SlideShare a Scribd company logo
1 of 51
Download to read offline
Presented By: Dr.Preetam Kumar Kar 
Facilitators: Dr.Dipanweeta Routray 
Dr.Manoj Kumar Dash 
Department of COMMUNITY MEDICINE 
S.C.B MEDICAL COLLEGE AND HOSPITAL 
CUTTACK.
LAYOUT OF PRESENTATION 
 Introduction 
 Background 
 Vision & Goals of Global Measles elimination Strategic 
Plan 2012 
 Guiding Principles to Eliminate Measles 
 Strategy to Eliminate Measles 
 Initiatives in India 
 Challenges in Implementing the Strategic Plan 
 Conclusion 
 Bibliography 
2
3
Background of measles 
Elimination 
4
GLOBAL SCENARIO 
 Measles is endemic virtually in all parts of the world. 
 In 2000: 5.35 lakh children died of measles, the 
majority in developing countries (WHO report). 
 Burden accounted for 5% of all under- five mortality. 
 Epidemics occur when proportion of susceptible children 
reaches about 40 percent. 
5
GLOBAL SCENARIO 
 All 35 countries in the Americas eliminated measles 
in 2002. 
 The Western Pacific Region 
 European and 
 Eastern Mediterranean 
 African 
 SE Asian countries 
reduced measles cases between 2009 
and 2012 and is now on the verge of 
measles elimination. 
focusses on measles control i.e 
reduction of measles morbidity and 
mortality in accordance with the target. 
6
7
Number of estimated measles deaths (in thousands) globally 
2000-2010 
8 
535.3 528.8 373.8 484.3 331.4 384.8 227.7 
Source: who global measles & rubella strategic plan 11 
177.9 
139.3 
130.1 
137.5
INDIAN SCENARIO 
 In India 2011- 33,634 cases with 56 deaths. 
 Leading cause of child deaths. 
 The national routine measles vaccination coverage is 
69% (DLHS-3). 
 Draft Comprehensive Multi Year Strategic Plan 
(2010-17) for immunisation of India the country 
with an objective of reducing measles related 
mortality by 90% by 2013 compared to 2000. 
9
10
MEASLES AS AN ELIMINABLE DISEASE 
1. Humans are the only reservoir for measles virus. 
2. Accurate diagnostic tests for measles. 
3. Effective interventions. 
4. Life long immunity. 
5. Sustained interruption of measles virus transmission. 
11
12
VISION 
Achieve and maintain a world without measles . 
GOALS 
A. By end 2015 
 Reduce global measles mortality by at least 95% 
compared with 2000 estimates. 
 Achieve regional measles elimination goals. 
B. By end 2020 
 Achieve measles elimination in atleast five WHO regions. 
13
Regional Measles & Rubella Elimination Goals 
WHO world map of regional goals for the elimination of measles and either the elimination or control of rubella 
14
 WHO defines elimination of measles as absence of 
endemic measles for a period of >=12 months in 
presence of adequate surveillance. 
 One indicator of measles elimination is a sustained 
measles incidence of <1/10 lakh population. 
15 
DEFINITION
16
1. COUNTRY OWNERSHIP AND 
SUSTAINABILITY 
National governments and civil society to work 
together. 
2. ROUTINE IMMUNIZATION AND HEALTH 
SYSTEMS STRENGTHENING 
Robust and effective health and immunization 
systems, particularly a strong national EPI. 
3. EQUITY 
Specifically target children missed by routine services, 
including underserved, migrant and poor children. 
17
4. LINKAGES 
 With polio eradication: 
Providing polio vaccination during measles SIAs , facilitate 
both polio eradication & measles control & elimination. 
 With other proven child survival interventions: 
The routine measles vaccination visit at nine months 
is widely used to provide vitamin A supplementation. 
18
19
 The strategy for 2012–2020 builds on the experiences in 
the Americas and in countries in other WHO regions that 
successfully eliminated indigenous transmission of 
measles. 
 High coverage with two doses of MCV serves as the 
foundation required to ensure high population immunity 
against measles. 
20
Component 1. 
ACHIEVE AND MAINTAIN HIGH LEVELS OF 
POPULATION IMMUNITY 
 Vaccination Coverage >=95% with each of the two doses 
of MCV. 
 Unvaccinated children old enough to receive MCV1 (9 or 
12 months). 
 Strengthening routine immunization - critical component. 
 Catch up and follow up. 
21
Component 2. 
MONITOR DISEASE USING EFFECTIVE SURVEILLANCE 
AND EVALUATE TO ENSURE PROGRESS 
Effective surveillance needed to provide information : 
1. To set priorities 
2. Plan activities 
3. Allocate resources 
4. Implement prevention programmes 
5. Respond to outbreaks 
6. Evaluate control measures 
22
Component 3. 
DEVELOP AND MAINTAIN OUTBREAK 
PREPAREDNESS AND RESPOND RAPIDLY TO 
OUTBREAKS 
 In elimination setting : 
Single case outbreak rapid investigation 
and response. 
 In emergency setting: 
Urgent coordinated SIAs include 
Vit. A supplementation prevent outbreaks and 
child mortality. 
23
Component 4. 
COMMUNICATE AND ENGAGE TO BUILD 
PUBLIC CONFIDENCE 
Community awareness regarding 
a. Immunization rights 
b. Benefits 
c. Safety 
d. Available services 
Will promote public acceptance and participation. 
24
Component 5. 
PERFORM RESEARCH AND DEVELOPMENT 
CDC in May 2011 highlighted critical research areas 
necessary to achieve measles eradication: 
1. Measles epidemiology 
2. Assessing vaccine efficacy and effectiveness 
3. Needle free vaccine delivery methods 
4. Improved methods for laboratory testing for 
measles 
25
5. New immunization strategies. 
6. Improved methods to monitor and evaluate vaccination 
programmes. 
7. Improved messages and strategies to communicate with 
potential beneficiaries and their families. 
8. Economic analyses of different strategic options and 
mathematical modeling. 
26 
Component 5. 
PERFORM RESEARCH AND DEVELOPMENT….contd
27
ACCELERATED MEASLES CONTROL 
STRATEGIES 
1. Improve and sustain RI coverage (MCV-1). 
2. Provide a second opportunity for measles immunization to all 
eligible children (MCV-2). 
3. Sensitive, laboratory supported measles outbreak surveillance 
for case/outbreak confirmation. 
4. Fully investigate all detected measles outbreaks and ensure 
appropriate case management. 
28
LEGEND 
2012 
2011 
Dhenkanal 
Sambalpur 
Ganjam 
Jajpur 
Kalahandi 
Cuttack 
Khurda 
Nabarangpur 
Koraput 
Malkangiri 
Nayagarh 
Bargarh 
Rayagada 
Bolangir 
Boudh 
Sonepur 
Angul 
Balasore 
Bhadrak 
Deogarh 
Jharsuguda 
Keonjhar 
Mayurbhanj 
Sundargarh 
Kendrapara 
Jagatsingpur 
Puri 
Gajapati 
ANDHRA 
PRADESH 
JHARKHAND 
N 
Reported Measles 
Outbreaks in the years 
2011, 12 & 13 
Kandhamal 
2011, 2012 & 2013 
2013 
Source: SMO , NPSP unit Ganjam 29
CASE OF CLINICAL MEASLES 
Any person in whom clinician suspects measles infection 
OR 
Any person with fever and maculo papular rash with Cough / 
Coryza / CONJUNCTIVITIS 
OR 
A death which occurs within one month of onset of measles 
For epidemiological investigation, clinical measles would be a case 
30 
within last 3 months.
CONFIRMATION OF OUTBREAK 
By Serology 
Positive Measles IgM antibody in any of the 5 blood 
samples collected during the outbreak and tested in a 
WHO accredited Laboratory. 
(Measles negative samples are tested for Rubella) 
31
WHICH POTENTIAL OUTBREAKS TO INVESTIGATE? 
Desk Review of Measles data every Tuesday at district level 
Identify blocks with 5 cases or 1 death in a week 
5 cases in a block Any death in a block 
Assess if these cases are clustered in 
