age, infants have antibodies from the mother that makes the vaccine ineffective.  If given after one year of birth, the vaccine has efficacy of 95 per cent.
    • CHALLENGES
    • # 1: INDIA 14 states with MCV1 < 80% are implementing measles SIAs Phase 1 (45 districts Target Vaccinated pop (millions) (millions) JAMMU & KASHMIR Coverage Phase-1 UTTARAKHAND 88% 42.9 28.6 67%* 72.7 Planned -- Total PUNJAB CHANDIGAR H 12.1 Phase-3 Phase 2 (157 districts) Remaining (159 districts) HIMACHAL PRADESH 13.8 Phase-2 covered) 129.4 40.7* -- HARYANA DELHI ARUNACHAL PR. SIKKIM UTTAR PRADESH RAJASTHAN ASSAM BIH AR * Phase-2 campaigns ongoing; data as on 23 Jan 2012. NAGALAND MEGHALAYA MANIPUR JHARKHAND MADHYA PRADESH WEST BENGAL TRIPURA MIZORAM GUJARAT CHHATTISGARH ORISSA DAMAN & DIU D&N HAVELI MAHARASHTRA ANDHRA PRADESH GOA KARNATAKA A&N ISLANDS PONDICHERRY TAMIL NADU LAK SHADWEEP KERALA 17 states with MCV1 coverage ≥ 80% introduced a routine second dose by August 2011. Source: Based on target population available with GoI
    • # 2: RESURGENCE IN AFRICA 600,000 100  90  80 70 400,000 60 300,000 50 Number of cases 40 WHO/UNICEF estimates 200,000 Administrative coverage 30 20 100,000 MCV1 coverage (%) No. of cases (in thousands) 500,000  4-fold increase since 2008 Large outbreaks in Burkina Faso (2009), S. Africa (2010), and DRC (2011) Outbreaks in drought affected Horn of Africa  High case-fatality 10 0 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010‡ Year Weekly Epidemiological Record (2011) 86:129-135
    • # 3: WEAK IMMUNIZATION SYSTEMS Measles 1st dose coverage among infants, 2010  1st dose:   2nd dose ( routine ):   50-79% (41 countries or 21%) 80-89% (24 countries or 12 %) >=90% (126 countries or 66%) 54 countries do not have routine 2nd dose Campaigns: Variable quality  Delayed  <50% (2 countries or 1%) 67 Countries have MCV1 coverage < 90%
    • # 4: FINANCING IS LATE AND UNPREDICTABLE Annual Donations 2001 - 2011 & Financial Resource Requirements, Projections, Funding Gap 2012  180  160 $ US Million 140 120  100 80 60  40 20 Lack of multi-year funding Countries not committing 50% of the operational costs of SIAs Outbreak response not budgeted for $ 32 million funding gap for 2012 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Donations Projected Donations Funding Gap *Excluding country contributions
    • SINCE 2000, 1ST DOSE COVERAGE UP BY 13% 2015 Target Source: WHO/UNICEF coverage estimates, 2011 revision. Date of slide: 29 July 2011
    • SCALING-UP 2ND DOSE STRATEGIES Number of MCV doses (in millions) 500 450 400 Number of doses of measles vaccine administered, by delivery strategy, 2000-2010 350 Measles Initiative 300 1 billion vaccinated as of July 2011 250 200 150 100 50 0 2000 2001 2002 2003 2004 1st routine dose 2005 2006 2nd routine dose 2007 2008 2009 2010 SIA 1st routine dose: WHO/UNICEF coverage estimates, The World Population Prospects New York, 2011. 2nd routine dose: WHO/UNICEF Joint reporting form, (not all countries report 2nd dose). SIA dose;: WHO SIA database, July 2011 (Provisional data)
    • INDIA Measles vaccine coverage in India, under the routine immunization program, was only 69 % in 2007-2008, according to the DLHFS III and 14 states had <80% coverage.  The nation-wide coverage rose to 74% in 2009,(Global – 84%, Rajasthan 65.6%) according to UNICEF. 
    • COVERAGE WITH MCV1 INDIA, 2007--2008* AMONG CHILDREN AGED 12--23 MONTHS, BY DISTRICT --- * Data are from the District Level Household and Facility Survey 2007--2008.
    • COVERAGE WITH MCV1 AMONG CHILDREN AGED 12--23 MONTHS, BY STATE --INDIA, 2007--2008* * Data are from the District Level Household and Facility Survey 2007--2008 for all states except Nagaland, for which data are from the UNICEF 2006 Coverage Evaluation Survey .
