Measles elimination orig


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Measles elimination orig

  3. 3. History• One of the earliest written descriptions of measles as a disease was provided by an Arab physician in the 9th century who described differences between measles and smallpox in his medical notes.• A Scottish physician, Francis Home, demonstrated in 1757 that Measles was caused by an infectious agent present in the blood of patients. In 1954 the virus that causes measles was isolated in Boston, Massachusetts, by John F. Enders and Thomas C. Peebles.
  4. 4. • Measles• Caused by a RNA virus• Paramyxo virus• Only one antigenic type• Remain active in room temp for at least• 24hrs• Reservoir/ source – human• Transmission – respiratory route
  5. 5. Contd….• Temporal pattern – peak in late winter• and spring• Communicability – 4days before and 4 days after rash onset• Incubation period – 10-12 days (7-18 d range)
  6. 6. Measles complications Corneal scarring causing blindness Vitamin A deficiency (Common) Encephalitis Older children, adults ≈ 0.1% of cases Chronic disability Pneumonia & Diarrhea (Common) Diarrhea common in developing countries Pneumonia ~ 5-10% of cases, usually bacterialdesquamation SEPIO Meet, 18-20 May 2011 Bose, WHO 6
  7. 7. Global burden• According to 2010 datas• 1,39,300 deaths globally due to measles• Nearly 380 deaths/day• 15 deaths/hr• Of these most of the deaths belongs to children < 5 years• >95% deaths occurs in low income countries with weak infrastructures
  8. 8. • Comparing datas with 2000• In the year 2000 there are 5,35,000 deaths due to measles compared to 1,39,300 in 2010• There is 74% reduction in deaths compared to 2000• 85% estimated MCV coverage in 2010 compared to 2000 with only 72%• 65% countries reached >= 90% MCV coverage in 2010
  10. 10. VisionAchieve and maintain a world without measles, rubella and CRSGoalsBy end 2015• Reduce global measles mortality by at least 95% compared with 2000 estimates• Achieve regional measles and rubella / CRS elimination goals
  11. 11. By end 2020 Achieve measles and rubella elimination in at least 5 WHO regionsMilestonesBy end 2015 Reduce annual incidence to < 5cases/mill and maintain that level Achieve at least 90% coverage with the first routine dose of MCV nationally
  12. 12. • And exceed 80% vaccination coverage in every district• Achieve at least 95% coverage with M,MR,or MMR during SIAs in every district• Establish a target date for the global eradication of measles
  13. 13. • By end 2020• Sustain the achievement of the 2015 goals• Achieve at least 95% coverage with both the first and second routine doses of measles vaccine in each districts and nationally
  14. 14. Strategy to eliminate measles• The strategy of 2012 – 2020 builds on experiences in AMERICAS and in countries in other WHO regions that successfully eliminated indigenous transmission of measles…• There are five components in this strategy :
  15. 15. Components• 1. Achieve and maintain high levels of population immunity by providing high vaccination coverage with 2 doses of measles 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
  16. 16. • 4. Communicate and engage to build public confidence and demand for immunization.• 5. Perform the research and development needed to support cost-effective operations and improve vaccination and diagnostic tools
  17. 17. 1.Achieve and maintain high levels of population immunity• Coverage >=95%• Unvaccinated children old enough to receive MCV1 (9 or 12 months)• Strengthening routine immunization• 2nd dose via RI 1 month after 1rst dose ( 15 to 18months gen) or at school entry• Catch up and follow up
  18. 18. 2.Monitor disease using effective surveillance and evaluate to ensure progress• Effective surveillance needed to provide information :• 1. To set priorities• 2. Plan activities• 3. Allocate resources• 4. Implement prevention programmes• 5. Respond to outbreaks• 6. Evaluate control measures
  19. 19. • WHO developed standards based on• 1. Case based surveillance with laboratory confirmation• 2. In depth outbreak investigations• 3. Identification of viral genotypes from every outbreak• Measles elimination : the absence of endemic measles cases for a period of 12 months or more, in the presence of adequate surveillance
  20. 20. • INDICATORS : 1. VACCINATION COVERAGE• Vaccination coverage indicator : vaccine coverage of both 1rst routine measles dose (MCV1) and 2nd dose of Measles vaccination (routine or SIAs)• Vaccination coverage target : achieving and maintaining at least 95% coverage with both MCV1 and the 2nd dose of measles vaccination in all districts and nationally
  21. 21. • 2.OUTBREAK SIZE:• Outbreak size indicator: monitoring of outbreak size of all outbreaks including outbreaks in closed setting and outbreaks where interventions have taken place to stop the outbreak• Outbreak size target : at least 80% of outbreaks should have less than 10 confirmed measles cases
  22. 22. • 3. INCIDENCE:• Incidence indicator: measles incidence /mill/year• Incidence target: measles incidence of less than 1 confirmed measles case per million population per year excluding cases confirmed as imported
  23. 23. • 4. ENDEMIC MEASLES VIRUS STRAIN(s):• Endemic measles indicator : the number of endemic measles virus strains• Endemic measles target : zero cases of measles caused by an endemic strain for at least 12months
  24. 24. 3.Develop and maintain outbreak preparedness and respond rapidly• In elimination setting :• Single case outbreak rapid investigation and response• In emergency setting:• Urgent coordinated SIAs include vit A supplementation prevent outbreaks and child mortality
  25. 25. • Mortality reduction setting• Each confirmed outbreak requires a thorough risk assessment to guide the decisions and planning of outbreak response immunization.
