Role of Schools in Implementation of
Measles catch-up campaigns
Meeting of Principals of Pvt. Schools
Training of Trainers for Measles SIAs
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Introduction
Measles is a leading cause of childhood mortality
Infants and young children, especially those who are malnourished,
are at highest risk of dying.
Measles outbreak surveillance data reveals that around 90% of the
measles cases are in the age group of <10 years.
Review of Indian Literature: Median case fatality ratio (CFR) of
measles 1.63%*
Because measles infection is so common, even with low CFR
there are many deaths which are “preventable” with a vaccine.
The national coverage for measles vaccine is only 69% (DLHS 3)
At 85% vaccine efficacy, this means 41% (10.3 million) children
are susceptible to Measles
Training of Trainers for Measles SIAs
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Disproportionate burden of measles mortality in India
India: 60,000-100,000 estimated
Measles Deaths (2008)
67%
= 1000 death
Data source: WHO/IVB, November 2009
Dots are randomly distributed in countries
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Measles disease
An acute viral infection
Airborne transmission via respiratory
secretions or aerosols
Classic manifestations:
Maculopapular rash
Fever
The “3Cs”: Cough, Coryza (runny
nose), Conjunctivitis (red eyes)
Complications and mortality highest
in children < 2 yrs and in adults
Measles case, Badaun district, Islamnagar block, Jan 2010
Training of Trainers for Measles SIAs
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Measles complications
Corneal scarring
causing blindness
Vitamin A deficiency
Older children, adults
≈ 0.1% of cases
Chronic disability
Pneumonia &
diarrhea
Encephalitis
Diarrhea common in developing countries
Pneumonia ~ 5-10% of cases, usually bacterial
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Global Context: Worldwide measles vaccination delivery
strategies, mid-2010
Govt of India decision in 2010
to introduce MCV2
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%)
Single dose (1 member state or 1%)
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Principles of control & rationale for second dose
Live attenuated vaccine gives long term immunity
Confers immunity to 85% children when given at 9-12
months of age
Confers immunity to 95% persons when given at >12
months of age
Persons who have failed to respond with first
dose will almost always become immune with
second dose
As coverage is never 100%, 1 dose schedule can
never achieve 95% population immunity.
Training of Trainers for Measles SIAs
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….Benefit after measles vaccination
Bullet points
Bullet Points
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Measles SIA phasing plan, India
State
Total number of Districts
Districts covered in Phase 1
Districts covered in Phase 2
ARUNACHAL PR.
16
1
15
ASSAM
27
1
26
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
TRIPURA
4
1
3
UTTAR PRADESH
75
Total
365
Target Population
~129,597,214
Coverage
(% Achieved)
Number of Districts for
Phase 3
18
22
32
23
3
72
45
153
167
13,845,686
40,167,580
~75,583,948
12,076,836
(87.2%)
36,001,191
(89.6%)
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As of date 24th July, 2012
Catch-up campaign: Basic vaccination strategy …
1/2
Target age group: 9 months to <10 years (irrespective of their prior
measles immunization status or disease history)
In general, this age group constitutes around 20-25% of the total
population
Expected coverage: More than 90% (evaluated coverage)
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
Training of Trainers for Measles SIAs
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Catch-up campaign: Basic vaccination strategy …
2/2
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 (Fixed sites): All health facilities at PHC
level and above will function as session sites throughout the campaign
duration
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Why Schools are Important
School Campaign in 1st week: “Make or Break” for
rest of the campaign
Since schools will cover around half of the target
children, the success of this campaign will depend
largely on the full support, commitment and
ownership of the education sector.
If properly planned, large number of children can be
vaccinated with lesser effort and duration than
community campaign
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School Sites & Teams
Vaccination sites at all educational institutes where <10
years children attend
Government and private schools, crèches, day-care
centers, Madrassa
Complete the vaccination in a school in one day
Timing: As per school timing; match with school shifts.
Extra vaccinators for Urban wards as higher number of
schools
Temporary skilled-vaccinators (nurses, intern doctors,
private doctors, senior nursing students etc.)
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Planning
Enlist all schools in the PHC area, using Form-3
Number of vaccinators to cover a school in one day
= Target population/200.
Vaccination team: Generally a vaccination team
will have




