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Supplementary Immunization Activities
Quality, Coverage of high risk populations/ areas,
proposed plans for 2012 - 14
IEAG Meeting
15 March 2011
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Outline of presentation
• SIAs – July 2011 to April 2012
• Quality of SIAs in high risk areas/populations
• Status of Emergency Preparedness & Response Plans
• Proposed SIA plans for 2012 - 2014
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Areas/ Populations at highest risk of polio
Historic reservoir areas
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Areas/ Populations at highest risk of polio
Areas with recent polio transmission
Historic reservoir areas
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Areas/ Populations at highest risk of polio
Historic reservoir areas
Areas with recent polio transmission
Areas with high migrant populations
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Polio SIAs , July to December 2011
SNID SNIDSNID
Aug Sep Nov
bOPV
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Polio SIAs , January to April 2012
Jan Feb
Jan Feb
SNID
NID
bOPV
tOPV
Mar Apr
SNID
NID
Mar Apr
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SIA quality in high risk areas/populations
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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
2012
2012
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Lot Quality Assurance Sampling (LQAS), Findings: HR blocks, UP
SNIDs: Aug 11 – Feb 12 # %
66 HR blocks
# lots accepted 260 85%
# lots cautioned 39 13%
# lots rejected 7 2%
Hypothesis: “The SIA coverage in this LOT is > 95%.”
N=54
Reasons for unvaccinated children
Child was not at home at time of team's visit
Refused immunization
Team failure
Non-resident child visiting house after team’s visit
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Percent unimmunized children in field huts in Kosi riverine area
Source of data : NPSP monitoring
Coverage in field huts of Kosi area, Bihar
~ 3,000 children checked each round
• > 300,000 clusters of field huts (basas) visited by vaccination teams each round
• Intensive supervision and monitoring
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Percent unvaccinated children: End-of-round surveyP
erc
en
t
N= 20,683 21,524 24,178 22,392 21,046 33,1497,805 8,989 9,271 10,430
West Bengal
Jharkhand
N= 2,945 3,213 9,779 8,398 4,163 5,509 6,151 5,242
Pe
rce
nt
3,422 4,981
Percent missed children < 5 yrs (average from Nov11, Jan12 & Feb12 SIAs), HR districts
Jharkhand
West Bengal
5,202
23,535
(Pakur & Sahibganj)
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Malegaon Municipal Corporation – Resistance still an issue
# houses with reluctance to accept OPV, End-of-round
Num
ber
Maharashtra
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Mapping and reaching migrants, India, 2011
Number of sites with migrants identified : ~162,000Number of children < 5 yrs in these sites : ~ 4.2 million
Number of sites identified by type
= 10 migrant sites
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Coverage of migratory communities in states with large migratory population
Special vaccination drives at social-religious congregations:
~1 m children vaccinated in 2011
Historic reservoir areas: ~ 1 m migrant children vaccinated during SNID
Other states with large migratory population: ~2.5 m children vaccinated during SNID
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Percent children < 5 yrs found unimmunized during end of the round survey
Punjab
Per
cent
Per
cent
N= 6,163 8,421 N= 8045,943
Gujarat
5,454 6,306 5345,988
Delhi
Per
cent
Per
cent
N= N= 6,0284,432
Gr. Mumbai
3,2146,189 8,490 9,366 5,297 5,32011,430 8,030 8,590 6,309 6,698
6,084 6,605 5,494 804 284 247
8,466
5,352
6,646
1,025
7,960
6,985 5,808
5,824
400 278 6757,570 6,105 3,054 3,725
959 1,367 2,608 1,201 2,269 2,377 2,712 2,785
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SIA quality - Summary
• Historic reservoir areas of UP and Bihar sustaining high SIA coverage
• Areas with recent transmission
– West Bengal quality variable; pockets with gaps in quality remain
– Malegaon: reluctance to accept OPV continues; Need to study role of social networks in vaccine avoidance behaviour
• Quality of coverage of migrants improving, consistency of quality over rounds an issue
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Status of Emergency Preparedness and Response Plans in India
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Emergency Preparedness & Response Plans (EPRP)
• National Plan prepared
• Formation of State plans in process
• Key components of State plans
– Constitution of Emergency Preparedness and Response Groups
– Identification and training of Rapid Response Team members (RRTs)
– Identification of high risk districts, blocks and sub block areas/populations
– Plans to strengthen Routine Immunization & SIA quality
– Communication risk assessment and social mapping
– Preparedness of the state for undertaking urgent mop ups within 7-10 days of WPV isolation
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EPRP : State Preparedness
• Emergency Preparedness & Response groups (EPRG) constituted
State EPRG constituted
31 blocks
Haryana Punjab
24 blocks
HR blocks being identified for intensification of SIAs & RI
• ~ 170 RRT members identified and trained
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Identification of sub block High Risk Areas, India
~ 162,000 Migrant sites
Migrant sites High risk areas in settled population
~ 64,000 HR areas in settled population
= 10 Migrant sites = 10 HR sites
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EPRP components that need strengthening in State plans
• Plans for overcoming staff vacancies in HR areas
• Systematic inclusion of high risk areas for RI strengthening
• Timeline for harmonization of SIA and RI microplans in high risk areas
• Assignment of HR districts to RRT members for regular review of RI and preparedness
• Assessment of communication risks and social mapping
• Identification of media spokesperson
• Plans for procurement of logistics and IEC materials for undertaking urgent mop ups
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Proposed SIA plans for 2012 – 2014
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Proposed SIA calendar, 2012
conducted planned
NID with tOPV SNID with bOPV
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Proposed SIA scheduleNID with tOPV SNID with bOPV2013
2014
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Questions for consideration of IEAG
• Is the proposed number and scope of SIAs from 2012 – 14 sufficient to maintain high population immunity?
• Which vaccine types and in what quantities should be maintained as buffer stocks?
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Thank You