MEASLES CATCH-UP IMMUNIZATIONCAMPAIGN DR. RAGHAVENDRA HUCHCHANNAVAR Junior Resident, Community Medicine, PGIMS, Rohtak
• Introduction• Rationale for second dose• Planning Measles Catch-up Campaign• Pre-implementation activities• Implementing Measles Catch-up Campaign• AEFI• Monitoring and evaluation• Post-campaign review
INTRODUCTION• Measles is a highly infectious viral disease for which humans are the only reservoir.• Agent -> single stranded RNA virus, family Paramyxovirus, genus Morbillivirus.• Transmission -> primarily person‐to‐person via aerosolised droplets.• Average incubation period –> 14 days (range 7–18 days).• Clinical features - characterised by generalised maculopapular rash that starts at the hairline and descends to whole body, fever, conjunctivitis, coryza, cough and the presence of Koplik‟s spots in the mouth.• Infectivity period – 4 days before to 4 days after onset of rash.
INTRODUCTION Complications -• Pneumonia, diarrhoea, otitis media, laryngo‐tracheo‐bronchitis (croup), encephalitis and long term disabilities blindness, deafness.• The 3 major causes of high case fatality are pneumonia, diarrhoea and croup.• Low Vitamin A status is associated with a higher rate of complications and death from measles.• India: 2010 - 219 outbreaks, 29808 reported cases& In 2011 - 129 outbreaks, 9211 reported cases (data as on 15th Jun, 2011)
SEROLOGICALLY CONFIRMED MEASLES OUTBREAKS:AGE AND VACCINATION STATUS OF MEASLES CASES,2011 Total cases = 9,221 4000 3800 3600 3400 61 % no or unknown 3200 3000 2800 2600 vaccination status 2400 2200 86 % < 10 yrs of age 2000 1800 1600 1400 1200 1000 800 600 400 200 0 < 1 year 1-4 years 5-9 years 10-14 years >= 15 years Vaccinated Not Vaccinated Unknown* data as on 15th Jun, 2011
DISPROPORTIONATE BURDEN OF MEASLES MORTALITY IN INDIA 77%Data source: WHO/IVB, November 2009 Department of Immunization, Vaccines and Biologicals (IVB)
INTRODUCTION• Vaccine : Most of the live, attenuated measles vaccines used now originate from the Edmonston strain of measles virus isolated by Enders and Peebles in 1954.• Strain widely used in India – Edmonston-Zagreb• Stored at 2 to 8°C and to be used within 4 hours after reconstitution.• Vaccine is heat and light sensitive.• Route and dose – 0.5ml given subcutaneously in the right upper arm (triceps fold).• WHO guidelines – first dose at 9-12 month, second dose at 16-24 months.
RATIONALE FOR SECOND DOSE• Measles is a leading cause of childhood mortality, and the reduction of child mortality is a key Millennium Development Goal (MDG 4).• Analysis of measles outbreak data for the period 2006 to 2009, in states with outbreak surveillance reveals that around 90% of the measles cases were in the age group of <10 years.• Vaccine effectiveness, under field conditions, 85% when given at 9 months and 95% when given at >12 months of age.• As per DLHS-3 survey coverage of the 1st dose of measles stands at 69.6%.
RATIONALE FOR SECOND DOSE• With 85% vaccine effectiveness for vaccination at 9 months, actual protection was offered to only 60% of annual birth cohorts (70% × 85% = 60%).• In other words, at least 40% remained susceptible to measles.• A second opportunity measles immunization given at or above one year of age (>95% effectiveness) along with simultaneous increase in first dose coverage in the population is an effective way to reduce the proportion of susceptible children in the community and to prevent measles outbreaks.• 192 of 193 Member States of WHO use 2 doses of measles vaccine in their national immunization programmes, India being the only exception.