    • LABORATORY-CONFIRMED MEASLES AND RUBELLA OUTBREAKS IN STATES CONDUCTING MEASLES OUTBREAK SURVEILLANCE --- INDIA, 2010* * Data are from the National Polio Surveillance Project measles surveillance database, 2010.
    • MCV2 IN INDIA In 2008, the Indian National Technical Advisory Group on Immunization (NTAGI) recommended introduction of a MCV2 at the age of 16-24 months.  States/UTs with >80% Measles coverage (21 States) have introduced MCV2 in their Routine Immunization Program by Aug 2011.  States/UTs with <80% coverage (14 states) are first covering all children b/w 9m -10y age through a Measles SIA as Catch-up campaigns in a phase-wise manner followed by introduction of 2nd dose under their routine immunisation programme.
    • CATCH-UP CAMPAIGNS  The campaign is divided in four phases. First phase of the campaign held from Nov 2010 to May 2011  The campaign runs in each district for three weeks. One week in schools ,Next two weeks at the community-level.  States covered in the first phase of the campaign were: Assam, Arunachal Pradesh, Haryana, Manipur, Rajasthan, Madhya Pradesh, Bihar, Chhattisgarh, Gujarat, Jharkhand, Tripura, Nagaland and Meghalaya.
    • INDIA: PHASED CATCH-UP CAMPAIGNS 2010-2013 Target population:  ~ 130 million children 9 months – 10 years of age  361 districts in 14 states JAMMU & KASHMIR HIMACHAL PRADESH PUNJAB CHANDIGAR H UTTARAKHAND HARYANA DELHI ARUNACHAL PR. SIKKIM UTTAR PRADESH RAJAST HAN ASSAM BIH AR NAGAL AND MEGHALAYA MANIPUR JHARKHAND MADHYA PRADESH WEST BENGAL TRIPURA MIZ ORAM GUJARAT CHHAT TISGARH No. of State No. of Distt Target Pop (9 m - 10 yrs) % Cover age P1 13 45 13,845,686 87.2 P2 14 157 42,931,906 82.9* P 3** 15 159 ~ 73,000,000 ORISSA DAMAN & DIU D&N HAVELI MAHARASHTRA Phase ANDHRA PRADESH GOA KARNATAKA A&N ISLANDS PONDICHERRY TAMIL NADU LAK SHADWEEP KERALA Source: Based on target population available with GoI * Provisional data as of 1st week of March 2012; 6 districts have not yet started the campaign ** Phase 3 will be conducted during Fiscal Year 2012-2013
    • RAJASTHAN  In Rajastan, five districts—Ajmer, Bhilwara, Nagaur, Rajsamand and Tonk— were selected for the first phase of the campaign that started on November 29, 2010.  In 2010, before the start of the campaign, there were four measles outbreak episodes in these five districts. In 2011, the outbreak incidents in these districts dipped to two.
    • MEASLES OUTBREAK SURVEILLANCE  Laboratory-supported measles outbreak surveillance was initiated in 2006 and, by 2010, was operational in eight states (Andhra Pradesh, Gujarat, Karnataka, Kerala, Madhya Pradesh, Rajasthan, Tamil Nadu, and West Bengal).  An outbreak is considered confirmed if measles immunoglobulin M (IgM) is detected in serum from at least two suspected cases. Sera are tested by a network of eight laboratories accredited by the World Health Organization. All samples testing negative for measles IgM are tested for rubella IgM.  During 2010, a total of 242 suspected outbreaks were investigated, and 198 (82%) were laboratory-confirmed as measles (Figure 3).  Among 8,984 measles patients from laboratory-confirmed outbreaks, 7% were aged <1 year, 41% were aged 1--4 years, 37% were aged 5--9 years, and 15% were aged ≥10 years.
    • GUIDING PRINCIPLES TO ELIMINATE MEASLES, RUBELLA AND CRS 1. Country Ownership And Sustainability 2. Routine Immunization And Health Systems Strengthening 3. Equity 4. Linkages  With polio eradication  With new vaccines  With other proven child survival interventions  Surveillance activities
    • CHALLENGES IN INDIA Need for  1) increasing the number of trained staff at all levels,  2) increasing public demand for and confidence in vaccines,  3) improving vaccine stock and cold chain management, and  4) developing a strong reporting and management system for adverse events after vaccination. Also challenges in planning and implementation, including obtaining strong state-level leadership and coordination, timely determination of campaign dates, reaching populations with the campaign messages, and reaching children in urban areas.
