MEASLES MORTALITY REDUCTION IN INDIA Status and Future Plans

1

• MEASLES MORTALITY REDUCTION IN INDIAStatus and
  Future Plans

2
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

3
Basic Demographics and Population Density, India
Total Population Density by State
35 States
Number of persons per sq. km
Updated July 2006
4
Evaluated Coverage for MCV 1 National Family
Health Survey


NFHS-III(2005-06)
NFHS-II(1998-99)
All India Measles Coverage NFHS-III
58.8 NFHS-II 50.7 NFHS-I 42.2
Source NFHS Survey
5
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

Source DLHS(2002-04) Survey
6
(No Transcript)
7
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)

8
Percentage Coverage (Measles) of Annual Target
achieved during last three Immunization Weeks
(2006-07)
9
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

10
Polio cases, India
Year
data as on 16th February 2007
11
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

12
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

13

Integrated AFP and measles surveillance
assisted by NPSP - 2007
Commenced in 2005 2006
Planned to initiate by March 2007
By September will cover 9 sates and 40 of the
population
Planned to initiate by Sept 2007
14
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
Karnataka Annual incidence 10.2 per 100,000
population
Andhra Pradesh Initiated in September 2006
data as on 15th February, 2007
15
Suspected measles outbreaks investigated,
2006 Possibly Karnataka has not tracked some of
the outbreaks
Tamil Nadu
Karnataka
Andhra Pradesh
data as on 15th February, 2007
16
Serologically confirmed measles
outbreaks Percentage of measles cases by age
groups, 2006 89 of cases in Karnataka are under
10 years
Andhra Pradesh
Karnataka
Tamil Nadu
Total cases- 290
Total cases- 1073
Total cases- 1012
data as on 15th February, 2007
17
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
Andhra Pradesh
Karnataka
N89
N407
N339
data as on 15th February, 2007
18
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

19
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

20
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

21
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.

22
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

23
Challenges

• Governments 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

24
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

25
Thank you
26
Monthly reported number of clinically confirmed
measles cases reported, 2006-2007Similar
seasonality in states in south India
Tamil Nadu
Karnataka
27
Estimated Paralytic Polio Cases/year, India
NIDs/SNIDs strengthened
NIDs/SNIDs started
OPV introduced in RI
28
Unicef CES (1998-2005) India (Measles )
Source Unicef CES Survey
All India (country level) data for 2001 not
available