Transcript Document

MEASLES MORTALITY REDUCTION IN
INDIA
Status and Future Plans
Presentation structure
 Status of routine immunization and polio
eradication
 Implementation of national measles strategic
plan
 Expansion of AFP surveillance to include
measles surveillance
 Coordinated assistance from partners
Basic Demographics and Population Density, India
Total Population Density by State
35 States
Table 1: Demography1
Total Population
Population Growth Rate2
Live Births
Birth Rate
Number of persons
per sq. km
Infant Mortality Rate 2
Children < 1 Year
Children < 5 Years
Children < 15 Years
2005
Percent of Total
Population
1,028,610,328
1.51%
27,552,928
2.7
26.7 / Per 1000 population
68 / Per 1000 live births
25,793,927
2.5
123,974,000
12.1
3
35.3
363,373,000
1
Source: SEAR Annual EPI Reporting Form, 2005.
2
Core Indicators, 2005 (Health Situation in WHO SEAR and WPR).
3
413,417,000 was used to calculate Non-Polio AFP rates in 2005.
Updated: July 2006
Evaluated Coverage for MCV 1: National Family Health Survey
NFHS-II(1998-99)
NFHS-III(2005-06)
Missing or Excluded
0% to 30%
30% to 50%
50% to 70%
70% to 80%
80% to 90%
90% and above
Source: NFHS Survey
All India Measles
Coverage
NFHS-III : 58.8%
NFHS-II : 50.7%
NFHS-I : 42.2%
District-wise evaluated MCV 1 coverage:
DLHS -2002-04
14% of districts coverage below 30%
24% of districts coverage between 30-50%
28% of districts coverage above 80%
Missing or Excluded
0% to 30%
30% to 50%
50% to 70%
70% to 80%
80% to 90%
90% and above
Source: DLHS(2002-04) Survey
Reported/surveyed annual measles vaccination coverage
and cases
India, 1974-2005
Reported measles cases
vaccination coverage (%)
300,000
100%
Reported
90%
250,000
80%
70%
200,000
60%
150,000
50%
Surveyed
100,000
40%
30%
20%
50,000
10%
0
0%
74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05
Year
Reported cases
Source: India MOH/UNICEF
Reported coverage
Unicef CES
NFHS
Key activities to improve routine
immunization coverage
 Development and implementation of multi year plan
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

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for Immunization
Enhanced budget and support through national rural
health mission (NRHM)
Immunization weeks in 2005 and 2006 in states with
low coverage
Monitoring of routine immunization clinics in low
performing states by government and partners
Introduced routine immunization monitoring system
(RIMS)
Percentage Coverage (Measles) of Annual Target
achieved during last three Immunization Weeks (2006-07)
100.00
90.00
70.00
59.52
60.00
50.00
40.00
35.70
30.38
30.00
25.59
18.62
20.00
15.83
15.23
12.35
7.08
10.00
NA
NA
NA
NA
NA
NA
NA
NA
States (reported data of IW1,IW2,IW3)
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Pr
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sh
0.00
A
ru
Coverage of Annula Target(%)
80.00
Current status of Polio eradication
 Consistent progress from 2002 through 2005, falling
cases, reduced geographic distribution of disease
 Outbreak in 2006 a temporary setback
 GOI mobilizing to finish as soon as possible
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Substantial financial commitment
Use of mOPV1
Accelerated rounds to rapidly immunize youngest
children
Capitalize on immunity resulting from recent outbreak
Polio cases, India
2000
1934
1750
1600
1500
1250
1126
1000
672
750
500
265
268
225
250
134
66
0
1998
1999
2000
2001
2002
Year
* data as on 16th February 2007
2003
2004
2005
2006*
Measles Surveillance in 2005
 Passive surveillance
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Aggregate data
Under reporting(52454 cases & 55 deaths in 2005)

States with low coverage reports least number of cases
Little useful epidemiological data
 Measles is included in integrated disease surveillance
program (IDSP)
 Outbreaks
 Investigations carried out by various national, state,
academic institutions
 No standard guidelines
 Limited efforts to consolidate information and initiate action

