Progress on SIAs and MCV2

introduction in India

Dr. Pradeep Haldar

Deputy Commissioner (Immunization)

Ministry of Health & Family Welfare

Government of India

Washington DC
18-19 Sep 12
 Measles Vaccination in India
• Measles vaccination was introduced under the
National Universal Immunization Programme
(UIP) in 1985 given to children at 9-12 months
age

• Line listing of measles outbreak cases started

in 2005 in selected states.

• In 2010, Government of India introduce 2nd

dose of Measles under UIP through a two
prong strategy.
 2nd dose of Measles vaccine:
State specific delivery strategies
National Technical Advisory Group on
Immunization recommended second
dose of measles vaccine for all states
through state specific delivery
strategies.

• 14 states with MCV1 <80%:

Measles SIA (9 month to <10
years) followed 6 month later by
MCV2 under RI

• 21 states with MCV1 > 80%:

MCV2 under RI at 16 to 24 months
MCV2: Coverage of Measles containing vaccine 2nd dose of age
per DLHS-3; CES-06 for Nagaland

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 MCUP: Basic considerations
 All children in target age-group (9 mo-<10 years) to be
vaccinated
– Irrespective of previous doses of measles vaccine received
– Irrespective of prior history of measles disease

 In general, this age group constitutes around 18-25% of

the total population
– Target: ~135 million children
– Expected coverage: More than 90% (evaluated coverage)

 Massive public health undertaking with an injectable

vaccine

 Both safety and high coverage are critical

 MOH&FW decided to take a phased approach

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 MCUP: Basic operational strategy

 All immunizations from static posts (no HTH immunization)

 Regular routine immunization sessions will be conducted without interruption

– Two regular routine immunization clinics per week
– Measles catch-up campaign in remaining four days

 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 non-school going children
or children missed during school week

 Training
– Only trained persons (ANMs) will work as vaccinators
– All ASHA/ AWW will be trained for beneficiary listing and Inter-personal communication
– Doctors (including clinicians in pvt. sector) have been trained in managing rare adverse
events, if any

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MCUP: session sites and teams
 Types of session sites
– Session sites at Educational Institutes.
– Outreach site (regular RI sites and additional sites in
village/urban mohalla)
– Mobile/Special team
– Facility based session site

 Team composition
– 1-2 Auxiliary Nurse Midwife (ANMs)
– ASHA (Accredited Social Health Activist)
– AWW (Anganwadi Worker)
– Volunteer

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 Overview of Measles SIA
JAMM U & KAS HM IR
Target population:
HI MAC H AL  ~ 135 million children 9
months – 10 years of age
PR AD ES H
PU NJA B
CH AN D IGA RH
UT T AR AK HA N D

 365 districts in 14 states

HA RY AN A

DE LH I AR UN AC H AL PR .

SIKK IM
UT T AR P RA DE SH
RA JAST H AN
ASSA M
NA GAL AN D
BIH AR
MEG HA LAY A

MAN IP UR
JHA RK HA N D
GUJ AR AT MAD H YA PR AD ESH W EST B EN GAL
TR IP UR A
MIZ OR AM Phase 1, 45 districts covered (~ 13 million)
CH H AT T ISG AR H
Phase 2, 152 districts covered (~ 40 million
DA MAN & D IU ORI SSA
D& N HA VEL I
MAH AR A SH TR A
Phase 3, 167 districts planned (~ 81 million)
AN DH R A P RA D ESH

PON D IC HE RR Y
KAR N AT AKA

GOA

A&N IS LAN D S

LAK SH AD W EEP TA MIL N AD U

KER AL A

Phase 1 in 2010 -11; Phase 2 in 2011-12; Phase 3 in 2012-13 Starting Sep 12

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Measles catch-up campaign (MCUP)

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 Measles SIA phasing plan, India
Number of
Total number of Districts covered in Districts covered in
State Districts for Phase
Districts Phase 1 Phase 2
3

ARUNACHAL PR. 16 1 15
ASSAM 26 1 25
BIHAR 38 5 15 18
CHHATTISGARH 18 9 9
GUJARAT 32 5 5 22
HARYANA 21 5 16
JHARKHAND 24 5 19
MADHYA PRADESH 50 5 13 32
MANIPUR 9 1 8
MEGHALAYA 7 1 6
NAGALAND 11 1 10
RAJASTHAN 33 5 5 23
TRIPURA 4 1 3
UTTAR PRADESH 75 3 72
Total 364 45 152 167

Target Population ~134,000,000 13,845,686 40,167,580 ~81,000,000

Coverage 12,076,836 36,102,564
(% Achieved) (87.2%) (89.9%)

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 Coverage achieved: Administrative and
RCA monitoring (MCUP Phase 1 & 2)

48,179,400 of 54,013,266 vaccinated (89.2%)

98 of 197 districts with >= 90% coverage

Number of
Children
monitored
2465 22438 287758 31462 49174 132343 140880 181299 160 3308 2175 41846 3280 27867

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 Campaign awareness & source of
information (in %)
100 94.9  Vast majority of those monitored were
aware of the campaign
90 83.7
 Session sites with visible IEC material –
80 82.6%
70  Sites where social mobilization was
being done by house visits – 88.3%
60
50
40
30
20 16.4
7.7 5.3
10
1.4
0
Awarness for the Health worker/ Teachers Family members/ Newspaper/ TV/Radio/Miking
campaign ASHA/AWW Community Poster/ Banner