  26. 26. 4.Communicate and engage to build public confidence• Community awareness regarding• 1. Immunization rights• 2. Benefits• 3. Safety• 4. Available services• Will promote public acceptance and participation
  27. 27. 5.Perform research and development• CDC in may 2011 highlighted critical research areas necessary to achieve measles eradication:• 1. Measles epidemiology• 2. Assessing vaccine efficacy and effectiveness• 3. Needle free vaccine delivery methods• 4. Improved methods for laboratory testing for measles
  28. 28. • 5. New immunization strategies• 6. Improved methods to monitor and evaluate vaccination programmes• 7. Development of effective advocacy tools to use with decision makers• 8. Improved messages and strategies to communicate with potential beneficiaries and their families• 9. Economic analyses of different strategic options and mathematical modeling.•
  29. 29. INITIATIVES IN INDIA• Accelerated measles control strategy• Update on accelerated measles control – Mcv-2 in routine services – Catch-up campaigns – Laboratory supported measles surveillance• Linkages with RI
  30. 30. Principles of accelerated measles control strategies in India1. Improve and sustain routine immunization coverage (MCV- 1)2. Provide a second opportunity for measles immunization to all eligible children (MCV-2)3. Sensitive, laboratory supported measles outbreak surveillance for case/outbreak confirmation4. Fully investigate all detected measles outbreaks and ensure appropriate case management
  31. 31. Global Context: Worldwide measles vaccination delivery strategies, mid-2010 India MCV1 & MCV2, no SIAs (40 member states or 21%) MCV1, MCV2 & one-time catch-up (36 member states or 19%) MCV1, MCV2 & regular SIAs (57 member states or 28%) MCV1 & regular SIAs (59 member states or 31%)
  33. 33. 2nd Dose of Measles vaccine: State specific delivery strategies SIA: MCV1 <80% RI: MCV1 > 80%MCV1: Coverage of Measles containing vaccineper DLHS-3; CES-06 for Nagaland
  34. 34. 2nd Dose ofMeasles in RI• 17 states (MCV1>80%) introduced measles 2nd dose in their routine immunization program• 45 districts, who completed measles campaign in phase -1 are in process of introducing 2nd dose in their RI program
  35. 35. MCV2 introduction through Supplementary Immunization Activity (SIA) in Phases Phase 1  Initiated in November 2010;  45 districts from 13 states o 9 district from Chhattisgarh o 5 districts from each of the 6 states (Bihar, Jharkhand, Rajasthan, Madhya Pradesh, Gujarat & Haryana) o 1 district from each of the 6 North-East states  Approximately 14 million target children 9 months – 10 yrs
  36. 36. Reasons for un-vaccinated children: RCA surveys results Parents didnt know about the 1 11 0 campaign IEC/IPC 9 (43.7%) 20 Parents didnt know about place 9 or date of the place or date of the campaign Fear of injection Un-aware of 10 need (43.9%) 16 Fear of AEFI 11 Operational Gap (3.7%) 20 3 Parents didnt give importanceN=unvaccinated children; 30,200Note: Figures are % of total responses provided
  37. 37. 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
  38. 38. Lesson learnt from 1st Phase: 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 ,BCC and interpersonal communication – IAP, IMA and private doctors sensitization – Private school principals orientation• Vaccination in urban areas• Injection waste management• Supervision at all levels
  39. 39. Measles SIA plan, India Phase 1, 45 districts covered Phase 2 A (144 districts) Phase 2 B (81 districts) Phase 3 (91 districts) Total target- 135 million children Districts- 361
  40. 40. Planned phases of measles catch-up campaigns Phase 1 Phase 2A Phase 2B Phase 3 TotalDates Q4 2010 – Q3 – Q4 Q1 2012 Q4 2012 Q2 2011 2011No. districts 45 144 81 91 361Target population 14.0 41.5 33.4 47.0 135.0(9m-10yrs)millionsChildren 12.0vaccinated(millions)
  41. 41. Expansion of measles outbreak surveillance • Reporting of clinical measles cases linked with AFP weekly reporting in these states • One state level lab2006 strengthened in each2007 state testing for measles2009 and rubella IgM2010 2011
  42. 42. 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 * Serologically and epidemiologically confirmed cases ** Data from 8 states (Andhra Pradesh, Gujarat, Karnataka, Kerala, Madhya Pradesh,* data as on 15th Jun, 2011 Rajasthan, Tamilnadu and West Bengal
  43. 43. Serologically confirmed# measles, rubella and mixed outbreaks (Andhra Pradesh, Gujarat, Karnataka, Kerala, Madhya Pradesh, Rajasthan, Tamil Nadu and West Bengal) # 2011* 2010 Widespread measles virus transmission indicating gaps in RI 129 outbreaks 219 outbreaks 109 Measles outbreaks confirmed 198 10 Rubella outbreaks confirmed 16 10 Mixed outbreaks confirmed 5* data as on 15th Jun, 2011 # Outbreak confirmation for Measles: 2011 ≥ 2 cases IgM positive for measles and rubella
  44. 44. RI – Measles synergies• Measles catch-up campaigns has helped, RI – By augmenting AEFI surveillance (reporting & management) – By improving injection safety practices on a large scale – By enforcing waste management practices (as per national guidelines) – By optimizing cold-chain space & efficient vaccine stock management practice at various levels (state/district/block) – Encouraging fixed-day , fixed-site session based approach• RI-measles synergy study is being done in jharkhand• Year 2012 declared year of intensification of RI – Operational plan under development
  45. 45. Thank you! 54