same/ adjacent villages 
IF YES 
Conduct preliminary field search in area to look for additional cases 
IF ADDITIONAL CASES FOUND (~10 CASES) 
conduct detailed investigation: HTH search, Serology from 5 cases, 
Rx for all cases (Vit A, ORT etc.) 32
PLANNING FOR MEASLES OUTBREAK 
INVESTIGATIONS 
ERT 
 Members: 
 CMO. 
 District Surveillance Officer 
 RCH Officer / DIO 
 Epidemiologist 
 Pediatrician / physician 
 Laboratory Specialist 
 Statistical Officer 
 Surveillance Medical Officer (SMO) 
 others from the district as appropriate (partner 
representatives) 
 The local MO to be co-opted at the time of the outbreak 
investigation. 
33
2. ASSIGNING OUTBREAK NUMBER & PRELIMINARY 
SEARCH 
 Assigning an Outbreak Number 
 MOB-ST-DIS-YY-NUM 
 MOB-0R-GJM-14-001 
 The PHC MO should ensure that the village/ locality of the 
area is searched for additional cases. 
 The outcome of the search should be communicated to 
the RCH Officer. 
 The RCH Officer/ SMO/IDSP-SO should decide if the 
outbreak needs to be investigated in detail. 
 The state should be notified using the VPD-OB001 form 
34
3. MOBILIZATION OF THE EPIDEMIC RESPONSE 
TEAM 
 When: As soon as an outbreak is identified. 
 Why: For detailed outbreak investigation at the outbreak 
locality. 
 Who: The CMO of the district convenes a meeting of all 
members of the ERT. 
 For: Micro planning the outbreak Investigation. 
35
Form VPD-OB003 
MEASLES OUTBREAK INVESTIGATION: DATA ON CASES 
Village / Area: ________________ PHC:_________________ Block:____________________D_is_t_ric_t :________________Sta_t_e_:______ _____________ 
Outbreak ID: _________________________________ Report sent by:_____________________Date Sent: ____________ 
Sex 
Date of last 
measles 
vaccine 
Date of onset 
of rash 
If died, date of 
death 
Date of blood 
specimen 
collection 
Setting: Urban / Rural 
M/F Years Months dd/mm/yyyy dd/mm/yyyy dd/mm/yyyy dd/mm/yyyy 
Yes 
No 
Yes 
No 
Unknown Unknown 
Unknown Unknown 
Yes Yes 
No No 
Unknown Unknown 
Age 
Yes Yes 
No No 
Patient's name, father's name 
and address 
Patient 
number 
Received 
measles 
vaccine 
(circle) 
Death 
(circle) 
36
Steps contd….. 
 Children suffering from Measles should be given 
 First dose of Vit A by health worker and informed of 
second dose. 
 Supervisor to follow up with second dose 
of Vit A. 
 Manage the existing cases. 
 Ask the family to report occurrence of new Measles 
cases to the local health worker/nearest health center 
immediately. 
37
6-7. COLLECTION AND SHIPMENT OF SPECIMENS 
TO THE LABORATORY
SPECIMEN COLLECTION & PROCESSING 
Collect serum in 
labeled sterile vials 
Centrifuge Clotted Blood 
Leave at 
Room Temp 
for clot 
formation (30 
mins.) 
Storage 
Centrifuge @ 1500 RPM – 10 Min
8. DATA ANALYSIS 
 Defining the outbreak in terms of time, place & person 
 Age distribution 
 Proportion of cases vaccinated in different age groups 
(How is RI performance?) 
 CFR 
 Mapping of cases: particular areas or communities of 
village affected. 
 Calculation of attack rates and vaccine efficacy if 
community survey done.
9. REPORT WRITING AND FEEDBACK 
 Share the experience with programme implementers 
(form VPD – OB004). 
 Document for comparison in the future Learning for an 
evolving programme. 
 To be sent to state government, IDSP, GoI and NPSP.
Form VPD-OB004 
MEASLES OUTBREAK INVESTIGATION: SUMMARY 
Outbreak ID: _______________________ 
Notification 
Source of notification: Weekly report / Active case search / Media / Other 
Index case reported by:______________ Name of DIO:________________________ 
Designation:____________________ Name of SMO:_______________________ 
Date of notification of index case: ______________ 
Preliminary investigation including desk review 
Desk review: date________________________ findings________________________________________________________ 
Date/s of preliminary search:__________________________ 
Number of health facilities searched: ___________________ Number of sub-centers/ urban wards searched: _________ 
Number of areas* searched:__________________ Total number of clinical measles cases:__________ 
Date of Epidemic Response Team meeting: ____________________ 
Whether considered as an outbreak requiring house to house investigation: Yes / No 
If No, reason: No clustering of cases Low case count 
Others (specify ) ________________________________________________________________ 
If Yes, provide details of outbreak investigation below
GLOBAL STRATEGY FOR MEASLES ELIMINATION
10. INITIATING ACTIONS 
 State level action 
 Collect data to guide development of policy. 
 Taking next step in measles control. 
 District Level action 
 Prevent death – Vit-A, ORT. Antibiotics, Referral chain. 
 Ensure availability of vaccines. 
 Improve routine immunization. 
 Targeting populations at risk. 
 Local level actions 
 Ensuring vaccine is available in all sessions. 
 Ensure that sessions are not missed. 
 Ensure coverage is complete in the target population.
45
1. FINANCIAL RISKS 
Sufficient predictable and sustainable funds . 
2. HIGH POPULATION DENSITY AND HIGHLY 
MOBILE POPULATIONS 
The highly infectious nature of measles makes 
control and elimination very challenging. 
3. CONFLICT AND EMERGENCY SETTINGS 
Humanitarian crises 
46
3. WEAK IMMUNIZATION SYSTEMS AND 
INACCURATE REPORTING OF VACCINATION 
COVERAGE 
High infectiousness & high rate of clinical disease. 
Strengthening routine immunization systems. 
4. MANAGING PERCEPTIONS AND 
MISPERCEPTIONS 
When individuals no longer see cases of a 
previously common disease they begin to believe 
the vaccine no longer provides benefits. 
47
CONCLUSION 
 Improving measles vaccination coverage and reducing 
measles-related deaths is a global imperative, particularly as 
it relates to the United Nation’s Millennium Development Goal 
4 (MDG4), which aims to reduce the overall number of deaths 
among children by two-thirds between 1990 and 2015. 
 We must work together to increase and sustain the socio-political 
and financial commitments required to end the 
devastation associated with preventable measles. 
48
TAKE HOME MESSAGE 
Reverse the resurgence of measles, 
achieve the 2015 mortality-reduction target 
& look beyond, to reap the tremendous 
long-term humanitarian and economic 
benefits associated with a world free of 
measles.
GLOBAL STRATEGY FOR MEASLES ELIMINATION
BIBLIOGRAPHY 
1.Levels & trends in child mortality report 2011: Estimates developed by the 
UN Inter-agency Group for Child Mortality Estimation. New York, NY, United 
Nations Children’s Fund, 2011 
(http://www.childinfo.org/files/Child_Mortality_Report_2011.pdf, accessed 11 
March 2012). 
2. Wolfson LJ et al. Estimates of measles case fatality ratios: a comprehensive 
review of community-based studies. International Journal of Epidemiology, 
2009, 38:192–205. 
3. WHO/UNICEF Global Plan for reducing measles mortality 2006–2010 
(http://whqlibdoc.who. int/hq/2005/WHO_IVB_05_11_eng.pdf). 
4. Strebel PM et al. A world without measles. Journal of Infectious Diseases, 
2011, 203:S1–S3. 
5.Park’s textbook of Preventive and Social Medicine 22nd edition. 
6.Health Policies and programmes in India.dr. D.K.Taneja.. 
51