Key actions for measles control since 2005
 GoI initiated a consultative process with WHO,
UNICEF, IAP, ICMR, NTAGI
 Strategic plan for Measles Control was endorsed
 National measles surveillance and outbreak
investigation guidelines were published
 National polio surveillance project was assigned to
assist and integrate measles surveillance with AFP
surveillance
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State by state approach
Integrated reporting from AFP surveillance sites
Track and investigation of measles outbreaks
 Laboratory network expanded
 One per each state starting measles surveillance
 Two laboratories were accredited and other two due in
2007
Integrated AFP and measles surveillance
assisted by NPSP - 2007
Commenced in
2005 & 2006
Planned to initiate by
March 2007
Planned to initiate
by Sept 2007
By September will cover 9 sates and
40% of the population
Clinically confirmed measles cases 2006
through weekly routine reporting: by blocks
Variation of incidence even among Southern states
Tamil Nadu
Annual incidence
2.8 per 100,000 population
* data as on 15th February, 2007
Karnataka
Annual incidence
10.2 per 100,000 population
Andhra Pradesh
Initiated in September
2006
Suspected measles outbreaks investigated, 2006
Possibly Karnataka has not tracked some of the outbreaks
Tamil Nadu
Karnataka
Tamil Nadu
Karnataka
Andhra Pradesh
29
(1098)
33
(1045)
13
(290)
Measles outbreaks negative
2
2
0
Rubella outbreaks confirmed
(Total cases)
0
2
(109)
0
0
1
(28)
0
Measles outbreaks confirmed
(Total cases)
* data as on
Andhra Pradesh
Mixed outbreaks confirmed
(Total
cases)
15th February,
2007
Serologically confirmed measles outbreaks
Percentage of measles cases by age groups, 2006*
89% of cases in Karnataka are under 10 years
Tamil Nadu
Karnataka
Andhra Pradesh
50
50
40
40
49
50
42
38
40
40
33
31
30
20
30
30
20
20
15
14
10
8
10
9
9
5
10
0
0
< 1 year
1-4 years
5-9 years
10-15 years > 15 years
Total cases- 1012
* data as on 15th February, 2007
4
2
2
0
< 1 year
1-4 years
5-9 years 10-15 years > 15 years
Total cases- 1073
< 1 year
1-4 years
5-9 years
10-15 years > 15 years
Total cases- 290
Serologically confirmed measles outbreaks
Vaccination status of measles cases (1-4 years), 2006
Low incidence, nearly 90% vaccinated cases and very low case fatality
indicates Tamilnadu may not be a priority state for a catch-up campaign.
Tamil Nadu
Karnataka
9% 4%
Andhra Pradesh
17%
25%
29%
22%
61%
87%
N=339
46%
N=407
Vaccinated
* data as on 15th February, 2007
Not Vaccinated
N=89
Unknown
India Technical Advisory Group for
Measles Control
 Formed to advise national government on measles
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
control
Terms of reference and composition recently
endorsed by the Ministry of Health
Director General, Indian Council of Medical Research
will be the chairperson of this 22 member group
Wide expertise and representation - national, state,
medical associations, WHO, UNICEF and
international experts, etc.
Government would call the first meeting in second
quarter of 2007
Coordinated partner assistance
 Draft concept paper has been prepared by
WHO and circulated to partners of measles
initiative
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Key areas for collaboration
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Advocacy
Data for decision-making
Implementation
Fund raising
Key activities for partner assistance:
(Advocacy and data for decision making)
 Ensure adequate staffing to provide measles
technical and managerial support.
 Technical support to review available data on
measles using the Measles Strategic Planning (MSP)
Tool and prepare a situational analysis on measles

Important background document for the first meeting of
the India technical advisory group for measles
 Conduct survey of community perceptions towards
measles and measles vaccination.

By UNICEF community mobilizers and WHO/NPSP
field volunteers
 Conduct measles case fatality rate studies in
selected states
Key issues for consideration and support of
partners: (Implementation)
 Through the GoI, explore potential readiness
and suitability of any States to conduct a SIA
in 2007/2008


Currently available USD 16.7 million from IFFIm
for about 29 million children
If national wide 9 months to -15Y campaigns
planned, would need to target around 350
million children and would need around USD
200 million.


Need to prioritize states according to low routine,
reported incidence and age distribution of cases
Building consensus in India expert advisory group
regarding early implementing states.
Key Area for assistance: Fund Raising
 WHO/UNICEF to further explore with NORAD
about highlighting measles activities
 Measles initiative to look for other potential
donors interested in India
Challenges
 Government’s heavy involvement in finishing
polio at the best opportunity
 Huge target populations for SIAs
necessitating enormous amount of resources
 Funds for surveillance
 Anti vaccination lobbies against polio and
Hepatitis B
Summary
 Government of India has started
implementing measles control strategies
 So far focus has been for routine
immunization strengthening and surveillance
 Government wants to introduce second
opportunity based on surveillance


State wise approach
SIAs need very good planning
 Coordinated support from partners will be
critical
Thank you
Monthly reported number of clinically confirmed
measles cases reported, 2006-2007*
Similar seasonality in states in south India
Tamil Nadu
Karnataka
1350
1350
1335
1200
1200
1050
1050
900
900
750
865
872
750
660
600
507
600
450
450
0
299
289
300
150
493
336
258
300
207
130
55
404
21
20
41
73
62
72
87
Measles cases
446
301
145
Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan05
05
06 06
06 06
06
06
06
06
06 06
06
06
07
421
144
150
111
139
0
Jan06
Feb06
Mar06
Apr06
May06
Jun- Jul-06 Aug06
06
Sep06
Measles cases
Oct06
Nov06
Dec06
Jan07
Estimated Paralytic Polio Cases/year, India
200,000
150,000
NIDs/SNIDs
NIDs/SNIDs strengthened
OPV
introduced started
in RI
100,000
50,000
0
Before
1978
1994
1998
2002
2006
Unicef CES (1998-2005)
India (Measles )
100
90
80
% coverage
70
68.1
60
55.6
55.2
50.2
50
40
30
20
10
0
1998
1999
1998
Source: Unicef CES Survey
NA
2001
2000
1999
2000
2001
2005
2005
All India (country level) data for 2001 not available