1. MEASLES CATCH-UP IMMUNIZATION
CAMPAIGN
DR. RAGHAVENDRA
HUCHCHANNAVAR
Junior Resident, Community Medicine,
PGIMS, Rohtak

2. • Introduction
• Rationale for second dose
• Planning Measles Catch-up Campaign
• Pre-implementation activities
• Implementing Measles Catch-up Campaign
• AEFI
• Monitoring and evaluation
• Post-campaign review

3. INTRODUCTION
• Measles is a highly infectious viral disease for which
humans are the only reservoir.
• Agent -> single stranded RNA virus, family Paramyxovirus,
genus Morbillivirus.
• Transmission -> primarily person‐to‐person via aerosolised
droplets.
• Average incubation period –> 14 days (range 7–18 days).
• Clinical features - characterised by generalised
maculopapular rash that starts at the hairline and descends
to whole body, fever, conjunctivitis, coryza, cough and the
presence of Koplik‟s spots in the mouth.
• Infectivity period – 4 days before to 4 days after onset of
rash.

4. INTRODUCTION
Complications -
• Pneumonia, diarrhoea, otitis
media, laryngo‐tracheo‐bronchitis (croup), encephalitis and
long term disabilities blindness, deafness.
• The 3 major causes of high case fatality are
pneumonia, diarrhoea and croup.
• Low Vitamin A status is associated with a higher rate of
complications and death from measles.
• India: 2010 - 219 outbreaks, 29808 reported cases&
In 2011 - 129 outbreaks, 9211 reported cases
(data as on 15th Jun, 2011)

5. SEROLOGICALLY CONFIRMED MEASLES OUTBREAKS:
AGE AND VACCINATION STATUS OF MEASLES CASES,
2011
Total cases = 9,221
4000
3800
3600
3400
 61 % no or unknown
3200
3000
2800
2600
vaccination status
2400
2200  86 % < 10 yrs of age
2000
1800
1600
1400
1200
1000
800
600
400
200
0
< 1 year 1-4 years 5-9 years 10-14 years >= 15 years
Vaccinated Not Vaccinated Unknown
* data as on 15th Jun, 2011

6. DISPROPORTIONATE BURDEN OF MEASLES
MORTALITY IN INDIA
77%
Data source: WHO/IVB, November 2009
Department of Immunization, Vaccines and Biologicals
(IVB)

7. INTRODUCTION
• Vaccine : Most of the live, attenuated measles vaccines
used now originate from the Edmonston strain of measles
virus isolated by Enders and Peebles in 1954.
• Strain widely used in India – Edmonston-Zagreb
• Stored at 2 to 8°C and to be used within 4 hours after
reconstitution.
• Vaccine is heat and light sensitive.
• Route and dose – 0.5ml given subcutaneously in the right
upper arm (triceps fold).
• WHO guidelines – first dose at 9-12 month, second dose at
16-24 months.

8. RATIONALE FOR SECOND DOSE
• Measles is a leading cause of childhood mortality, and the
reduction of child mortality is a key Millennium Development
Goal (MDG 4).
• Analysis of measles outbreak data for the period 2006 to
2009, in states with outbreak surveillance reveals that
around 90% of the measles cases were in the age group of
<10 years.
• Vaccine effectiveness, under field conditions, 85% when
given at 9 months and 95% when given at >12 months of
age.
• As per DLHS-3 survey coverage of the 1st dose of measles
stands at 69.6%.

9. RATIONALE FOR SECOND DOSE
• With 85% vaccine effectiveness for vaccination at 9 months,
actual protection was offered to only 60% of annual birth
cohorts (70% × 85% = 60%).
• In other words, at least 40% remained susceptible to
measles.
• A second opportunity measles immunization given at or
above one year of age (>95% effectiveness) along with
simultaneous increase in first dose coverage in the
population is an effective way to reduce the proportion of
susceptible children in the community and to prevent
measles outbreaks.
• 192 of 193 Member States of WHO use 2 doses of measles
vaccine in their national immunization programmes, India
being the only exception.

10. RATIONALE FOR SECOND DOSE
MCV1 & MCV2, no SIAs (41 member states or 21%)
MCV1, MCV2 & one-time catch-up (37 member states or 19%)
MCV1, MCV2 & regular SIAs (54 member states or 28%)
MCV1 & regular SIAs (60 member states or 31%)
Single dose (1 member state or 1%)
Data source: WHO/IVB measles database as of 26 January 2010

11. PLANNING
SIA: MCV1 <80%
RI: MCV1 > 80%

12. PLANNING
The National Technical Advisory Group on Immunization
(NTAGI) recommendations
• For states/UT with evaluated coverage of ≥80% -
A second dose of measles vaccine through routine
immunisation be given to children of 16-24 months of age.
21 states/UT qualify for this strategy.
Of these 4 states/UTs (Delhi, Goa, Puducherry and
Sikkim) are already using second dose of measles in their
RI programme (as mumps-measles-rubella vaccine) through
state resources.
Annual targets :1-2 year population: ~10 million

13. PLANNING
• For states/UT with evaluated coverage of <80% -
Supplementary immunization activity (SIA) to provide a
second opportunity for immunisation.
14 states qualify for large scale catch-up campaigns.
The catch-up campaigns will target 134 million children .
All children in the target age group (9 months – 10
years) will be vaccinated irrespective of their previous
immnisation status or history of measles disease.