More Related Content

What's hot

Child health program in Nepal
Child health program in NepalChild health program in Nepal
Child health program in NepalRAVIKANTAMISHRA
 
global polio eradication and endgame strategy
global polio eradication and endgame strategyglobal polio eradication and endgame strategy
global polio eradication and endgame strategyDr Arun Kumar Pandey
 
polio endgame strategy and ipv introduction
polio endgame strategy and ipv introductionpolio endgame strategy and ipv introduction
polio endgame strategy and ipv introductionRuchita1989
 
Curves in epidemiology: An overview
Curves in epidemiology: An overview Curves in epidemiology: An overview
Curves in epidemiology: An overview Bhoj Raj Singh
 
Disease eradication past and future
Disease eradication past and futureDisease eradication past and future
Disease eradication past and futurearijitkundu88
 
International health regulation
International health regulationInternational health regulation
International health regulationVenu Bolisetti
 
National framework for malaria elimination in india
National framework for malaria elimination in indiaNational framework for malaria elimination in india
National framework for malaria elimination in indiaAparna Chaudhary
 
investigation of an epidemic
investigation of an epidemicinvestigation of an epidemic
investigation of an epidemicBala Vidyadhar
 
Investigation of epidemic presentation
Investigation of epidemic presentationInvestigation of epidemic presentation
Investigation of epidemic presentationMoustapha Ramadan
 