RATIONALE FOR SECOND DOSE MCV1 & MCV2, no SIAs (41 member states or 21%) MCV1, MCV2 & one-time catch-up (37 member states or 19%) MCV1, MCV2 & regular SIAs (54 member states or 28%) MCV1 & regular SIAs (60 member states or 31%) Single dose (1 member state or 1%)Data source: WHO/IVB measles database as of 26 January 2010
PLANNING The National Technical Advisory Group on Immunization (NTAGI) recommendations• For states/UT with evaluated coverage of ≥80% - A second dose of measles vaccine through routine immunisation be given to children of 16-24 months of age. 21 states/UT qualify for this strategy. Of these 4 states/UTs (Delhi, Goa, Puducherry and Sikkim) are already using second dose of measles in their RI programme (as mumps-measles-rubella vaccine) through state resources. Annual targets :1-2 year population: ~10 million
PLANNING• For states/UT with evaluated coverage of <80% - Supplementary immunization activity (SIA) to provide a second opportunity for immunisation. 14 states qualify for large scale catch-up campaigns. The catch-up campaigns will target 134 million children . All children in the target age group (9 months – 10 years) will be vaccinated irrespective of their previous immnisation status or history of measles disease.
PLANNING• Measles catch-up campaigns need coordination and participation at all levels – national, state, district and block for successful implementation and achievement of high coverage levels.• Establishing SIA implementation committees at each levels for all aspects of campaign is critical for success..• Regular scheduled meetings should include review of progress, problems encountered, proposed solutions and new action points with clearly defined responsibilities and deadlines.
COMMITTEES• At national level there will be two committees National Steering Committee Central Operations Group• At state level there will be State Steering Committee State Operations Group Catch-up campaign control room• At district level there will be District Task Force District Control Room
AT NATIONAL LEVEL National Steering Committee• This will be chaired by Secretary (Health and Family Welfare), Government of India• The committee will coordinate activities among Government departments like Education, Women and Child Development, Social Welfare, NRHM, AYUSH, Railways, Civil Aviation etc. to mobilize human and other resources .• Coordination with civil society organizations like Rotary, Lions etc; professional bodies like IMA, IAP, IPHA, IAPSM etc and partners like WHO, National Polio Surveillance Project (NPSP), UNICEF, USAID, Red cross and other organisations.
AT NATIONAL LEVEL Central Operations Group (COG)• A Central Operations Group will be established to coordinate the technical aspects of the activity.• It will comprise officials from Government of India, WHO, National Polio Surveillance Project (NPSP), UNICEF, USAID, Red Cross and other partners at the national level chaired by the Joint Secretary (RCH), Health & Family Welfare, Government of India.
The role of the Central Operations Group is to meet on a regular basis to:• Provide technical and logistic support to plan, implement, monitor and evaluate the catch-up campaign at national and state levels.• Ensure inter departmental coordination with donor coordination division, vaccine procurement division and IEC division.• Develop and finalize media plan with timeline.• Monitor implementation of IEC/Social Mobilization activities at national, state and district levels.• Coordinate with DAVP (Directorate Of Advertising And Visual Publicity), Song and Drama Division, Doordarshan, AIR, Field publicity etc.• Provide feedback to the Secretary and obtain timely approvals within the Government
STATE LEVEL State Steering Committee (SSC)• Established under the chairmanship of the State Health Secretary.• Its role is similar to that of Central Steering Committee i.e, To mobilize human/other resources and coordinate planning and implementation of activities with other government departments and partner agencies. Coordinate activities among Government departments, civil organizations, professional bodies, partners and other organizations.
STATE LEVEL State Operations Group (SOG)• The SOG will lead planning and implementation activities at the state.• The Mission Director/Director, Family Welfare will chair the Operations Group.• The State Immunization Officer (SIO) will be the member- secretary.• State level representatives of key Departments such as Social Welfare, Education, IDSP, Panchayati Raj Institutions, WCD, Transport, Media and partners such as WHO-NPSP, UNICEF, Red Cross, Professional bodies like IMA, IAP etc, religious leaders, minority groups should be invited to attend coordination committee meetings.
STATE LEVEL The role of State Operations Group (SOG) is to• Provide technical and logistic support• Ensure inter sectoral coordination and full utilization of resources.• Provide feedback to the Secretary and obtain timely approvals.• Develop a communication plan: Utilize all available resources and channels for delivering simple and clear messages to the community.• Draw up state specific IEC and IPC plans.• Monitor implementation of IEC/social mobilization activities in the states.• Respond appropriately to the media regarding program implementation, progress, safety and AEFI.
STATE LEVEL Catch-up campaign control room• The control room will be set up in each state.• The State EPI Officer, State Cold Chain Officer, NPSP, UNICEF, representatives from other development partners and a nominated member from the state government should be stationed in the Control Room for planning, monitoring, coordination and implementation of activities.• The role of the control room should be to monitor preparedness on a day to day basis especially mobilization of human and other resources like transport, ensure inter- sectoral coordination and full utilization of resources from partner government and non-government departments.