    • GLOBAL MEASLES SUMMARY  Achievements      Challenges   1st dose coverage up to 85% 1 billion doses delivered in campaigns 2 / 3 reduction in cases 3 / 4 reduction in deaths Catch - up in India, outbreaks in Africa, weak systems, unpredictable funding New Strategic Plan, 2012 - 2020  Addition of rubella as a “ game changer "
    • Strategies and Operational Plans MEASLES CONTROL IN INDIA For 26 & 27th July 2010 Dr Pradeep Haldar Assistant Commissioner (Immunization) Government of India
    • TARGET POPULATION AND VACCINE DOSES REQUIRED  SIA in 14 states      Target population (9 mo-10 years): 134 million Vaccine doses +AD: 147 million Mixing syringe : 29.5 million Operational cost as per JE norms MCV2 in RI in 17 states: Annual targets   1-2 year population: 9.36 million Vaccine doses: 11.23 million
    • SIA PHASING Will be in three phase  First phase – 40 districts from 14 states  one district from each of the North-East states, (6 states excluding Mizoram & Sikkim)  2 districts from each of the UP and Bihar (2 States)  5 districts from each of the remaining states (6 States)  Planned for 40 districts in late 2010   Second and third phase will be built-upon the first phase and will be in 2011.
    • KEY VACCINATION STRATEGIES  Target group: 9 m to 10 yrs (irrespective of measles immunization status)    Regular RI sessions will be conducted without interruption   Measles catch-up campaign in remaining days Immunization will be at fixed posts to ensure safe injection practices      This age group constitutes ~ 20-25% of total population Target population (9 mo-10 years): 134 million All sites used for routine immunization sessions Additional sites to cover all villages Schools with children under 10 years Special plans for hard to reach areas and/or underserved populations 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 remaining children
    • STRATEGIC PLANS FOR IMMUNIZATION     Training of all staff followed by development of micro-plan Complete measles immunization in one day in a village or an urban area (Mohalla) or in a school 1 team = 1-2 vaccinator + 1 ASHA/AWW + 1-2 volunteers (1 vaccinator in NE/ other sparsely populated area) One vaccinator will be able to vaccinate in a day Approx. 125-150 children in community based booths  Approx. 200 children in a school booth   Children will be finger marked with indelible ink  Catch-up campaign card for each immunized child
    • ROLES IN IMMUNIZATION SITE   Immunization session will be conducted from 8-2 pm and there after the worker will do the routine activity till 4 pm. Rapid assessment of coverage by Supervisors & independent monitors on a daily basis:    Missed children will be immunized in areas found to have <90% coverage ASHA/AWW will bring in subsequent weekly RI session in village Waste disposal: per National guidelines
    • AEFI MANAGEMENT   Medical Officers will carry Emergency Medicines – Mobile Supervisory cum Medical Units AEFI training/ reporting and management:      All government centre will work as AEFI management centres Additional sites at private sector clinics, if required Involvement of professional bodies like IAP, IAPSM, IPHA AEFI kits will be available at all these sites Daily monitoring  VHSCs/plans for transport serious AEFI cases  Pro-active media plan with designated spokesperson
    • PLANNING & COORDINATION  Committees  at central and state levels Steering committee To mobilize resources and coordinate planning and implementation activities with other departments  Broad based including relevant departments, civil society organization, professional bodies, opinion leaders  Chairperson: Secretary Health   Working Group   Smaller group for day-to-day monitoring of campaign planning and implementation State Control room during the campaign  District Task Force (DTF)  To supervise, support, monitor and ensure implementation of the highest quality measles campaign in the district.  Chairperson: District Collector/ Magistrate  A measles catch-up control room at District level
    • KEY LOGISTIC NEED FOR SESSIONS          Vaccine doses required = Target population X 1.1 (WMF) Vaccine vials required = Vaccine doses / 5 (for 5 dose vials) Diluent vials required = Vaccine vials required Auto disable syringes = Target population X 1.1 (WMF) Reconstitution syringes (5 ml) = Vaccine vials X 1.1 (WMF) Hub cutters = Number of teams Red plastic bags = 1 per 50 syringes Black plastic bags = 2 per session site Ensure adequate cold chain space