Disease for control elimination & eradication
Disease for control elimination & eradication Disease for control elimination & eradication
Disease for control elimination & eradication RINSAVAHEED1
 
outbreak investigation - types of epidemics and investigating them
outbreak investigation - types of epidemics and investigating themoutbreak investigation - types of epidemics and investigating them
outbreak investigation - types of epidemics and investigating themTimiresh Das
 
Measles - Epidemiology and Control
Measles - Epidemiology and ControlMeasles - Epidemiology and Control
Measles - Epidemiology and ControlRizwan S A
 

What's hot (20)

Child health program in Nepal
Child health program in NepalChild health program in Nepal
Child health program in Nepal
 
global polio eradication and endgame strategy
global polio eradication and endgame strategyglobal polio eradication and endgame strategy
global polio eradication and endgame strategy
 
polio endgame strategy and ipv introduction
polio endgame strategy and ipv introductionpolio endgame strategy and ipv introduction
polio endgame strategy and ipv introduction
 
Curves in epidemiology: An overview
Curves in epidemiology: An overview Curves in epidemiology: An overview
Curves in epidemiology: An overview
 
Disease eradication past and future
Disease eradication past and futureDisease eradication past and future
Disease eradication past and future
 
Epidemic Curve
Epidemic CurveEpidemic Curve
Epidemic Curve
 
International health regulation
International health regulationInternational health regulation
International health regulation
 
National framework for malaria elimination in india
National framework for malaria elimination in indiaNational framework for malaria elimination in india
National framework for malaria elimination in india
 
investigation of an epidemic
investigation of an epidemicinvestigation of an epidemic
investigation of an epidemic
 
Investigation of epidemic presentation
Investigation of epidemic presentationInvestigation of epidemic presentation
Investigation of epidemic presentation
 
Disease for control elimination & eradication
Disease for control elimination & eradication Disease for control elimination & eradication
Disease for control elimination & eradication
 
NVBDCP
NVBDCPNVBDCP
NVBDCP
 
Vaccine Logistics
Vaccine LogisticsVaccine Logistics
Vaccine Logistics
 
Measles eradication
Measles eradicationMeasles eradication
Measles eradication
 
outbreak investigation - types of epidemics and investigating them
outbreak investigation - types of epidemics and investigating themoutbreak investigation - types of epidemics and investigating them
outbreak investigation - types of epidemics and investigating them
 
Measles - Epidemiology and Control
Measles - Epidemiology and ControlMeasles - Epidemiology and Control
Measles - Epidemiology and Control
 
Surveillance
SurveillanceSurveillance
Surveillance
 
Epidemic investigation
Epidemic investigationEpidemic investigation
Epidemic investigation
 
Rmnch+a
Rmnch+aRmnch+a
Rmnch+a
 
Rmnch+a
Rmnch+a  Rmnch+a
Rmnch+a
 

Viewers also liked

Measles elimination orig
Measles elimination origMeasles elimination orig
Measles elimination origSiva Mbbs
 
Measles dr harivansh chopra
Measles   dr harivansh chopraMeasles   dr harivansh chopra
Measles dr harivansh chopraHarivansh Chopra
 
Measles surveillance sepio mtg 18 20 may 2011 (ab) v1
Measles surveillance sepio mtg 18 20 may 2011 (ab) v1Measles surveillance sepio mtg 18 20 may 2011 (ab) v1
Measles surveillance sepio mtg 18 20 may 2011 (ab) v1Prabir Chatterjee
 
Video Game Addiction : Don't Let It Happen To You !
Video Game Addiction : Don't Let It Happen To You !Video Game Addiction : Don't Let It Happen To You !
Video Game Addiction : Don't Let It Happen To You !ridzuanarshard
 
Turning Data into People: Perspectives on game addiction (Rune K. L. Nielsen)
Turning Data into People: Perspectives on game addiction (Rune K. L. Nielsen)Turning Data into People: Perspectives on game addiction (Rune K. L. Nielsen)
Turning Data into People: Perspectives on game addiction (Rune K. L. Nielsen)Karel Van Isacker
 
Global burden of disease & International Health Regulation
Global burden of disease & International Health RegulationGlobal burden of disease & International Health Regulation
Global burden of disease & International Health RegulationSujata Mohapatra
 
Measles, mumps and rubella
Measles, mumps and rubellaMeasles, mumps and rubella
Measles, mumps and rubellaLaurenGentner
 
Measles:AiA007
Measles:AiA007Measles:AiA007
Measles:AiA007AiApvde
 
Video Game Addiction
Video Game AddictionVideo Game Addiction
Video Game Addictionnantha96
 

Viewers also liked (19)

Measles elimination orig
Measles elimination origMeasles elimination orig
Measles elimination orig
 
Measles catch up campaign
Measles catch up campaignMeasles catch up campaign
Measles catch up campaign
 
Measles dr harivansh chopra
Measles   dr harivansh chopraMeasles   dr harivansh chopra
Measles dr harivansh chopra
 
8 measles
8 measles8 measles
8 measles
 
Measles
MeaslesMeasles
Measles
 
Rbsk
RbskRbsk
Rbsk
 
Measles surveillance sepio mtg 18 20 may 2011 (ab) v1
Measles surveillance sepio mtg 18 20 may 2011 (ab) v1Measles surveillance sepio mtg 18 20 may 2011 (ab) v1
Measles surveillance sepio mtg 18 20 may 2011 (ab) v1
 
Measles
MeaslesMeasles
Measles
 
AFP surveillance
AFP surveillanceAFP surveillance
AFP surveillance
 
Video Game Addiction : Don't Let It Happen To You !
Video Game Addiction : Don't Let It Happen To You !Video Game Addiction : Don't Let It Happen To You !
Video Game Addiction : Don't Let It Happen To You !
 
