role of schools - in implementation of measles catch-up campaigns

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Training of Trainers for Measles SIAs

Role of Schools - in Implementation of

Measles catch-up campaigns

Meeting of Principals of Pvt. Schools

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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

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Disproportionate burden of measles mortality in India

Data source: WHO/IVB, November 2009

India: 60,000-100,000 estimated Measles Deaths (2008)

67%

= 1000 deathDots are randomly distributed in countries

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Measles disease

An acute viral infectionAirborne transmission via respiratory secretions or aerosolsClassic manifestations:

Maculopapular rashFeverThe “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

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Measles complications

Corneal scarring causing blindnessVitamin A deficiency

Encephalitis

Older children, adults

≈ 0.1% of cases

Chronic disability

Pneumonia &diarrheaDiarrhea common in developing countries

Pneumonia ~ 5-10% of cases, usually bacterial

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Global Context: Worldwide measles vaccination delivery strategies, mid-2010

MCV1 & MCV2, no SIAs (40 member states or 21%)

MCV1 & regular SIAs (59 member states or 31%)

MCV1, MCV2 & one-time catch-up (36 member states or 19%)

MCV1, MCV2 & regular SIAs (57 member states or 28%)

Single dose (1 member state or 1%)

Govt of India decision in 2010 to introduce MCV2

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Principles of control & rationale for second dose

Live attenuated vaccine gives long term immunityConfers immunity to 85% children when given at 9-12 months of ageConfers 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.

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Bullet pointsBullet Points

….Benefit after measles vaccination

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Measles SIA phasing plan, India

State Total number of Districts Districts covered in Phase 1 Districts covered in Phase 2Number of Districts for

Phase 3

ARUNACHAL PR. 16 1 15

ASSAM 27 1 26

BIHAR 38 5 15 18

CHHATTISGARH 18 9 9

GUJARAT 32 5 5 22

HARYANA 21 5 16

JHARKHAND 24 5 19

MADHYA PRADESH 50 5 13 32

MANIPUR 9 1 8

MEGHALAYA 7 1 6

NAGALAND 11 1 10

RAJASTHAN 33 5 5 23

TRIPURA 4 1 3

UTTAR PRADESH 75 3 72

Total 365 45 153 167

Target Population ~129,597,214 13,845,686 40,167,580 ~75,583,948

Coverage (% Achieved)

12,076,836 (87.2%)

36,001,191 (89.6%)

As of date 24th July, 2012

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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

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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 campaignSince 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-3Number 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 planTeams should not leave any waste at the school site.

AEFI ManagementAssist the vaccination team in case of emergency

Provide transportation if required

Allay concerns of students and parents

Not a single case of serious AEFI from – 655921 injection in Patna District

Team of Expert doctors for AEFI -120 with AEFI Kit

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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* 1 year post Phase 1 MCUP

Total number confirmed measles

outbreaks

Total number of confirmed

measles cases


measles outbreaks


measles cases

Gujarat Mar 11-Jul 1118

6600

0

Madhya Pradesh Dec 10-Jan 118

6130

0

Rajasthan Nov 10-Dec 104

2112

54

Grand Total30

1,4842

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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

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19 Lab confirmed measles outbreaks 1 Lab confirmed rubella outbreaks 9 Lab confirmed outbreaks negative for both measles & rubella

2012 Surveillance results: Lab confirmed measles outbreaks = 19 Total cases = 1089; Deaths = 8 48% unvaccinated 82% < 10 years of age

MCUP phase 1 Dec 2010-Jan 2011

MCUP phase 2 Nov 2011-Feb 2012

Bihar: Signs of campaign impact

N=(1089)

6%

41%36%

11%7%

As on wk - 35

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21 Lab confirmed measles outbreaks 2 Lab confirmed rubella outbreaks 6 Lab confirmed outbreaks negative for both measles & rubella

2011 Surveillance results: Lab confirmed measles outbreaks = 21 Total cases = 2527; Deaths = 16 72% unvaccinated 85% < 10 years of age

MCUP phase 1 Dec 2010-Jan 2011

MCUP phase 2 Nov 2011-Feb 2012

Bihar: Signs of campaign impact

N=(2527)

6%

42%

37%

11%8%

As on wk - 35

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Sr. No.

Name of Block Target Coverage Percentage

1 Athmalgola 19936 13258 672 Bakhtiyarpur 49453 33904 693 Barh 31603 24216 774 Belchhi 12867 9577 745 Bihta 55513 32574 596 Bikram 37145 23776 647 Danapur 54642 30903 578 Daniyawan 18367 13124 719 Dhanarua 46845 32914 70

10 Dulhin Bazar 27005 15649 5811 Fathua 41079 22397 5512 Ghoswari 15559 13733 8813 Khusrupur 21397 13777 6414 Maner 54282 22384 4115 Masaurhi 52835 24517 4616 Mokama 44987 25869 5817 Naubatpur 45014 25038 5618 Paliganj 57137 32724 5719 Pandarak 33187 22456 6820 Patna Sadar 45744 36288 7921 Phulwarishriff 48944 16641 3422 Punpun 33659 17925 5323 Sampatchak 24546 19354 79

871745 522998 601252828 655921 52

Patna Rural

District Total

Block Wise Achievement Report of Measles Campaign of Patna Rural(03.12.2012 - 16.12.2012)

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Sr. No.

Name of Block Target Coverage Percentage

24 SDH Barh 11801 9043 77

25 SDH Danapur 33234 14768 44

26 SDH Masaurhi 11801 8730 74

27 Urban Gardanibagh Hos 48271 15623 32

28 Urban Guljar bagh Hos. 16832 6208 37

29 Urban Guru gobind singh Hos 42267 13900 33

30 Urban Jai prabha Hos 29861 8121 27

31 Urban Kankarbagh Hos. 26809 7119 27

32 Urban Maroofganj Hos 20980 13844 66

33 Urban NGRH 26667 11722 44

34 Urban Rajbanshi Nagar Hos. 61561 12149 20

35 Urban Rajendra nagar Hos. 51000 11502 23

36 Kurji Holy Family 194381084 132923 35

1252828 655921 52District Total

Patna Urban

Block Wise Achievement Report of Measles Campaign of Patna Urban(03.12.2012 - 16.12.2012)

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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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Table 5: AEFI Kit

Inj. Adrenaline

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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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Urban Planning UnitsNo 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

PTN_URBAN NEW GARDINER ROAD 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

Patna Urban Total 1623 1119 200 304

MCUP- Urban Schools Details

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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 – [email protected]

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Thanks

role of schools - in implementation of measles catch-up campaigns

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