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
of age
MCV2: Coverage of Measles containing vaccine 2nd dose
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
HI MAC H AL
PR AD ES H
PU NJA B
CH AN D IGA RH
UT T AR AK HA N D
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
Target population:
 ~ 135 million children 9
months – 10 years of age
 365 districts in 14 states
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
Phase 1, 45 districts covered (~ 13 million)
TR IP UR A
W EST B EN GAL
MIZ OR AM
Phase 2, 152 districts covered (~ 40 million
CH H AT T ISG AR H
ORI SSA
DA MAN & D IU
D& N HA VEL I
Phase 3, 167 districts planned (~ 81 million)
MAH AR A SH TR A
AN DH R A P RA D ESH
KAR N AT AKA
PON D IC HE RR Y
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
Total number of
Districts
Districts covered in
Phase 1
Districts covered in
Phase 2
ARUNACHAL PR.
16
1
15
ASSAM
26
1
25
BIHAR
38
5
15
CHHATTISGARH
18
9
9
GUJARAT
32
5
5
HARYANA
21
5
16
JHARKHAND
24
5
19
MADHYA PRADESH
50
5
13
MANIPUR
9
1
8
MEGHALAYA
7
1
6
NAGALAND
11
1
10
RAJASTHAN
33
5
5
4
1
3
State
TRIPURA
UTTAR PRADESH
75
Number of
Districts for Phase
3
18
22
32
23
3
72
Total
364
45
152
167
Target Population
~134,000,000
13,845,686
40,167,580
~81,000,000
12,076,836
(87.2%)
36,102,564
(89.9%)
Coverage
(% Achieved)
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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
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160
3308
2175
41846
3280
27867
Campaign awareness & source of
information (in %)
100
94.9
90

83.7
80


70
60
Vast majority of those monitored were
aware of the campaign
Session sites with visible IEC material –
82.6%
Sites where social mobilization was
being done by house visits – 88.3%
50
40
30
16.4
20
7.7
10
0
Awarness for the
campaign
Health worker/
ASHA/AWW
Teachers
Family members/
Community
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N= 638,660 children monitored
13
5.3
Newspaper/
Poster/ Banner
1.4
TV/Radio/Miking
Reasons for missing vaccination during
Measles catch-up campaigns-India (RCA)
Social mobilisation
Operational
52%
44%
Others
Social mobilisation includes
•Parents didn’t know of campaigns,
•Didn’t know about Place/Date,
•Didn't give Importance
•Fear of Injection & AEFI
4%
(N – 87,197)
Operational
• No vaccine/logistics
• No vaccinator
•Site too far, long queue
Others
•Family travelling, sick child,
•Gone to School etc
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N - Total No of Unvaccinated children verified by RCA – (87,197)
14
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Measles SIA timeline (3rd phase)
MADHYA
PRADESH
Period of campaign
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
GUJARAT
RAJASTHAN
BIHAR
UTTAR
PRADESH
No. of Districts
12 (17 Sep) 22 (13 Sep) 9 (17 Sep)
7
8
5
8
6
18
22
16
11
23
Feb -13
Mar -13
Apr-13
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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
States with MCV2 through MCUP
Surveillance initiated
2006
States with MCV2 in RI
2007
2009
2010
2011
2012*
MCUP: Measles catch-up campaign
* State workshops conducted in Haryana, March 2012
MCV2: Measles containing vaccine, 2nd dose
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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
districts*
State
MCUP Phase &
(No. of districts
covered)
Reference
period
(From)
MM-YYYY
1 (1)
Assam
2 (26)
Bihar
1 (5)
07-2011
Total
number
confirmed
measles
outbreaks
Total
number of
confirmed
measles
cases
NA
NA
7
MCUP
activity
completed
by
Post-MCUP Surveillance data from MCUP
districts #
MM-YYYY
Total
number of
confirmed
measles
outbreaks
Total
number of
confirmed
measles
cases
12-2010
12-2011
0
0
353
06-2012
08-2012
0
0
NA
NA
01-2011
01-2012
0
0
MM-YYYY
Reference
period
(until)
2 (15)
06-2011
2
82
02-2012
08-2012
0
0
1 (5)
07-2010
14
546
07-2011
07-2012
0
0
2 (5)
03-2011
1
15
03-2012
08-2012
0
0
NA
NA
03-2011
03-2012
0
0
Gujarat
Jharkhand
Madhya
Pradesh
1 (5)
2 (19)
07-2011
7
238
03-2012
08-2012
0
0
1 (5)
07-2010
5
354
01-2011
01-2012
0
0
2 (13)
01-2011
8
492
01-2012
08-2012
0
0
1 (5)
12-2009
4
211
12-2010
12-2011
2
54
2 (5)
03-2011
3
60
03-2012
08-2012
0
0
1 ( 26)
23
1111
2
54
2 (83)
28
1240
0
0
Rajasthan
Grand
Total
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Data as on 13/08/2012
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
Upto 1 yr before SIA
Upto 1 yr after SIA


Outbreaks
Measles cases
51
2351
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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