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N= 638,660 children monitored

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Reasons for missing vaccination during
Measles catch-up campaigns-India (RCA)
Social mobilisation
Operational
52% Others
44% Social mobilisation includes
•Parents didn’t know of campaigns,
•Didn’t know about Place/Date,
•Didn't give Importance
•Fear of Injection & AEFI

Operational
• No vaccine/logistics
• No vaccinator
•Site too far, long queue
4%
Others
•Family travelling, sick child,
(N – 87,197) •Gone to School etc

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N - Total No of Unvaccinated children verified by RCA – (87,197)
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 Measles SIA timeline (3rd phase)
MADHYA UTTAR
GUJARAT RAJASTHAN BIHAR
PRADESH PRADESH
Period of campaign No. of Districts
Sep-12 12 (17 Sep) 22 (13 Sep) 9 (17 Sep)
Oct-12 7
Nov-12 8 18
Dec-12 5 8 22
Jan-13 6
Feb -13 16
Mar -13 11
Apr-13 23

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Partner support in measles 2nd dose
 Key partners : WHO and UNICEF
 Areas of Support:
 Support to steering committee and operational groups at
national, state and district level.
 Development of strategic guidelines, tools and IEC prototypes
 Program implementation support to states incl. capacity
building and supportive supervision
 Media sensitization at national, state and district levels
 Surveillance in 11 states
 Strengthening cold chain through assessment, supply and
capacity building
 Micro-planning, training, and social mobilization using polio
resources (SMOs and SMNet)
 Campaign monitoring
 Data analysis and dissemination incl. quarterly newsletter

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 Summary of measles 2nd dose
 Measles 2nd dose under RI at 16-24 months introduced in 21
States/UTs in 2010
 Measles SIA completed in 197 districts in 14 states with
coverage of 90% in two phases.
 In 9 states out of 14 completed measles SIA in all districts.
 2nd dose of measles under RI started 6 month after measles SIA
 Remaining 167 districts in 5 states planned/ on going measles
SIA during 2012-13 with target of 81 million children (UP, MP, BI,
RAJ, GUJ)
 Case based surveillance, expansion of laboratory network,
 Rubella vaccination refer to sub committee of NTAGI on strategy
ie vaccinate children or adolescent group or both.

 MEASLES 2ND DOSE WILL BE UNIVERASLIZED IN THE ENTIRE

COUNTRY BY 2014

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Impact on measles transmission

[Data as on August 2012]

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SIA and RI Plans Line listing of measles
surveillance

Surveillance initiated
States with MCV2 through MCUP
2006
States with MCV2 in RI 2007

2009
2010
2011

2012*

MCUP: Measles catch-up campaign

MCV2: Measles containing vaccine, 2nd dose * State workshops conducted in Haryana, March 2012

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Measles cases and outbreaks in districts completed catch-up campaigns and lab
supported measles surveillance before and after start of MCUP
Pre-MCUP Surveillance data from MCUP Post-MCUP Surveillance data from MCUP
districts* MCUP districts #
activity
MCUP Phase & Reference Total Total completed Reference Total Total
State
(No. of districts period number number of by period number of number of
covered) (From) confirmed confirmed (until) confirmed confirmed
measles measles MM-YYYY measles measles
MM-YYYY outbreaks cases MM-YYYY outbreaks cases

1 (1) NA NA 12-2010 12-2011 0 0

Assam 2 (26) 07-2011 7 353 06-2012 08-2012 0 0

1 (5) NA NA 01-2011 01-2012 0 0

Bihar
2 (15) 06-2011 2 82 02-2012 08-2012 0 0

1 (5) 07-2010 14 546 07-2011 07-2012 0 0

Gujarat
2 (5) 03-2011 1 15 03-2012 08-2012 0 0

1 (5) NA NA 03-2011 03-2012 0 0

Jharkhand
2 (19) 07-2011 7 238 03-2012 08-2012 0 0

Madhya 1 (5) 07-2010 5 354 01-2011 01-2012 0 0

Pradesh
2 (13) 01-2011 8 492 01-2012 08-2012 0 0

1 (5) 12-2009 4 211 12-2010 12-2011 2 54

Rajasthan
2 (5) 03-2011 3 60 03-2012 08-2012 0 0

1 ( 26) 23 1111 2 54
Grand
Total
2 (83) 28 1240 0 0

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 Summary
 Of 14 states implementing measles SIA, 6 states (Assam, Bihar,
Gujarat, Jharkhand, MP & Rajasthan) have lab supported measles
surveillance data to make before-after comparisons
– The ‘post-’ window for phase-2 activity is <1 year (Range: 1-7 months) for all
states
– Surveillance sensitivity is variable across states and should be taken into
account while interpreting results
– Quality of MCUP activities have also varied among states

 Overall, in phase 1 & 2 districts

SIA Outbreaks Measles cases
Upto 1 yr before SIA 51 2351
Upto 1 yr after SIA 2 54

 Overall the MCUP strategy has been effective in reducing measles

transmission
 In measles 2nd dose states the size and frequency of measles outbreak
reduced

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 Thank-You
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