1 trained vaccinator (ANM / Others) *
1 ASHA /Link worker or similar staff (for urban areas)
1 AWW
1 volunteer
* In case the beneficiary load is 150-300 at one outreach site or 200-400
at one school site, the team will have two vaccinators.
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Role of Schools
Organize measles vaccination centre inside the school
Identify a nodal person from the school who will
Provide space in the school
Mobilize and control the flow of children.
Identify teachers as volunteers systematic queue management, mark
tally sheets / marking fingers of children
Mobilize school teachers to support vaccination teams.
Send prior intimation to parents of school children regarding
day of measles immunization at the school and
seek their cooperation.
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Role of Schools
To train teachers to teach school children and parents
about
Benefit of measles immunization in connection with
child health
Inform about the date, time and place of vaccination.
To encourage children to educate/share information
with their parents on
Importance of measles immunization
Date, time and vaccination site for younger siblings
(children less than 5 years in the family)
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Role of Schools
Injection Safety & Waste management plan
Teams should not leave any waste at the school site.
AEFI Management
Assist the vaccination team in case of emergency
Provide transportation if required
Allay concerns of students and parents
Team of Expert doctors for AEFI -120 with AEFI Kit
Not a single case of serious AEFI from – 655921 injection in Patna District
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Impact
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Assessing the impact of campaigns
MCUP-States having
measles surveillance
Phase -1 catch-up
campaign dates
1 year pre Phase 1 MCUP*
Total number
confirmed
measles
outbreaks
Total number of
confirmed
measles cases
1 year post Phase 1 MCUP
Total number of
confirmed measles
outbreaks
18
Gujarat
Mar 11-Jul 11
0
660
8
Madhya Pradesh
Dec 10-Jan 11
Rajasthan
Nov 10-Dec 10
613
0
2
211
30
1,484
Note: Surveillance not implemented until after the campaigns;
Data updated as on 4th March 2012
* Approximately 1 year before start of Phase 1 activity including the campaign months
Training of Trainers for Measles SIAs
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0
0
4
Grand Total
Total number of
confirmed measles
cases
54
2
54
Bihar: Signs of campaign impact
2012 Surveillance results:

Lab confirmed measles outbreaks = 19

Total cases = 1089; Deaths = 8

48% unvaccinated

82% < 10 years of age
N=(1089)
500
41%
36%
400
300
200
11%
7%
MCUP phase 1 Dec 2010-Jan 2011
MCUP phase 2 Nov 2011-Feb 2012
19 Lab confirmed measles outbreaks
1 Lab confirmed rubella outbreaks
9 Lab confirmed outbreaks negative for both measles & rubella
100
6%
0
< 1 year 1-4 years 5-9 years
Training of Trainers for Measles SIAs
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As on wk - 35
10-14
years
>= 15
years
Bihar: Signs of campaign impact
2011 Surveillance results:

Lab confirmed measles outbreaks = 21

Total cases = 2527; Deaths = 16

72% unvaccinated

85% < 10 years of age
1100
N=(2527)
1000
900
42%
800
37%
700
600
500
400
300
MCUP phase 1 Dec 2010-Jan 2011
MCUP phase 2 Nov 2011-Feb 2012
200
100
11%
6%
< 1 year 1-4 years 5-9 years
21 Lab confirmed measles outbreaks
2 Lab confirmed rubella outbreaks
6 Lab confirmed outbreaks negative for both measles & rubella
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As on
wk - 35
8%
0
10-14
years
>= 15
years
Block Wise Achievement Report of Measles Campaign of Patna Rural
(03.12.2012 - 16.12.2012)
Sr.
No.
Name of Block
1
Athmalgola
2
Bakhtiyarpur
3
Barh
4
Belchhi
5
Bihta
6
Bikram
7
Danapur
8
Daniyawan
9
Dhanarua
10
Dulhin Bazar
11
Fathua
12
Ghoswari
13
Khusrupur
14
Maner
15
Masaurhi
16
Mokama
17
Naubatpur
18
Paliganj
19
Pandarak
20
Patna Sadar
21
Phulwarishriff
22
Punpun
23
Sampatchak
Patna Rural
District Total
Target
Coverage
Percentage
19936
49453
31603
12867
55513
37145
54642
18367
46845
27005
41079
15559
21397
54282
52835
44987
45014
57137
33187
45744
48944
33659
24546
871745
1252828
13258
33904
24216
9577
32574
23776
30903
13124
32914
15649
22397
13733
13777
22384
24517
25869
25038
32724
22456
36288
16641
17925
19354
522998
655921
67
69
77
74
59
64
57
71
70
58
55
88
64
41
46
58
56
57
68
79
34
53
79
60
52
Training of Trainers for Measles SIAs
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Block Wise Achievement Report of Measles Campaign of Patna Urban
(03.12.2012 - 16.12.2012)
Sr.
No.
Name of Block
24 SDH Barh
25 SDH Danapur
26 SDH Masaurhi
27 Urban Gardanibagh Hos
28 Urban Guljar bagh Hos.
29 Urban Guru gobind singh Hos
30 Urban Jai prabha Hos
31 Urban Kankarbagh Hos.
32 Urban Maroofganj Hos
33 Urban NGRH
34 Urban Rajbanshi Nagar Hos.
35 Urban Rajendra nagar Hos.
Target
Coverage
Percentage
11801
33234
11801
48271
16832
42267
29861
26809
20980
26667
61561
51000
9043
14768
8730
15623
6208
13900
8121
7119
13844
11722
12149
11502
194
132923
655921
77
44
74
32
37
33
27
27
66
44
20
23
36 Kurji Holy Family
Patna Urban
District Total
381084
1252828
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35
52
Example of a well organized school
campaign
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Queue with vaccination card
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Vaccination & Position of child by teachers/staff
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Make the measles campaign a big event in the district.
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Proper queuing for efficient time management
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Table 1: Well planned site. Note Immunization Cards on table
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Table 2 for Vaccination: Noting the time of reconstitution on the vial
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Table 2: Correct Procedure AD syringe / No touching of the needle or hub / 450
angle for subcutaneous injection
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Table 3: Waste Disposal
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Table 3: Hub Cutter in use
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Table 4: Filling up the Tally sheet
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Inj. Adrenaline
Table 5: AEFI Kit
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Waiting at least 30 minutes after the injection.
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Everybody has an Immunization Card
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MCUP- Urban Schools Details
No of
Schools
No of
Schools
activity
done
No of
Schools
given
time
No of
Schools
not given
time
PTN_DANAPUR SDH
157
119
15
23
PTN_SADAR
238
193
28
17
PTN_URBAN GARDANIBAGH
167
137
0
30
PTN_URBAN GULJARBAGH HOSPITAL
79
59
0
20
PTN_URBAN JAI PRABHA HOSPITAL
88
48
12
28
PTN_URBAN KANKARBAGH
160
91
25
44
PTN_URBAN MAROOFGANJ HOSPITAL
126
109
13
4
85
69
6
10
PTN_URBAN PATNA CITY
133
93
24
16
PTN_URBAN RAJBANSHI NAGAR
200
85
63
52
PTN_URBAN RAJENDRA NAGAR
190
116
14
60
1623
1119
200
304
Urban Planning Units
PTN_URBAN NEW GARDINER ROAD
Patna Urban Total
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For Any Quarry / Support
Please contact to :1- Dr. Lakhinder Prasad,
Civil Surgeon - Patna
(Mob.-09470003600)
2- Dr. S.P. Vinayak,
District Immunization Officer - Patna
(Mob.-09470003548)
3- Dr. Rajesh Kumar Verma
SMO, Patna, Mobile – 09771496458
email – addsmopatna@npsuindia.org
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Thanks
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