STATE LEVEL• Catch-up campaign control room should also monitor implementation of the programme during the activity.• The control room will be providing feedback to the state steering committee and state operations group on progress being made and also on any obstacles being faced.
DISTRICT LEVEL District Task Force (DTF)• DTF should be formed under the chairmanship of the District Collector/ Magistrate in each district, CMO/DIO should be the member secretary.• District level officers from Education, ICDS, Police, transport, Media, CDO/ ADM, PRI, DUDA (District Urban Development Agency), local bodies like municipalities, councils etc, professional bodies and partner organizations along with representatives from religious groups and opinion leaders should be the participating members of DTF.• The role of the district task force is to support, supervise, monitor and ensure implementation of the highest quality measles campaign in the district .
DISTRICT LEVEL District Task Force Meetings• The District Task Force should meet at least five times.• The District Magistrate/District Collector will chair these meetings.• He/she may delegate this responsibility to CDO or ADM for some of these meetings.• The second and the fourth meetings are critical and should always be chaired by District Magistrate.• A compliance report on the decisions taken must be submitted in the subsequent meeting.Chief Development Officer(cdo) , Additional District Magistrate(ADM)
DISTRICT LEVEL Meetings of district task force• First: Four weeks before the round to review preparations and logistics• Second: One week prior to the start of the campaign to review preparedness, validate micro-plans and address any problems• Third: One week after the start of the campaign to review progress of school activity and make corrections.• Fourth: 2 weeks after the start of the campaign to review progress and make mid-course corrections.• Fifth: Immediately after the completion of the campaign to review monitoring and other data and ensure that children in areas with low coverage are immunized immediately.
DISTRICT LEVEL• A Control room at District level should be set up to monitor preparedness of blocks/ PHCs/ urban areas on a day to day basis and to monitor implementation of the programme during the activity and give feedback to the state control room.
PRE-IMPLEMENTATION ACTIVITIES Conducting pre-campaign meetings, trainings and workshops• To ensure that the micro-planning guidelines are followed, logistics and supplies properly arranged for, and personnel involved at all operational levels clearly understand their roles and activities to be undertaken; trainings/meetings listed below must be conducted before the measles catch- up campaign at each level.• A meetings/training plan and timeline should be included in the microplan for each state, district and block.
TRAINING CASCADE • National Measles SIA Training of Trainers (ToT) • State Measles SIA Training of Trainers (ToT) • District Measles SIA Training • Block Level Trainings
PRE-IMPLEMENTATION ACTIVITIES The overall objectives of the training are:• To ensure that all staff involved in Measles SIA understand their role in the SIA• That the micro-plans at the sub centre level are completed.• That all vaccinators have appropriate knowledge and skills to conduct the SIA at each of their catchment areas.• The batch size at all trainings at any level should not be more than 30.
PRE-IMPLEMENTATION ACTIVITIES• National and State level Training of Trainers:• First stage: one day training by central team to State Health Functionaries (Deputy Health Directors, State Immunization Officers, other identified State level master trainers). This training of trainers will be completed at least 2 months prior to the SIA in each phase.• Second stage:course will be conducted at state level for District Level Trainers (District level health officers, Medical Officers, Health Assistants, and Cold Chain Officers etc). The training will be completed at least 6 weeks prior to the SIA in each phase.
PRE-IMPLEMENTATION ACTIVITIES• Third stage: each district will conduct a district SIA training of trainers for all block level trainers like medical officers, cold chain handlers, data handlers and other block level functionaries. This will be one day training and should be competed at least 4 weeks before the SIA in each phase.• Vaccinators, Supervisors Training: All vaccinators (ANMs, MPWs, Nurses and others) of each vaccination team and supervisors (HA, LHV, BEE, HS etc) will be trained by the Block Medical Officer and team (duration one day) at the block level. The training will be completed 1-2 weeks prior to the SIA in each phase.• Volunteer orientation: At PHC level will be done by the Medical Officers and supervisors. This will be 2-3 hours training and should be completed at least 1 week prior to
MICRO-PLAN: BASIC NORMS• Target population:Enumeration/reliable estimate of target population (9months - <10 years).• Estimation of children enrolled in schools• Take the highest of the available estimates for planning.• Vaccine doses supplied to school session (1st week) = No. of beneficiaries in school X 1.1• Vaccine doses supplied to outreach session (2nd & 3rd weeks) = No. of beneficiaries in village X 1.1 X 75%.
