Update on the Implementation of
Measles 2nd Dose in India
Ms. Anuradha Gupta
Joint Secretary, Ministry of Health
Govt. of India
Global Measles and Rubella Management Meeting
Salle B, WHO Headquarters, Geneva, Switzerland
15-17 March, 2011
Presentation outline
 Context
 Introducing 2nd dose of measles
vaccine in India
- MCV2 – Routine immunization
- MCV2 – Catch-up campaigns
 Road map and way forward
India Context
 India steps up public investment in health
 National Rural Health Mission (NRHM)
provides augmented funding to states to
the tune of over INR 550 billion (>$12
billion) during 2005-2010
 System strengthening
- HR Augmentation: 2nd ANM*, 800 000 ASHAs#, additional
doctors
- Infrastructure, Ambulance networks
- Communitization
- Flexible financing
* ANM: Auxiliary Nurse Midwife
#
ASHA: Accredited Social Health Activist
Global Context: Worldwide measles
vaccination delivery strategies, mid-2010
MCV1 & MCV2, no SIAs (40 member states or 21%)
India national immunization
programme introduced
second dose of measles in 2010
Data source: WHO/IVB measles database as of 26 January 2010
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%)
Single dose (1 member state or 1%)
Recommendations from expert Indian
committees


National Technical Advisory Group on
Immunization (NTAGI) recommended:
1.
States with MCV1 coverage <80%: Second opportunity for measles
vaccine through measles catch-up campaigns in 9 months - 10
years age
2.
States with MCV1 coverage >80% MCV2 through routine
immunization at 16-24 months of age
Ad hoc expert review committee reviewed
above strategy in early 2010 and endorsed
the NTAGI recommendation
MCV2 introduction:
State-specific delivery strategies
 SIA in 14 states:
- Target population (9 mo-10
years): 134 million
- Vaccine doses and AD
syringes: 147 million
- Mixing syringe : 29.5 million
 MCV2 in routine
immunization in 21
states:
- Annual targets
 1-2 year population: ~10 million
 Vaccine doses: ~12 million
SIA: MCV1 <80%: 14 states
RI: MCV1 > 80%: 21 states
Introduction of 2nd dose of Measles in RI,
India
Annual Target 1-2 year
Ongoing:
4 states (0.4 million)
2010:
3 states (1.2 million)
2011:
11 states (5.9 million)
To be decided: 3 states (2.2 mln)
Measles Catch-up campaigns
MCV2 introduction through catch-up
vaccination campaign (MCUP) Phase 1
 In three phases
- Target: 134 million in 351
districts
 Phase 1:
- 45 districts from 13 states with
~13 million target children
 9 district from Chhattisgarh
 5 districts from each of the 6 states
(Bihar, Jharkhand, Rajasthan, Madhya
Pradesh, Gujarat & Haryana)
 1 district from each of the North-East
states
 Phase 2 to take place from
September 2011
 Phase 3 in 2012
Key operational strategies: MCUP-1
 Immunization from fixed posts to ensure safe injection
practices
- Routine immunization and outreach sites used
- Additional sites added as needed
- Schools with children under 10 years targeted
- Specific 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
 Medical officers trained to establish AEFI management
networks equipped with management kits
 Regular weekly RI sessions continued without interruption
- Measles catch-up campaign activities conducted during remaining days
of week
Measles catch-up campaign budget
1. Vaccine/ADS,
33.2 million USD
2. Op cost
25.9 million USD
3. Total
59.1 million USD

Target

Per child cost
134 million
0.44 USD
Administrative coverage achieved in MCUP1@
10.2 million children vaccinated so far (92% coverage)
in 39 districts across 11 states
100
90
80
% Coverage
70
60
50
40
30
20
10
(9
)
Jh
ar
kh
an
d*
(5
)
Na
ga
lan
d*
(1)
Tr
ip
ur
a*
(1)
isg
ar
h
(5
)
Ch
ha
tt
ha
n
Ra
jas
t
M
an
ip
ur
(1)
(5
)
Pr
ad
es
h
5)
na
(
M
ad
hy
a
Ha
ry
a
Bi
ha
r(
5)
(1)
sa
m
As
Ar
un
ac
ha
lP
r.
(1)
0
State (No. of Districts covered in phase 1)
* Provisional data
@
From 39 districts where campaign completed
Reasons for non-vaccination in MCUP1
(from Monitoring data)*
Parents didn't know about campaign
9.1
Parents didn't know place or date of the
campaign
Fear of injection
20.2
15.5
Fear of AEFI
1.1
1.3
1.0
10.0
Parents didn't give importance to
campaign
Child was sick
Comm
unicati
on
related
There was no vaccine at the site
There was no vaccinator at the site
8.6
11.3
Site was too far
Child was traveling
19.9
Source: MoHFW, RCA monitoring
1.8
Other Reason
* As reported by caregivers to monitors
Operat
ional
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
Areas for improvement
 Coordination and planning
- Better coordination among the three primary 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.
Way forward
 MCV2 introduction
- Routine Immunization (21 states): Started in 7 states; will start in
all 21 by 2011
- Catch-up: Will complete in all 14 states by 2012
 State and national review meetings to compile best practices and
lessons learned planned in April 2011
 Measles mortality reduction through immunization plus NRHM
initiatives to improve access to health care at grassroots
 Laboratory supported measles surveillance initially in states
with higher burden
- At least one state level laboratory in each state for measles
serology
 Build synergies of catch-up campaigns with
Routine Immunization