    • ADVOCACY TO GAIN AND SUPPORT TO THE CAMPAIGN 1. Various depts at the state/district level (edu, rural devpt) 2. Educational institutions, mainly schools (teachers body) 3. Professional medical/ pediatrics associations 4. Local NGOs and community-based organizations 5. Influential individuals within communities/religious groups 6. Media Advocacy activities planned/underway 1. Seminars, workshops , group discussions 2. Powerpoints and outreach materials with targeted messaging for each group
    • PLANNING FORMATS – PHC / BLOCK LEVEL S Level Who will fill Name of format 1 Subcenter ANM Village List / School List / H2R List 2 Subcenter ASHA/AWW/ANM/Volunt eers Beneficiary Due List 3 PHC / Block ANM + Supervisor Microplan 4 PHC / Block ANM + Supervisor Educational Facility Plan 5 PHC / Block ANM + Supervisor + MO H2R Plan 6 PHC / Block PHC / Block Cold Chain Handler PHC and Block Logistics Plan 7 PHC / Block PHC / Block Cold Chain Handler Vaccine Distribution Plan 8 PHC / Block Supervisor Supervisor Plan 9 PHC / Block Cold Chain Handler + MO Waste Management + Contingency Plan 1 PHC / Block 0 Supervisor + MO + ANM Communication Plan
    • PLANNING FORMATS – DISTRICT LEVEL S No Level Who will fill Name of format 1 District District Cold Chain Officer + DIO District Vaccine & Logistics Planning Format 2 District District Cold Chain Officer + DIO District Cold Chain Planning Format 3 District District Cold Chain Officer District Contingency Plan 4 District DIO and Other Program Managers District Supervision Plan * Fund Distribution Plan will also be developed at the district once financial norms have been finalized When
    • REPORTING FORMATS – PHC / BLOCK LEVEL S N o Level Who will fill Name of format 1 Session Site Vaccinator (ANM) / AWW Immunization Card 2 Session Site Vaccinator (ANM) Tally Sheet 3 Sector Supervisor Supervisor Checklist 4 PHC Supervisor Supervisor Compilation report 5 Block Block Data Handler (IO / Computer / HS etc) Block Compilation Report When
    • REPORTING FORMATS – DISTRICT / STATE LEVEL S No Level Who will fill Name of format 1 District District Computer District Assistant / Data Handler / Compilation Statistical Officer Report format 2 State State CA State Compilation Report format When
    • REPORTING FORMATS – NATIONAL LEVEL Sl No 1 Level Village / Session site Who will fill Name of format National / Independent Rapid Assessment Observers Format When
    • TIMELINE.. S.No Activity Timeline 1 Develop Action Plan (Core group) Mar 2010 2 Estimate Budget and operational costs for SIA Mar 2010 3 Logistics timeline /Costs etc. For SIA Mar 2010 4 Raising current indent for the vaccine Apr-10 5 Initiating process for procurement of additional vaccines 6 Expected availability of vaccine Aug-10 7 AD Syringes Apr-10 8 9 Initiating process for emergency procurement of additional AD Apr-10 syringes Training and Operational Guidelines including AEFI Draft by Apr-10 guidelines 10 Training Plans 11 Communication Package and Branding for SIA May 2010 12 Vaccinator guidelines Draft by May-10 13 Training guide Draft by May-10
    • TIMELINE..(2) S.No Activity Timeline 14 Key messages Draft by May-10 15 Do's and don'ts Draft by May-10 16 Print and Distribute National guidelines Jun-10 17 National Workshop Jun 2010 18 State level workshops Jun 2010 19 Develop communication materials Jul-10 20 Training of vaccinators and ASHA/AWW Aug-10 21 District level workshops Aug-10 22 Prepare micro-plans Aug-10 23 Review micro-plans Aug-10 24 Review of cold chain systems at district/sub-district levels Jun-10 25 Flow of funds for Ops costs to state Aug-10 26 Flow of funds for Ops costs from state to district Aug-10
    • TIMELINE.. (3) S.No Activity Timeline 27 District level coordination meetings Before campaign/ During campaign for midcourse correction/After SIA to identify gaps 28 Distribution of Vaccines to state Aug-10 29 Distribution of other logistics to state Aug-10 30 SIA Implementation Stage Sep 2010 31 Pre-campaign monitoring end August 32 Campaign monitoring Concurrent - Sept 2010 33 Post-campaign evaluation Oct 2010; results finalized by end Oct 34 Post campaign review at state level Nov-10
    • REFFERENCES          Hoekstra_Measles technical update Moss_Research Agenda INDIAN PEDIATRICS, Vol.49__May 16, 2012 ANNUAL REPORT to the People on Health Government of India, Ministry of Health and Family Welfare September 2010 Epidemiology of Measles,Prof. Ashry Gad Mohd Prof. of Epidemiology Global eradication of measles, WHO EXECUTIVE BOARD, 126th Session Provisional agenda item 4.14, EB126/17, 26 November 2009 GLOBAL MEASLES AND RUBELLA, Strategic Plan 2012- 2020 MILLENNIUM DEVELOPMENT GOALS INDIA, COUNTRY REPORT 2011, Central Statistical Organization, Ministry of Statistics and Programme Implementation, Government of India, www.mospi.nic.in MMWR Weekly / Vol. 60 / No. 38 September 30, 2011