MICRO-PLAN: BASIC NORMS• Vaccine vials required=Vaccine doses / 5 (for 5 dose vials).• Reconstitution syringes (5 ml) Required = Vaccine vials• Hub cutters=At least 1 per vaccinator• Marker Pens = 1 pen per 300 children. At least 1 per session site.• Red plastic bags = 1 per 50 syringes• Black plastic bags = 2 per session site per day
MICRO-PLAN: BASIC NORMS• Number of teams needed to cover a school in one day = Target population/200.• Number of teams needed to cover a village/urban area in one day = Target population/150.• 1 supervisor per 3 teams.• Plan to complete measles immunization in one day in a village or an urban area (mohallas) or in a school by 1 or more vaccinator teams as required.• DIO is accountable for completeness, timeliness and quality.• PHC will be the unit of micro-planning.
MICRO-PLAN: BASIC NORMS• 1 litre of cold chain space for vaccine storage= 200 doses of measles vaccine (excluding diluents)• Cold chain space required for vaccine (in litres)= measles vaccine doses required /200.• 1 litre of cold chain space for diluent storage = Diluents for 250 doses of measles vaccine• Minimum Cold chain space required for diluents (in litres) = Diluent doses required for 1 day/250.• 1 ILR small with net vaccine storage volume of 45 litre can store 9,000 doses of Measles vaccine without diluents.• In case of inadequate space, vaccines can be supplied in aliquots (50% before activity, 25% at end of first week and 25% at end of second week).• During the campaign, only large standard vaccine carriers with four icepacks will be used for carrying vaccine.
MICRO-PLAN: SUB-DISTRICT LEVEL• Micro-plans at the Block/PHC level should have the following components 1.Session site and human resource plan with vaccine and logistic estimates by session sites 2.Map showing location of session sites. 3.Cold chain plan including ice pack freezing plan 4.Logistics distribution plan with route charts on map 5.Waste management plan 6.Training plan 7.Communication Plan 8.AEFI management plan 9.Supervision plan Plan for covering missed children Contingency plans for human resources, logistics and cold chain
VACCINATION TEAM• A Vaccination team will have• 1-2 vaccinators (ANM / Male HWs / LHV / retd. ANMs, LHVs / pharmacists / nurses / doctors).• In case the beneficiary load is 150-300 at outreach site or 200-400 at school site, the team will have two vaccinators.• 1 ASHA / Link worker or similar staff (for urban areas).• 1 AWW• 1 volunteer To ensure injection safety no team will conduct more than one vaccination session in one day. Zero tolerance to AEFI due to program errors (TSS or wrong diluent)
COMMUNICATION AND SOCIAL MOBILIZATION Proper communication will help to• Build and maintain confidence in immunization.• Create an enabling environment for vaccine introduction and demand.• Improve quality of interaction between health workers and caregivers.• Manage controversies.
COMMUNICATION AND SOCIAL MOBILIZATION Engaging religious leaders Briefing mediaIPC with community Engaging school children Using mid-media
COMMUNICATION AND SOCIAL MOBILIZATION Communication campaign• The communication campaign begins with advocacy and social mobilization, and includes both IEC (information, education, communication) and IPC (Interpersonal communication).• Apart from advocacy at state and district levels, all functionaries at the service delivery level (ANM, Supervisor, ASHA, AWW, volunteer) should be trained to deliver the right messages through IPC.• This will include focus group discussions at the village level (involving opinion leaders and parents/caregivers) prior to the campaign to address their concerns and questions
COMMUNICATION AND SOCIAL MOBILIZATION Advocacy• Success of a campaign will depend on strong advocacy with related Government departments, civil society including the press and professional groups (IMA, IAP etc.) at each level.• A very strong partner is media (both at the state and local levels).• This calls for special advocacy with the media to gain their support for the campaign – from planning stages to the end of the campaign and after.• Partnership with media will also be useful in the event of AEFI.• Advocacy Meeting should be held with all teachers and Teachers union of schools having target children, local religious and community leaders, among Government departments, civil organizations, professional bodies, partners and other organizations.