14. PLANNING
States with coverage <80%
are
• Chattisgarh (79.9%) • Madhya Pradesh (57.7%)
• Gujarat (72.6%) • Bihar (54.2%)
• Jharkhand (70.5%) • Meghalaya (52.5%)
• Haryana (69%) • Tripura (51.7%)
• Rajasthan (67.5%) • Uttar Pradesh (47%)
• Arunachal Pradesh (65.5%) • Nagaland (data not
• Assam (64.4%) available)
• Manipur (58.9%)

15. PLANNING
• Measles catch-up campaigns need coordination and
participation at all levels – national, state, district and block
for successful implementation and achievement of high
coverage levels.
• Establishing SIA implementation committees at each levels
for all aspects of campaign is critical for success..
• Regular scheduled meetings should include review of
progress, problems encountered, proposed solutions and
new action points with clearly defined responsibilities and
deadlines.

16. COMMITTEES
• At national level there will be two committees
National Steering Committee
Central Operations Group
• At state level there will be
State Steering Committee
State Operations Group
Catch-up campaign control room
• At district level there will be
District Task Force
District Control Room

17. AT NATIONAL LEVEL
National Steering Committee
• This will be chaired by Secretary (Health and Family
Welfare), Government of India
• The committee will coordinate activities among Government
departments like Education, Women and Child
Development, Social
Welfare, NRHM, AYUSH, Railways, Civil Aviation etc. to
mobilize human and other resources .
• Coordination with civil society organizations like
Rotary, Lions etc; professional bodies like
IMA, IAP, IPHA, IAPSM etc and partners like WHO, National
Polio Surveillance Project (NPSP), UNICEF, USAID, Red
cross and other organisations.

18. AT NATIONAL LEVEL
Central Operations Group (COG)
• A Central Operations Group will be established to
coordinate the technical aspects of the activity.
• It will comprise officials from Government of
India, WHO, National Polio Surveillance Project
(NPSP), UNICEF, USAID, Red Cross and other partners at
the national level chaired by the Joint Secretary
(RCH), Health & Family Welfare, Government of India.

19. The role of the Central Operations Group is to meet on a
regular basis to:
• Provide technical and logistic support to
plan, implement, monitor and evaluate the catch-up
campaign at national and state levels.
• Ensure inter departmental coordination with donor
coordination division, vaccine procurement division and IEC
division.
• Develop and finalize media plan with timeline.
• Monitor implementation of IEC/Social Mobilization activities
at national, state and district levels.
• Coordinate with DAVP (Directorate Of Advertising And
Visual Publicity), Song and Drama
Division, Doordarshan, AIR, Field publicity etc.
• Provide feedback to the Secretary and obtain timely
approvals within the Government

20. STATE LEVEL
State Steering Committee (SSC)
• Established under the chairmanship of the State Health
Secretary.
• Its role is similar to that of Central Steering Committee i.e,
To mobilize human/other resources and coordinate
planning and implementation of activities with other
government departments and partner agencies.
Coordinate activities among Government
departments, civil organizations, professional
bodies, partners and other organizations.

21. STATE LEVEL
State Operations Group (SOG)
• The SOG will lead planning and implementation activities at
the state.
• The Mission Director/Director, Family Welfare will chair
the Operations Group.
• The State Immunization Officer (SIO) will be the member-
secretary.
• State level representatives of key Departments such as
Social Welfare, Education, IDSP, Panchayati Raj
Institutions, WCD, Transport, Media and partners such as
WHO-NPSP, UNICEF, Red Cross, Professional bodies like
IMA, IAP etc, religious leaders, minority groups should be
invited to attend coordination committee meetings.

22. STATE LEVEL
The role of State Operations Group (SOG) is to
• Provide technical and logistic support
• Ensure inter sectoral coordination and full utilization of
resources.
• Provide feedback to the Secretary and obtain timely
approvals.
• Develop a communication plan: Utilize all available
resources and channels for delivering simple and clear
messages to the community.
• Draw up state specific IEC and IPC plans.
• Monitor implementation of IEC/social mobilization activities
in the states.
• Respond appropriately to the media regarding program
implementation, progress, safety and AEFI.

