MEASLES CONTROL IN INDIA

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MEASLES CONTROL IN INDIA STATUS, STRATEGIES
PLANS

Ms Aradhana Johri, Joint Secretary, Dr Naresh
Goel Asstt Commissioner Ministry of Health
Family Welfare Govt. of India
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Introduction

• Measles Control particularly Mortality Reduction
  is a priority for Government of India.
• GoI constituted India Technical Advisory Group on
  Measles (ITAGM) to develop strategies for Measles
  Control
• In 2008, National Technical Advisory Group on
  Immunization (NTAGI) endorsed recommendations
  made by ITAGM
• GoI has initiated action to implement NTAGI
  recommendation

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Presentation

• Measles morbidity and mortality
• Immunization coverage
• Actions under national strategy for measles
  control

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Measles morbidity and mortality
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Reported Measles Cases India, 1990-2007
MCV1
Source WHO/UNICEF Estimated Coverage, 1997-2007
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Estimated Measles Mortality, India, 2006
150,000 Deaths
94 deaths
4 states ( UP, BI, MP, RJ) contributes to 80
deaths
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Immunization Coverage
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MCV1 coverage (), India 2003 - 2007
Source WHO/UNICEF Estimated Coverage, 1997-2007
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Measles - Coverage 2006 - 07
4 States contributes to 80 mortality, and has
100 million 9m-10 yr population
4 States
17 States with MCV1lt 80 highlighted in RED
Source CES 2006
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Actions under national strategy for measles
control
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Goals - Multi-year strategic plan 2005 - 10

• Reduce measles mortality by two thirds by 2010
  compared to 2000 estimates.
• Achieve at least 90 coverage with measles
  vaccine in 80 districts of country by 2009.
• Collect good quality epidemiological data through
  active surveillance and outbreak investigation
  and use it for further action

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NTAGI Recommendations..

• 2nd Dose as MR in routine EPI States with 80
  evaluated MCV1
• Catch-up measles SIA campaigns (9mo-10 Yr)
  States with lt80 evaluated MCV1.
• Case fatality rate studies in selected high
  burden states.
• Expansion of measles surveillance to be done in
  states with high measles mortality for SIA
  planning and generate baseline data.

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GoI Strategy for sustainable measles mortality
reduction

• Surveillance (aggregate / case-
• based)

4. Improved case management
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Routine Immunization

• Since 2005 GoI initiated multiple steps under
  NRHM to strengthen RI service delivery and
  quality of immunization.
• Intensified efforts for
• Improving service delivery
• Replacement and Expansion of Cold Chain
• Training of immunization staff
• Accelerated disease control,
• AEFI surveillance
• Strengthening program management capacity
• Introduction of under utilized and new vaccines.
• Further in 2009 steps to focus on microplanning,
  review meeting upto subdistrict level, monitoring
  and training of all category of immunization
  staff have been initiated

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2nd Opportunity MR in UIP schedule

• States with 80 evaluated MCV1
• 18 states qualify for MR vaccination in EPI
• MR vaccine will be introduced at 16-24 months
  along with DPT Booster
• Target population 7.36 million
• Vaccine procurement process has been initiated,
  expected to be rolled out in 2nd half 2009

CES 2006 UNICEF/ GOI
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2nd Opportunity Measles SIAs

• States with lt80 evaluated MCV1
• 17 states qualify for measles SIAs
• 4 states ( UP, Bihar, MP, Rajasthan) contribute
  to approx. 80 of total measles mortality in
  country are prioritized for 2009-10.
• Target 9m-10 yr children in 4 states are approx.
  100 million (UP 45m, BI 23 m, MP 16m, RJ 15m)
• Consultation meeting held with 4 states to
  develop operational plan for initiating
  surveillance.

CES 2006 UNICEF/ GOI
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2nd Opportunity Measles SIAs

• Support from partners is required for
• Capacity building particularly in areas of AEFI
  and Waste Management ( WHO )
• Cold chain strengthening in states where SIAs
  are planned (Unicef)
• Setting up of Outbreak Surveillance in states to
  gather baseline data and better understanding of
  case fatality ( NPSP and CDC )
• Planning in detail all aspects of SIA like
  vaccine procurement and phasing of activities
  etc. ( NPSP and others )

CES 2006 UNICEF/ GOI
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Measles Surveillance

• Measles surveillance integrated with AFP
  surveillance in 6 good performing states to track
  and investigate measles outbreaks.
• Consultation meeting held with 4 high priority
  states to expand measles surveillance in these
  states in 2009 assisted by NPSP. Target Regular
  measles reporting is expected by June/July 2009
• Integration being done with IDSP network

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Surveillance data of 6 states- Year 2008
Serologically confirmed measles, rubella and
mixed outbreaks- 2008
142 outbreaks 7185 cases
7185 cases
Age distribution of measles cases - serologically
confirmed measles outbreaks, 2008
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Conclusion

• National measles mortality reduction strategic
  plan is in place.
• NTAGI recommendations guiding Government of India
  in formulating and accelerating national/state
  specific strategies for measles control.
• Actions have been initiated to step up
  surveillance and SIAs in 4 states, which
  contributes to 80 of measles mortality in
  country.

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Thank You
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Measles Coverage Cases