Download - Supplementary Immunization Activities Quality, Risks and Risk Management IEAG Meeting 13 July 2011
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Supplementary Immunization Activities
Quality, Risks and Risk Management
IEAG Meeting
13 July 2011
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Supplementary Immunization Activities (SIAs) India, Jan to June 2011
NID SNID
Endemic & risk states
Endemic & risk states
Zone 1 UP/Bihar, Delhi & HR areas
Mar Apr May JunJan Feb
mop up in West Bengal / Jharkhand
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SIAs – India, January to February 2011
23 Jan
2nd week Feb
27 Feb
mOPV1mOPV3
bOPV
tOPV
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SIAs – India, March to June 2011
March
bOPV
tOPV
April
May June
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Emergency Outbreak Response Howrah, West Bengal, 2011
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Day 6
Mop up conducted
Day 4
•National level partners meeting•Media plan operationalized•Vaccine arrived in district
Day 3
•State & District Task Force Meetings•14 additional SMOs arrive in districts•IEC plan developed•Marker pens & other logistics procured
Day 2
•Field Investigation (NCDC/NPSP/UNICEF)•National Technical Group Meeting •Decision on mop up
Day 1
Chief Minister & Chief Secretary WB
informed by GoI
Day 0
Wild Polio virus
notified
Day5
Vaccine & other logistics reach blocks
Key Immediate Actions that followed detection of case
7 Feb 2011 13 Feb 2011
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Major Issues Identified• Microplanning
– Missed Areas– High work load of vaccinators & supervisors– Composition of vaccination teams not appropriate – No revisits planned to ‘X’ houses
• Training– Weak interpersonal communication skills of vaccinators– Untrained vaccinators working as team members
• Non-acceptance of vaccine– High refusals (~ 47000 refusals in Howrah and 3 neighbouring districts)– Myths against vaccine safety
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Outbreak Response Actions(GoI/ GoWB, WHO-NPSP, UNICEF, Rotary, CORE)
• Identification of 36 high risk blocks/municipalities & 222 high risk Gram Panchayats/wards to focus activities
• Enhanced oversight & coordination by central and state officials, DMs, CMOs, Municipality/ Ward Officers, BDOs, BMOs
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Outbreak Response Actions (2)(GoI/ GoWB, WHO-NPSP, UNICEF, Rotary, CORE)
• 25 experienced additional SMOs deployed to the outbreak area for 4 months to support
– Improvements in microplans: ensure no missed areas, appropriate team composition and workload
– Trainings: to improve skills & performance of vaccinators and supervisors
– Intensive monitoring of preparedness & implementation in high risk areas
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Outbreak Response Actions (3)(GoI/ GoWB, WHO-NPSP, UNICEF, Rotary, CORE)
• Scale up of IEC/ mobilization efforts– 1900 NGO mobilizers deployed– Additional IEC materials produced– Enhanced media support– Sensitization of Influencers/ religious
leaders and local practitioners– Advocacy/ vaccination during community
events– Health Camps– Vaccination at clinics of important
practitioners
• Mandatory revisits to ‘X’ marked houses accompanied by doctors/ local influencers
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Outbreak response, West Bengal
Howrah, 2011
Murshidabad, 2010
bOPV mOPV1
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
WPV1 notified
07 Feb 2011
WPV1 notified
12 Feb 2010
1
123
45
6
7
2
3
456
7
Num
ber
of W
PV
5 weeks 17 weeks
1 week7 weeksWPV1
WPV3
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Summary – SIAs in 2011
• At least one SIA with tOPV conducted in all areas in the country – most areas got 2 tOPV rounds
• 3 to 5 campaigns conducted with bOPV in high risk areas
• Aggressive Emergency Outbreak Response conducted in West Bengal following detection of WPV type 1 in Howrah district in 2011
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SIA quality in high risk areas/populations
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Areas/ Populations at highest risk of polio
Areas with recent polio transmission
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Areas/ Populations at highest risk of polio
Areas with recent polio transmission
Endemic areas
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Areas/ Populations at highest risk of polio
Areas with recent polio transmission
Endemic areas
Areas with high migrant populations
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West Bengal Jharkhand
Malegaon (Maharashtra)
Areas with recent transmission
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Percent unvaccinated children End-of-round survey
Southern districts, West Bengal
Per
cent
Per
cent
N= 7,525 6,665 8,193 11,933
N= 6,556 7,574 7,686
11,027
7,065
Northern districts, West Bengal
1,371 4,490 2,996 4,020 3,515
11,787
10,320
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Howrah
Per
cent
Per
cent
24-Parganas South
N= 2,158 762 1,034 1,487
N= 2,405 2,347 1,998 2,341
Per
cent
24-Parganas North
N= 1,153 866 2,067 2,535 2,858 2,018
1,423
Per
cent
Kolkata
N= 1,451 2,220 2,674 3,995 3,629
Percent unvaccinated children, End-of-round survey, 2011
Quality of SIAs in southern districts - West Bengal
2,092 3,393
2,846 2,847
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Percent unvaccinated children, End-of-round survey
Jharkhand
West Bengal
High coverage achieved in high risk areas of Jharkhand
Per
cent
Pakur & Sahibganj
N= 2,945 3,213 5,904 9,779 8,398 6,088 4,163 5,568 5,509 6,197 6,151
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Jharkhand
West Bengal
Lot Quality Assurance Sampling (LQAS) West Bengal & Jharkhand – Feb to June 2011
District Feb 11 Mar 11 Apr 11 May 11 Jun 11
Murshidabad (West Bengal)
# lots accepted 6 2 1 3 4
# lots cautioned 1 2 3 2 1
# lots rejected 1 0 0 0 0
Birbhum (West Bengal)
# lots accepted 1 - - - -
# lots cautioned 0 - - - -
# lots rejected 0 - - - -
Pakur
(Jharkhand)
# lots accepted 8 - - - 10
# lots cautioned 1 - - - 0
# lots rejected 0 - - - 0
Hypothesis: “The SIA coverage in this LOT is > 90%.”