COMMUNICATION AND SOCIAL MOBILIZATION• Inter personal communication (IPC)• At least two weeks before the campaign ASHA (or AWW if ASHA not designated) will visit all the households in her area and complete a due listing of all target age group children.• During the process of due listing ASHA will do IPC regarding the campaign and inform parents/care-givers about dates and session sites at schools and village as relevant.• In the week before the campaign ASHA will revisit the households.• During the campaign after the school phase ASHA (or AWW) will check and update her due list.• On the campaign day in the village, by mid-morning ASHA (or AWW) will track the un-immunized children from her due list.• Urban areas will have to be covered in a similar manner in coordination with staff from urban ICDS, municipalities and other departments
EXPERIENCES FROM PHASE 1 CATCH-UP CAMPAIGNS• GoI supported all logistic and operation costs of the activities Budget committed for subsequent phases• Cold chain capacity and management met expectations• No major issues with vaccine and injection equipment management• Large scale campaigns with injectable vaccines can be conducted safely in India Medical officers in all SIA districts trained in AEFI management, reporting No instance of AEFI due to programme error detected All reported AEFIs managed effectively• Administrative coverage variable across states: 39 districts completed campaigns so far 49% (19/39) with >= 90% coverage
REASONS FOR NON-VACCINATION IN MCUP1 (FROM MONITORING DATA)* Parents didnt know about campaign 9.1 Parents didnt know place or date of the 20.2 campaign Comm Fear of injection 15.5 unicati Fear of AEFI on Parents didnt give importance to related campaign 1.1 Child was sick 1.3 10.0 1.0 There was no vaccine at the site There was no vaccinator at the site 8.6 11.3 Site was too far Operat ional Child was traveling 1.8 19.9 Other ReasonSource: MoHFW, RCA monitoring * As reported by caregivers to monitors
AREAS FOR IMPROVEMENT• Coordination and planning Better coordination among the departments of Health, Education and ICDS Flexible approach with states for timeline; but stringent adherence to agreed upon timeline• Communication and advocacy IEC and interpersonal communication at grass-root level Civil society and professional bodies: Indian Academy of Pediatrics, Indian Medical Association, Others Private schools• Vaccination in urban areas poses special challenges• Injection waste management needs strengthening• Supervision needs to be improved at all levels.
CATCH-UP CAMPAIGN• All immunizations from static posts (no HTH immunization)• Types of session sites Session sites at Educational Institutes: All types of schools where <10 years children attend will be used as vaccination sites. These sites will be covered in the first week of the campaign. Outreach site (regular RI sites and additional sites in village/urban mohalla): Children who do not go to school or those left out during the vaccination week in schools will be covered from regular RI/UIP sites during the 2nd and 3rd weeks. Mobile/Special team: Street children and other high-risk populations in urban areas are most likely to have missed their routine dose in their infancy and may also miss the second opportunity. Facility based session site: All health facilities at PHC level and above will function as session sites throughout the campaign
CATCH-UP CAMPAIGN• Key operational strategies1. Measles immunization will be given from fixed sites and each session site will remain open from 8:00 AM to 2:00 PM.2. Routine immunization will continue uninterrupted per weekly schedule.3. ASHA/AWW will mobilize target children to session site and also help ANM in organizing the session and manage crowd control.4. Three weeks campaign (12 working days) 1st week in educational institutes; 2nd and 3rd week in existing UIP outreach sites.5. Only trained vaccinators will be used for vaccination.6. Volunteer support will be required at each vaccination post.
CATCH-UP CAMPAIGN7. Within national guidelines certain flexibility will be allowed at local level considering local limitations and constraints.8. Strong monitoring of cold chain system to ensure vaccine potency and safety.9. Only the large vaccine carrier with four ice-packs will be used during campaign for transporting vaccines.10. All components of immunization safety will be adhered to.11. Throughout the campaign period (3 weeks) one fixed vaccination centre in block and municipality will remain open to vaccinate the children missed during day-to-day campaign activities.
MONITORING & MID-COURSE CORRECTION• Supervisors will monitor areas immediately on completion of activity and check at least 20 target age-group children.• BMO should review supervisors‟ checklists and monitoring feedback on a daily basis to identify areas requiring action as below.• Rapid assessment of coverage by Supervisors & independent monitors on a daily basis:• If according to either supervisors‟ independent monitors‟ observations 2 or 3 children found „missed‟ (un-immunized): motivate and mobilize missed children to the nearest campaign or routine immunization session site. 4 or more children found un-immunized: Vaccinator team should revisit the area to immunize all missed children.