Turning Data into People: Perspectives on game addiction (Rune K. L. Nielsen)
Turning Data into People: Perspectives on game addiction (Rune K. L. Nielsen)Turning Data into People: Perspectives on game addiction (Rune K. L. Nielsen)
Turning Data into People: Perspectives on game addiction (Rune K. L. Nielsen)
 
Measles
MeaslesMeasles
Measles
 
Global burden of disease & International Health Regulation
Global burden of disease & International Health RegulationGlobal burden of disease & International Health Regulation
Global burden of disease & International Health Regulation
 
Game addiction
Game addictionGame addiction
Game addiction
 
Measles kpn 2017
Measles kpn 2017Measles kpn 2017
Measles kpn 2017
 
Measles, mumps and rubella
Measles, mumps and rubellaMeasles, mumps and rubella
Measles, mumps and rubella
 
Measles:AiA007
Measles:AiA007Measles:AiA007
Measles:AiA007
 
Poliomyelitis
PoliomyelitisPoliomyelitis
Poliomyelitis
 
Video Game Addiction
Video Game AddictionVideo Game Addiction
Video Game Addiction
 

Similar to GLOBAL STRATEGY FOR MEASLES ELIMINATION

National Vector Borne Disease Control Programme
National Vector Borne Disease Control ProgrammeNational Vector Borne Disease Control Programme
National Vector Borne Disease Control ProgrammeDr Lipilekha Patnaik
 
National Immunization Program of Nepal from POSDCORB Perspectives
National Immunization Program of Nepal from POSDCORB PerspectivesNational Immunization Program of Nepal from POSDCORB Perspectives
National Immunization Program of Nepal from POSDCORB PerspectivesMohammad Aslam Shaiekh
 
EPI Senegal comprehensive multi-year plan for 2012-2016
EPI Senegal comprehensive multi-year plan for 2012-2016 EPI Senegal comprehensive multi-year plan for 2012-2016
EPI Senegal comprehensive multi-year plan for 2012-2016 vencheles23
 
Ri in ut of puducherry success story of sepio dr.sudha goel
Ri in ut of puducherry  success story of sepio dr.sudha goelRi in ut of puducherry  success story of sepio dr.sudha goel
Ri in ut of puducherry success story of sepio dr.sudha goelSudha Goel
 
RNTCP-Basic Presantation.ppt
RNTCP-Basic Presantation.pptRNTCP-Basic Presantation.ppt
RNTCP-Basic Presantation.pptNandiniMengar
 
Investigation disease outbreak and disease survelience.pdf
Investigation disease outbreak and disease survelience.pdfInvestigation disease outbreak and disease survelience.pdf
Investigation disease outbreak and disease survelience.pdfMohammed Najib Kamarolzaman
 
Buruli ulcer (Mycobacterium ulcerans infection).pdf
Buruli ulcer (Mycobacterium ulcerans infection).pdfBuruli ulcer (Mycobacterium ulcerans infection).pdf
Buruli ulcer (Mycobacterium ulcerans infection).pdfShanthilallRamsunkar
 
Reasons for innovations and changing strategies in RNTCP 2019
Reasons for innovations and changing strategies in RNTCP 2019Reasons for innovations and changing strategies in RNTCP 2019
Reasons for innovations and changing strategies in RNTCP 2019Drsadhana Meena
 
National Tuberculosis Center (NTC)
National Tuberculosis Center (NTC)National Tuberculosis Center (NTC)
National Tuberculosis Center (NTC)BikashDangaura1
 
Revised national tuberculosis control programme (RNTCP) in India
Revised national tuberculosis control programme (RNTCP) in IndiaRevised national tuberculosis control programme (RNTCP) in India
Revised national tuberculosis control programme (RNTCP) in IndiaKavya .
 
WHO Global Technical Strategy for Malaria 2016-2030
WHO Global Technical Strategy for Malaria 2016-2030WHO Global Technical Strategy for Malaria 2016-2030
WHO Global Technical Strategy for Malaria 2016-2030Shaan Ahmed
 
M. Tildeslay - Real-time decision making - Appropriate use of infectious dise...
M. Tildeslay - Real-time decision making - Appropriate use of infectious dise...M. Tildeslay - Real-time decision making - Appropriate use of infectious dise...
M. Tildeslay - Real-time decision making - Appropriate use of infectious dise...EuFMD
 
Leprosey Represented by NIRJESH KUMAR
Leprosey Represented by NIRJESH KUMARLeprosey Represented by NIRJESH KUMAR
Leprosey Represented by NIRJESH KUMARNirjesh Kumar
 

Similar to GLOBAL STRATEGY FOR MEASLES ELIMINATION (20)

National Vector Borne Disease Control Programme
National Vector Borne Disease Control ProgrammeNational Vector Borne Disease Control Programme
National Vector Borne Disease Control Programme
 
National Immunization Program of Nepal from POSDCORB Perspectives
National Immunization Program of Nepal from POSDCORB PerspectivesNational Immunization Program of Nepal from POSDCORB Perspectives
National Immunization Program of Nepal from POSDCORB Perspectives
 
ntep.pptx
ntep.pptxntep.pptx
ntep.pptx
 
EPI Senegal comprehensive multi-year plan for 2012-2016
EPI Senegal comprehensive multi-year plan for 2012-2016 EPI Senegal comprehensive multi-year plan for 2012-2016
EPI Senegal comprehensive multi-year plan for 2012-2016
 
Dots
DotsDots
Dots
 
Ri in ut of puducherry success story of sepio dr.sudha goel
Ri in ut of puducherry  success story of sepio dr.sudha goelRi in ut of puducherry  success story of sepio dr.sudha goel
Ri in ut of puducherry success story of sepio dr.sudha goel
 
RNTCP-Basic Presantation.ppt
RNTCP-Basic Presantation.pptRNTCP-Basic Presantation.ppt
RNTCP-Basic Presantation.ppt
 