Only 1 of 46 lots rejected in North Bengal/Jharkhand during last 5 SIAs
LQAS findings validate monitoring findings from end-of-round surveys
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Per
cent
Percent unvaccinated children, End-of-round survey
N= 1,989 4,424 4,193 3,151 3,844 3,946 3,115 3,155
Malegaon Municipal Corporation
# houses with reluctance to accept OPV, End-of-round
Num
ber
3,798
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Summary – Areas with recent transmission
• West Bengal (Northern districts): Improvement in SIA quality since September 2010 - sustained over last 9 months – a few pockets of low coverage persist
• West Bengal (Southern districts): Rapid improvement in SIA quality during past 4 months, however quality variable in districts; pockets with gaps in quality remain – require immediate addressal
• Jharkhand: Sustained good quality campaigns over last 9 months
• Malegaon (Maharashtra): Large proportion of unvaccinated children during multiple rounds – recent worsening of quality
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Western UPCentral Bihar
Endemic Areas
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Continued intensive focus on vaccination in field huts - Kosi area, Bihar
• > 280,000 clusters of field huts (basas) visited by vaccination teams each round
• Intensive supervision and monitoring
Percent unvaccinated children detected in field huts (basas)
~ 3,000 children checked per round
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Percent unvaccinated children – end of round survey
West UP
2009 2010 2011
Bihar
2009 2010 2011
~40,000 children checked for vaccination status each round in 107 high risk blocks
High polio vaccination coverage sustained in 107 highest risk blocks of UP and Bihar
66 HR blocks
41 HR blocks
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Lot Quality Assurance Sampling (LQAS), 66 highest risk blocks, West UP, June 2011 – A Pilot
SIA round 66 HR blocks
June 2011
# lots accepted 58
# lots cautioned 11
# lots rejected 1
Hypothesis: “The SIA coverage in this LOT is > 95%.”
HR blocks in which LQAS done
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Percent households having a child with diarrhea that had received Zinc tablets, June 2011
Source: NPSP SIA monitoring data
1% 22%
Household checked =1,444 Households checked =2,115
Zinc distribution to children with diarrhea 107 highest risk blocks of UP and Bihar
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Summary – Endemic Areas
• Intensive series of SIAs conducted with bOPV in endemic areas in first half of 2011
• High coverage during polio SIAs being sustained in the high risk areas of UP and Bihar
• Implementation of certain components of 107 high risk block plan remain a challenge
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# children: 0.8 mn in each round
# children: 0.5 mn in each round # children: 1.1 mn
in each round
# children: 0.7 mn in each round
Migrant populations vaccinated 5-6 times (Jan to June 2011)
Areas with high migrants / mobile populations
Delhi, Mumbai, Punjab, Haryana, Gujarat, Uttarakhand, West Bengal
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Punjab
Per
cent
Per
cent
N= 3,054 3,725 6,163 8,421 N= 8045,943
Gujarat
537 650 5,454 6,306 5345,988
Delhi
Per
cent
Per
cent
N= 2,608 1,201 2,681 2,802 N= 6,0284,432
Gr. Mumbai
2,218 2,640 2,631 2,611 3,2146,189 8,490 9,366 9,715 5,297 5,320
Percent unvaccinated children, End-of-round survey
11,430 5,503
8046,084
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Uttar Pradesh
Bihar
INDIA
NEPAL
~314,000 children vaccinated (April to June 2011)
Vaccination post
Blocks with vaccination post
Continuous vaccination along Indo-Nepal border
81 vaccination posts
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Coverage during major religious congregations/ population movement
1. Ajmer Urs (Rajasthan)
22 May to 14 June 2011
~ 300,000 children vaccinated
2. Piran Kaliyar (Uttarkhand): Feb 2011: ~60,000 children vaccinated
3. Holi - returnee migrants (West Bengal, UP, Bihar): March 2011: ~245,000 children vaccinated
4. Planned activity: Shrawani Mela (Bihar & Jharkhand): July – August 2011: ~300,000 children expected to be vaccinated
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Migrants sites identification, India – June 2011
Number of sites with migrants identified : 150,000Number of children < 5 yrs in these sites : ~ 4.2 million
Number of sites identified by type
= 10 migrant sites
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• Intensive SIAs to vaccinate migrants in high risk states during first half of 2011
• Quality of coverage of migrants variable in different states
• Additional opportunities to vaccinate migrants at congregations, borders being utilized
• National data base of migrant families being prepared
Summary – Coverage of migrants
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Conclusions
• Number and scope of SIAs during first half of 2011 conducted as recommended by last IEAG
• Aggressive outbreak response conducted in West Bengal in early 2011
• Endemic areas sustaining high SIA coverage
• Strategy to cover migrants in high risk states and other areas being optimized
• Overall SIA quality in areas with recent transmission improved in 2011, however certain pockets remain a matter of concern
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Questions for consideration of IEAG
• What is the optimum number, timing and scope of SIAs between July and December 2011?
• What should be the scope and number of SIAs during early 2012?
• What types of polio vaccines should be used in the SIAs?
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Proposed SIAs – India, July to December 2011(As recommended by Nov 2010 IEAG)
SNID
Sep Oct Nov DecJul Aug
Sep Nov
bOPV
SNID
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Monthly incidence of WPV1 cases, 2005-2011
0
5
10
15
20
25
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Planned SNID
Planned SNID
Most recent SNID conducted
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Thank You