Haryana – Phase 1, 2A and 2B 95Phase 1Phase 2 APhase 2 B DATA OF 2011 IS UPTO WK 38
HARYANA SCENARIO• Measles Catch-up Campaign Phase-1 was conducted in 2010 in 5 districts of Haryana namely Faridabad, Guragaon, Mewat, Palwal and Jhajjar, wherein 13 lakh children were vaccinated.• Phase 2-A: was conducted from November 14 to December 5, 2011 in six districts (Rohtak, Bhiwani, Sonipat, Panipat, Mahendragarh and Rewari) with a target population of 13 lakh children.• Rohtak – Target population – 190,822 Coverage – 185042 (96.97%)
HARYANA SCENARIO• The phase 2-B of Measles catch up campaign will be launched in 10 districts of Haryana from January 9.• The campaign will be launched in Ambala, Fatehabad, Hisar, Jind, Kaithal, Karnal, Kurukshetra, Panchkula, Sirsa and Yamunanagar.• Haryana would be the first state in the country to complete Measles catch-up campaign in all its districts.
IMMUNISATION SAFETY• It may be more difficult to maintain immunization safety standards during campaigns than during routine services.• To ensure the safety of injections during campaigns and outbreak control activities, WHO and UNICEF recommend that sufficient quantities of auto‐destruct syringes (which cannot be reused) and safety boxes be provided for every fixed or temporary post and every outreach team.• Injections must not be given during campaigns if adequate quantities of these syringes are not available.
IMMUNISATION SAFETY• Use a new sterile packed AD syringe for each injection for each child.• Use the same syringe to draw and administer the vaccine.• Do not pre-fill syringes.• Do not attempt to recap the needle.• Immediately after injecting the child, the AD syringe must be cut.• Safe disposal of injection waste.
IMMUNISATION SAFETY• In order to ensure immunization safety, health workers must be particularly aware of the need to ensure that the vaccine vial monitor does not indicate that the vial has been exposed to high temperature at some point, to keep reconstituted measles vaccine cool, to use an AD syringe for every injection, even if this means ending a session early.• Proper injection procedures should be observed at all times.• Reconstituted vaccine should be discarded after four hours or at the end of a session, whichever comes first. A VVM is not of use after the vial is open.
Using the Hub-cutter Correctly Cut here Handle Hub NeedleInsertion Hole Puncture proof container •Cut needles and hub • Broken vials and ampoules
ADVERSE EVENTS FOLLOWING IMMUNISATION(AEFI)Causes of AEFI DescriptionProgrammatic These are events caused by an error in vaccine handling,errors preparation or administration. Programmatic errors are the most frequent cause of adverse events and can be avoided.Vaccine reaction Caused by the vaccine even when given correctly. This is caused by inherent properties of the vaccine itself or by an individual‟s response to the vaccineCoincidental The event occurs after immunization, there is no association between the immunization and the medical incident following the immunization.Injection Reaction An event from anxiety about, or pain from, the injection itself rather than the vaccine.Unknown cause
RISK OF COMPLICATIONS AFTER NATURAL MEASLES INFECTIONAND SELECTED AEFI AFTER MEASLES VACCINATION Complication Risk after vaccination (events/no. of doses) Fever ≥ 39.4 C 1 in 9 Rash 1 in 10 Febrile convulsions 1 in 2500 Encephalitis/ Encephalopathy (and 1 in 1,000,000 other serious neurological disorders Sub‐acute sclerosing panencephalitis 1 in 1,000,000 Anaphylaxis 1 in 1,000,000
ADVERSE EVENTS FOLLOWING IMMUNISATION(AEFI)• Anaphylaxis is are but severe and potentially fatal allergic reaction.• Vaccinators, paramedics and physicians should be able to distinguish anaphylaxis from fainting (Vasovagal syncope), anxiety and breath-holding spells.
CONTENTS OF AN AEFI TREATMENT KIT• Injection adrenalin (1:1000) solution – 2 ampoules• Injection Hydrocortisone (100 mg) – 1 vial• Disposable Syringe (insulin type) having 0.01 ml graduations and 26G IM needle – 2 sets• Disposable Syringe (5 ml) and 24/26G IM needle – 2 sets• Scalp vein set – 2 sets• Tab Paracetamol (500 mg) - 10 tabs• I/V fluids (Ringer lactate/Normal Saline): 1 unit in plastic bottle• I/V fluids (5% Dextrose): 1 unit in plastic bottle
CONTENTS OF AN AEFI TREATMENT KIT• IV drip set: 1 set• Cotton wool + adhesive tape : 1 each• AEFI reporting form (FIR)• Label showing: Date of inspection, Expiry date of Inj. Adrenaline and shortest expiry date of any of the components• Drug dosage tables for Inj Adrenaline and Hydrocortisone• At hospital setting, Oxygen support and airway intubation facility should be available.
