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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
Number of persons per sq. km
Total Population Density by State
Updated: July 2006
Table 1: Demography1 2005Percent of Total
PopulationTotal Population 1,028,610,328
Population Growth Rate2 1.51%Live Births 27,552,928 2.7
Birth Rate
Infant Mortality Rate 2
Children < 1 Year 25,793,927 2.5
Children < 5 Years 123,974,000 12.1
Children < 15 Years 363,373,000 3 35.3
26.7 / Per 1000 population
68 / Per 1000 live births
1Source: SEAR Annual EPI Reporting Form, 2005.
3 413,417,000 was used to calculate Non-Polio AFP rates in 2005.
2 Core Indicators, 2005 (Health Situation in WHO SEAR and WPR).
35 States
NFHS-III(2005-06)NFHS-II(1998-99)
Source: NFHS Survey
Evaluated Coverage for MCV 1: National Family Health Survey
Missing or Excluded
0% to 30%
30% to 50%
50% to 70%
70% to 80%
80% to 90%
90% and above
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
Source: DLHS(2002-04) Survey
Missing or Excluded
0% to 30%
30% to 50%
50% to 70%
70% to 80%
80% to 90%
90% and above
14% of districts coverage below 30%24% of districts coverage between 30-50%28% of districts coverage above 80%
Reported/surveyed annual measles vaccination coverage and cases
India, 1974-2005
0
50,000
100,000
150,000
200,000
250,000
300,000
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
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Reported cases Reported coverage Unicef CES NFHS
Source: India MOH/UNICEF
Reported measles cases vaccination coverage (%)
Reported
Surveyed
Key activities to improve routine immunization coverage Development and implementation of multi year plan
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)
59.52
25.59
35.70
12.35
30.38
7.08
18.62
NA NA NA NA NA NA
15.23
NA NA
15.83
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00
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Bihar
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Mad
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Uttara
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Wes
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States (reported data of IW1,IW2,IW3)
Co
vera
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of
An
nu
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arg
et(%
)Percentage Coverage (Measles) of Annual Target
achieved during last three Immunization Weeks (2006-07)
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
Substantial financial commitment Use of mOPV1 Accelerated rounds to rapidly immunize youngest
children Capitalize on immunity resulting from recent outbreak
Measles Surveillance in 2005
Passive surveillance 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 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
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
Integrated AFP and measles surveillance assisted by NPSP - 2007
Clinically confirmed measles cases 2006 through weekly routine reporting: by blocks
Variation of incidence even among Southern states
* data as on 15th February, 2007
Tamil NaduAnnual incidence2.8 per 100,000 population
KarnatakaAnnual incidence10.2 per 100,000 population
Andhra Pradesh
Initiated in September 2006
Suspected measles outbreaks investigated, 2006Possibly Karnataka has not tracked some of the outbreaks
Tamil Nadu Karnataka Andhra Pradesh
Measles outbreaks confirmed
(Total cases)
29
(1098)
33
(1045)
13
(290)
Measles outbreaks negative 2 2 0
Rubella outbreaks confirmed
(Total cases)0
2
(109)0
Mixed outbreaks confirmed
(Total cases)0
1
(28)0
* data as on 15th February, 2007
Tamil Nadu Karnataka Andhra Pradesh
Serologically confirmed measles outbreaksPercentage of measles cases by age groups, 2006*
89% of cases in Karnataka are under 10 years
Total cases- 290Total cases- 1073
Total cases- 1012
* data as on 15th February, 2007
Andhra PradeshKarnatakaTamil Nadu
Serologically confirmed measles outbreaksVaccination 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.
N=89
Andhra Pradesh
Vaccinated Not Vaccinated Unknown
* data as on 15th February, 2007
N=407
Karnataka
N=339
Tamil Nadu
India Technical Advisory Group for Measles Control Formed to advise national government on measles
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 Key areas for collaboration
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
Monthly reported number of clinically confirmed measles cases reported, 2006-2007*Similar seasonality in states in south India
Tamil Nadu Karnataka
Estimated Paralytic Polio Cases/year, India
OPV introduced
in RI
NIDs/SNIDsstarted
NIDs/SNIDs strengthened