Investigation disease outbreak and disease survelience.pdf
Investigation disease outbreak and disease survelience.pdfInvestigation disease outbreak and disease survelience.pdf
Investigation disease outbreak and disease survelience.pdf
 
NTEP and recent advances.pptx
NTEP and recent advances.pptxNTEP and recent advances.pptx
NTEP and recent advances.pptx
 
Buruli ulcer (Mycobacterium ulcerans infection).pdf
Buruli ulcer (Mycobacterium ulcerans infection).pdfBuruli ulcer (Mycobacterium ulcerans infection).pdf
Buruli ulcer (Mycobacterium ulcerans infection).pdf
 
Reasons for innovations and changing strategies in RNTCP 2019
Reasons for innovations and changing strategies in RNTCP 2019Reasons for innovations and changing strategies in RNTCP 2019
Reasons for innovations and changing strategies in RNTCP 2019
 
National Tuberculosis Center (NTC)
National Tuberculosis Center (NTC)National Tuberculosis Center (NTC)
National Tuberculosis Center (NTC)
 
NLEP
NLEPNLEP
NLEP
 
Revised national tuberculosis control programme (RNTCP) in India
Revised national tuberculosis control programme (RNTCP) in IndiaRevised national tuberculosis control programme (RNTCP) in India
Revised national tuberculosis control programme (RNTCP) in India
 
WHO Global Technical Strategy for Malaria 2016-2030
WHO Global Technical Strategy for Malaria 2016-2030WHO Global Technical Strategy for Malaria 2016-2030
WHO Global Technical Strategy for Malaria 2016-2030
 
M. Tildeslay - Real-time decision making - Appropriate use of infectious dise...
M. Tildeslay - Real-time decision making - Appropriate use of infectious dise...M. Tildeslay - Real-time decision making - Appropriate use of infectious dise...
M. Tildeslay - Real-time decision making - Appropriate use of infectious dise...
 
What have we overlooked in the epidemiology of antimicrobial resistance in Eu...
What have we overlooked in the epidemiology of antimicrobial resistance in Eu...What have we overlooked in the epidemiology of antimicrobial resistance in Eu...
What have we overlooked in the epidemiology of antimicrobial resistance in Eu...
 
Tuberculosis
TuberculosisTuberculosis
Tuberculosis
 
Leprosey Represented by NIRJESH KUMAR
Leprosey Represented by NIRJESH KUMARLeprosey Represented by NIRJESH KUMAR
Leprosey Represented by NIRJESH KUMAR
 
European Vaccine Action Plan (EVAP)
European Vaccine Action Plan (EVAP)European Vaccine Action Plan (EVAP)
European Vaccine Action Plan (EVAP)
 

Recently uploaded

ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdfHongBiThi1
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectiondrhanifmohdali
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfDolisha Warbi
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 

Recently uploaded (20)

ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissection
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 