STEPS IN MANAGEMENT OF ANAPHYLAXIS Anaphylaxis? Assess ABC: Airway/Breathing/Circulation Diagnosis: Look for Acute onset of illness/Life threatening problems with A-B- C/Skin changes Call for help/Lie patient flat/Raise patient’s legs/Keep airway clear/If necessary give CPR Inj. Adrenaline IM (1:1000 solution) Inj Hydrocortisone Refer to next level, as needed In hospital settings: Establish airway/High flow oxygen/IV fluids
MONITORING AND EVALUATION• State and District level Officers should be allotted districts/blocks/urban areas which should be meticulously visited before the activity for monitoring the preparedness and during the activity to monitor the implementation of the activity.• Qualitative and quantitative assessment on the immunization activity from observers should be utilized for mid-course corrective actions like retraining of vaccinators, review of micro-plans etc. or immediate corrective actions like repeating the activity in an area where significant number of unimmunized children are found after completion of activity.
MONITORING AND EVALUATION• Following the campaign, review meetings should take place at District, State and National levels to identify the strengths and weaknesses of the activities.• It is important that all stakeholders should participate in this process to document best practices and lessons learned to ensure the highest quality of campaigns in the future.• The outcome of the catch-up campaign is measured by the proportion of the target population (children 9 months to 10 years) who were vaccinated during the SIA.
MONITORING AND EVALUATION• There are two approaches to estimate measles campaign vaccination coverage:1. Administratively based on campaign field reports and estimated target populations.2. Conventional household surveys using cluster sampling methodologies.• The second approach is often used to validate administrative coverage and is seen as the gold standard for assessment of the coverage attained during a measles catch-up campaign.
MONITORING AND EVALUATION• Evaluation of the impact of the campaign• Impact of the campaign is related to the reduction in measles related morbidity and mortality as a result of the measles catch-up campaign and the increased immunity of the population to the virus.• This will be measured through sensitive laboratory supported measles surveillance.
POST-CAMPAIGN REVIEW• Criteria for the determination of the interval and age target during follow up measles SIAs1. After measles SIAs that achieve relatively homogeneous coverage rates of >90%• If routine measles coverage >60%‐79% ‐ an interval of 3 years is recommended targeting children aged 9‐47 months.• If routine measles coverage <60% ‐ an interval of 2 years is recommended targeting children 9‐35 months of age.2. After measles SIAs that achieve relatively homogeneous coverage rates <90%• If routine measles coverage >80% ‐ an interval of 3 years is recommended.• If routine measles coverage <80% ‐ an interval of 2 years is recommended.3. After measles SIAs with “relatively heterogeneous” coverage rates• A decision should be made on a case by case basis after detailed analysis of country data
POST-CAMPAIGN REVIEW• New measles mortality reduction goal• In May 2010, the WHA (World Health Assembly) endorsed the following measles control targets for 2015 as milestones towards measles eradication: • Increasing measles immunization coverage to >90% nationally and >80% in every district; • Reporting an incidence of <5 cases/1 000 000 population; and • Reducing measles mortality by 95% compared with 2000 levels.
REFERENCES• WHO/UNICEF Joint Annual Measles Report 2010.• Measles Catch-up Immunization Campaign, Guidelines for Planning and Implementation, Ministry of Health and Family Welfare Government of India, June 2010.• Measles SIAs Planning & Implementation Field Guide, World Health Organisation Regional Office For Africa, April 2010.• Measles Catch-up Immunization Campaign, Handbook for field level workers, Ministry of Health and Family Welfare Government of India, August 2010.• iGovernment ,Haryana News.• Measles Control in SEAR, Current Progress and Plans, Annual Meeting of Partners for Measles Advocacy American Red Cross National Headquarters .
• Facilitators‟ guide: Handbook for field level workers, MoHFW, Govt. of India, August 2010.• National Measles SIA Training of Trainers,16-17th August 2010, NIHFW.• Office of Civil surgeon, Rohtak, Haryana.
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