GLOBAL STRATEGY FOR MEASLES ELIMINATION

  • 1. Presented By: Dr.Preetam Kumar Kar Facilitators: Dr.Dipanweeta Routray Dr.Manoj Kumar Dash Department of COMMUNITY MEDICINE S.C.B MEDICAL COLLEGE AND HOSPITAL CUTTACK.
  • 2. LAYOUT OF PRESENTATION  Introduction  Background  Vision & Goals of Global Measles elimination Strategic Plan 2012  Guiding Principles to Eliminate Measles  Strategy to Eliminate Measles  Initiatives in India  Challenges in Implementing the Strategic Plan  Conclusion  Bibliography 2
  • 3. 3
  • 4. Background of measles Elimination 4
  • 5. GLOBAL SCENARIO  Measles is endemic virtually in all parts of the world.  In 2000: 5.35 lakh children died of measles, the majority in developing countries (WHO report).  Burden accounted for 5% of all under- five mortality.  Epidemics occur when proportion of susceptible children reaches about 40 percent. 5
  • 6. GLOBAL SCENARIO  All 35 countries in the Americas eliminated measles in 2002.  The Western Pacific Region  European and  Eastern Mediterranean  African  SE Asian countries reduced measles cases between 2009 and 2012 and is now on the verge of measles elimination. focusses on measles control i.e reduction of measles morbidity and mortality in accordance with the target. 6
  • 7. 7
  • 8. Number of estimated measles deaths (in thousands) globally 2000-2010 8 535.3 528.8 373.8 484.3 331.4 384.8 227.7 Source: who global measles & rubella strategic plan 11 177.9 139.3 130.1 137.5
  • 9. INDIAN SCENARIO  In India 2011- 33,634 cases with 56 deaths.  Leading cause of child deaths.  The national routine measles vaccination coverage is 69% (DLHS-3).  Draft Comprehensive Multi Year Strategic Plan (2010-17) for immunisation of India the country with an objective of reducing measles related mortality by 90% by 2013 compared to 2000. 9
  • 10. 10
  • 11. MEASLES AS AN ELIMINABLE DISEASE 1. Humans are the only reservoir for measles virus. 2. Accurate diagnostic tests for measles. 3. Effective interventions. 4. Life long immunity. 5. Sustained interruption of measles virus transmission. 11
  • 12. 12
  • 13. VISION Achieve and maintain a world without measles . GOALS A. By end 2015  Reduce global measles mortality by at least 95% compared with 2000 estimates.  Achieve regional measles elimination goals. B. By end 2020  Achieve measles elimination in atleast five WHO regions. 13
  • 14. Regional Measles & Rubella Elimination Goals WHO world map of regional goals for the elimination of measles and either the elimination or control of rubella 14
  • 15.  WHO defines elimination of measles as absence of endemic measles for a period of >=12 months in presence of adequate surveillance.  One indicator of measles elimination is a sustained measles incidence of <1/10 lakh population. 15 DEFINITION
  • 16. 16
  • 17. 1. COUNTRY OWNERSHIP AND SUSTAINABILITY National governments and civil society to work together. 2. ROUTINE IMMUNIZATION AND HEALTH SYSTEMS STRENGTHENING Robust and effective health and immunization systems, particularly a strong national EPI. 3. EQUITY Specifically target children missed by routine services, including underserved, migrant and poor children. 17
  • 18. 4. LINKAGES  With polio eradication: Providing polio vaccination during measles SIAs , facilitate both polio eradication & measles control & elimination.  With other proven child survival interventions: The routine measles vaccination visit at nine months is widely used to provide vitamin A supplementation. 18
  • 19. 19
  • 20.  The strategy for 2012–2020 builds on the experiences in the Americas and in countries in other WHO regions that successfully eliminated indigenous transmission of measles.  High coverage with two doses of MCV serves as the foundation required to ensure high population immunity against measles. 20
  • 21. Component 1. ACHIEVE AND MAINTAIN HIGH LEVELS OF POPULATION IMMUNITY  Vaccination Coverage >=95% with each of the two doses of MCV.  Unvaccinated children old enough to receive MCV1 (9 or 12 months).  Strengthening routine immunization - critical component.  Catch up and follow up. 21
  • 22. Component 2. MONITOR DISEASE USING EFFECTIVE SURVEILLANCE AND EVALUATE TO ENSURE PROGRESS Effective surveillance needed to provide information : 1. To set priorities 2. Plan activities 3. Allocate resources 4. Implement prevention programmes 5. Respond to outbreaks 6. Evaluate control measures 22
  • 23. Component 3. DEVELOP AND MAINTAIN OUTBREAK PREPAREDNESS AND RESPOND RAPIDLY TO OUTBREAKS  In elimination setting : Single case outbreak rapid investigation and response.  In emergency setting: Urgent coordinated SIAs include Vit. A supplementation prevent outbreaks and child mortality. 23
  • 24. Component 4. COMMUNICATE AND ENGAGE TO BUILD PUBLIC CONFIDENCE Community awareness regarding a. Immunization rights b. Benefits c. Safety d. Available services Will promote public acceptance and participation. 24
  • 25. Component 5. PERFORM RESEARCH AND DEVELOPMENT CDC in May 2011 highlighted critical research areas necessary to achieve measles eradication: 1. Measles epidemiology 2. Assessing vaccine efficacy and effectiveness 3. Needle free vaccine delivery methods 4. Improved methods for laboratory testing for measles 25
  • 26. 5. New immunization strategies. 6. Improved methods to monitor and evaluate vaccination programmes. 7. Improved messages and strategies to communicate with potential beneficiaries and their families. 8. Economic analyses of different strategic options and mathematical modeling. 26 Component 5. PERFORM RESEARCH AND DEVELOPMENT….contd
  • 27. 27
  • 28. ACCELERATED MEASLES CONTROL STRATEGIES 1. Improve and sustain RI coverage (MCV-1). 2. Provide a second opportunity for measles immunization to all eligible children (MCV-2). 3. Sensitive, laboratory supported measles outbreak surveillance for case/outbreak confirmation. 4. Fully investigate all detected measles outbreaks and ensure appropriate case management. 28
  • 29. LEGEND 2012 2011 Dhenkanal Sambalpur Ganjam Jajpur Kalahandi Cuttack Khurda Nabarangpur Koraput Malkangiri Nayagarh Bargarh Rayagada Bolangir Boudh Sonepur Angul Balasore Bhadrak Deogarh Jharsuguda Keonjhar Mayurbhanj Sundargarh Kendrapara Jagatsingpur Puri Gajapati ANDHRA PRADESH JHARKHAND N Reported Measles Outbreaks in the years 2011, 12 & 13 Kandhamal 2011, 2012 & 2013 2013 Source: SMO , NPSP unit Ganjam 29
  • 30. CASE OF CLINICAL MEASLES Any person in whom clinician suspects measles infection OR Any person with fever and maculo papular rash with Cough / Coryza / CONJUNCTIVITIS OR A death which occurs within one month of onset of measles For epidemiological investigation, clinical measles would be a case 30 within last 3 months.
  • 31. CONFIRMATION OF OUTBREAK By Serology Positive Measles IgM antibody in any of the 5 blood samples collected during the outbreak and tested in a WHO accredited Laboratory. (Measles negative samples are tested for Rubella) 31
  • 32. WHICH POTENTIAL OUTBREAKS TO INVESTIGATE? Desk Review of Measles data every Tuesday at district level Identify blocks with 5 cases or 1 death in a week 5 cases in a block Any death in a block Assess if these cases are clustered in same/ adjacent villages IF YES Conduct preliminary field search in area to look for additional cases IF ADDITIONAL CASES FOUND (~10 CASES) conduct detailed investigation: HTH search, Serology from 5 cases, Rx for all cases (Vit A, ORT etc.) 32
  • 33. PLANNING FOR MEASLES OUTBREAK INVESTIGATIONS ERT  Members:  CMO.  District Surveillance Officer  RCH Officer / DIO  Epidemiologist  Pediatrician / physician  Laboratory Specialist  Statistical Officer  Surveillance Medical Officer (SMO)  others from the district as appropriate (partner representatives)  The local MO to be co-opted at the time of the outbreak investigation. 33
  • 34. 2. ASSIGNING OUTBREAK NUMBER & PRELIMINARY SEARCH  Assigning an Outbreak Number  MOB-ST-DIS-YY-NUM  MOB-0R-GJM-14-001  The PHC MO should ensure that the village/ locality of the area is searched for additional cases.  The outcome of the search should be communicated to the RCH Officer.  The RCH Officer/ SMO/IDSP-SO should decide if the outbreak needs to be investigated in detail.  The state should be notified using the VPD-OB001 form 34
  • 35. 3. MOBILIZATION OF THE EPIDEMIC RESPONSE TEAM  When: As soon as an outbreak is identified.  Why: For detailed outbreak investigation at the outbreak locality.  Who: The CMO of the district convenes a meeting of all members of the ERT.  For: Micro planning the outbreak Investigation. 35
  • 36. Form VPD-OB003 MEASLES OUTBREAK INVESTIGATION: DATA ON CASES Village / Area: ________________ PHC:_________________ Block:____________________D_is_t_ric_t :________________Sta_t_e_:______ _____________ Outbreak ID: _________________________________ Report sent by:_____________________Date Sent: ____________ Sex Date of last measles vaccine Date of onset of rash If died, date of death Date of blood specimen collection Setting: Urban / Rural M/F Years Months dd/mm/yyyy dd/mm/yyyy dd/mm/yyyy dd/mm/yyyy Yes No Yes No Unknown Unknown Unknown Unknown Yes Yes No No Unknown Unknown Age Yes Yes No No Patient's name, father's name and address Patient number Received measles vaccine (circle) Death (circle) 36
  • 37. Steps contd…..  Children suffering from Measles should be given  First dose of Vit A by health worker and informed of second dose.  Supervisor to follow up with second dose of Vit A.  Manage the existing cases.  Ask the family to report occurrence of new Measles cases to the local health worker/nearest health center immediately. 37
  • 38. 6-7. COLLECTION AND SHIPMENT OF SPECIMENS TO THE LABORATORY
  • 39. SPECIMEN COLLECTION & PROCESSING Collect serum in labeled sterile vials Centrifuge Clotted Blood Leave at Room Temp for clot formation (30 mins.) Storage Centrifuge @ 1500 RPM – 10 Min
  • 40. 8. DATA ANALYSIS  Defining the outbreak in terms of time, place & person  Age distribution  Proportion of cases vaccinated in different age groups (How is RI performance?)  CFR  Mapping of cases: particular areas or communities of village affected.  Calculation of attack rates and vaccine efficacy if community survey done.
  • 41. 9. REPORT WRITING AND FEEDBACK  Share the experience with programme implementers (form VPD – OB004).  Document for comparison in the future Learning for an evolving programme.  To be sent to state government, IDSP, GoI and NPSP.
  • 42. Form VPD-OB004 MEASLES OUTBREAK INVESTIGATION: SUMMARY Outbreak ID: _______________________ Notification Source of notification: Weekly report / Active case search / Media / Other Index case reported by:______________ Name of DIO:________________________ Designation:____________________ Name of SMO:_______________________ Date of notification of index case: ______________ Preliminary investigation including desk review Desk review: date________________________ findings________________________________________________________ Date/s of preliminary search:__________________________ Number of health facilities searched: ___________________ Number of sub-centers/ urban wards searched: _________ Number of areas* searched:__________________ Total number of clinical measles cases:__________ Date of Epidemic Response Team meeting: ____________________ Whether considered as an outbreak requiring house to house investigation: Yes / No If No, reason: No clustering of cases Low case count Others (specify ) ________________________________________________________________ If Yes, provide details of outbreak investigation below
  • 44. 10. INITIATING ACTIONS  State level action  Collect data to guide development of policy.  Taking next step in measles control.  District Level action  Prevent death – Vit-A, ORT. Antibiotics, Referral chain.  Ensure availability of vaccines.  Improve routine immunization.  Targeting populations at risk.  Local level actions  Ensuring vaccine is available in all sessions.  Ensure that sessions are not missed.  Ensure coverage is complete in the target population.
  • 45. 45
  • 46. 1. FINANCIAL RISKS Sufficient predictable and sustainable funds . 2. HIGH POPULATION DENSITY AND HIGHLY MOBILE POPULATIONS The highly infectious nature of measles makes control and elimination very challenging. 3. CONFLICT AND EMERGENCY SETTINGS Humanitarian crises 46
  • 47. 3. WEAK IMMUNIZATION SYSTEMS AND INACCURATE REPORTING OF VACCINATION COVERAGE High infectiousness & high rate of clinical disease. Strengthening routine immunization systems. 4. MANAGING PERCEPTIONS AND MISPERCEPTIONS When individuals no longer see cases of a previously common disease they begin to believe the vaccine no longer provides benefits. 47
  • 48. CONCLUSION  Improving measles vaccination coverage and reducing measles-related deaths is a global imperative, particularly as it relates to the United Nation’s Millennium Development Goal 4 (MDG4), which aims to reduce the overall number of deaths among children by two-thirds between 1990 and 2015.  We must work together to increase and sustain the socio-political and financial commitments required to end the devastation associated with preventable measles. 48
  • 49. TAKE HOME MESSAGE Reverse the resurgence of measles, achieve the 2015 mortality-reduction target & look beyond, to reap the tremendous long-term humanitarian and economic benefits associated with a world free of measles.
  • 51. BIBLIOGRAPHY 1.Levels & trends in child mortality report 2011: Estimates developed by the UN Inter-agency Group for Child Mortality Estimation. New York, NY, United Nations Children’s Fund, 2011 (http://www.childinfo.org/files/Child_Mortality_Report_2011.pdf, accessed 11 March 2012). 2. Wolfson LJ et al. Estimates of measles case fatality ratios: a comprehensive review of community-based studies. International Journal of Epidemiology, 2009, 38:192–205. 3. WHO/UNICEF Global Plan for reducing measles mortality 2006–2010 (http://whqlibdoc.who. int/hq/2005/WHO_IVB_05_11_eng.pdf). 4. Strebel PM et al. A world without measles. Journal of Infectious Diseases, 2011, 203:S1–S3. 5.Park’s textbook of Preventive and Social Medicine 22nd edition. 6.Health Policies and programmes in India.dr. D.K.Taneja.. 51