23. STATE LEVEL
Catch-up campaign control room
• The control room will be set up in each state.
• The State EPI Officer, State Cold Chain
Officer, NPSP, UNICEF, representatives from other
development partners and a nominated member from the
state government should be stationed in the Control Room
for planning, monitoring, coordination and implementation of
activities.
• The role of the control room should be to monitor
preparedness on a day to day basis especially mobilization
of human and other resources like transport, ensure inter-
sectoral coordination and full utilization of resources from
partner government and non-government departments.

24. STATE LEVEL
• Catch-up campaign control room should also monitor
implementation of the programme during the activity.
• The control room will be providing feedback to the state
steering committee and state operations group on progress
being made and also on any obstacles being faced.

25. DISTRICT LEVEL
District Task Force (DTF)
• DTF should be formed under the chairmanship of the
District Collector/ Magistrate in each district, CMO/DIO
should be the member secretary.
• District level officers from
Education, ICDS, Police, transport, Media, CDO/
ADM, PRI, DUDA (District Urban Development
Agency), local bodies like municipalities, councils
etc, professional bodies and partner organizations along
with representatives from religious groups and opinion
leaders should be the participating members of DTF.
• The role of the district task force is to
support, supervise, monitor and ensure implementation
of the highest quality measles campaign in the district .

26. DISTRICT LEVEL
District Task Force Meetings
• The District Task Force should meet at least five times.
• The District Magistrate/District Collector will chair these
meetings.
• He/she may delegate this responsibility to CDO or ADM for
some of these meetings.
• The second and the fourth meetings are critical and should
always be chaired by District Magistrate.
• A compliance report on the decisions taken must be
submitted in the subsequent meeting.
Chief Development Officer(cdo) , Additional District Magistrate(ADM)

27. DISTRICT LEVEL
Meetings of district task force
• First: Four weeks before the round to review preparations
and logistics
• Second: One week prior to the start of the campaign to
review preparedness, validate micro-plans and address any
problems
• Third: One week after the start of the campaign to review
progress of school activity and make corrections.
• Fourth: 2 weeks after the start of the campaign to review
progress and make mid-course corrections.
• Fifth: Immediately after the completion of the campaign
to review monitoring and other data and ensure that children
in areas with low coverage are immunized immediately.

28. DISTRICT LEVEL
• A Control room at District level should be set up to
monitor preparedness of blocks/ PHCs/ urban areas on a
day to day basis and to monitor implementation of the
programme during the activity and give feedback to the
state control room.

29. PRE-IMPLEMENTATION ACTIVITIES
Conducting pre-campaign meetings, trainings and
workshops
• To ensure that the micro-planning guidelines are followed,
logistics and supplies properly arranged for, and personnel
involved at all operational levels clearly understand their
roles and activities to be undertaken; trainings/meetings
listed below must be conducted before the measles catch-
up campaign at each level.
• A meetings/training plan and timeline should be included in
the microplan for each state, district and block.

30. TRAINING CASCADE
• National Measles SIA Training of Trainers (ToT)
• State Measles SIA Training of Trainers (ToT)
• District Measles SIA Training
• Block Level Trainings

31. PRE-IMPLEMENTATION ACTIVITIES
The overall objectives of the training are:
• To ensure that all staff involved in Measles SIA understand
their role in the SIA
• That the micro-plans at the sub centre level are completed.
• That all vaccinators have appropriate knowledge and skills
to conduct the SIA at each of their catchment areas.
• The batch size at all trainings at any level should not be
more than 30.

32. PRE-IMPLEMENTATION ACTIVITIES
• National and State level Training of Trainers:
• First stage: one day training by central team to State
Health Functionaries (Deputy Health Directors, State
Immunization Officers, other identified State level master
trainers). This training of trainers will be completed at least
2 months prior to the SIA in each phase.
• Second stage:course will be conducted at state level for
District Level Trainers (District level health officers, Medical
Officers, Health Assistants, and Cold Chain Officers etc).
The training will be completed at least 6 weeks prior to the
SIA in each phase.

33. PRE-IMPLEMENTATION ACTIVITIES
• Third stage: each district will conduct a district SIA training
of trainers for all block level trainers like medical
officers, cold chain handlers, data handlers and other block
level functionaries. This will be one day training and should
be competed at least 4 weeks before the SIA in each
phase.
• Vaccinators', Supervisors' Training: All vaccinators
(ANMs, MPWs, Nurses and others) of each vaccination
team and supervisors (HA, LHV, BEE, HS etc) will be
trained by the Block Medical Officer and team (duration one
day) at the block level. The training will be completed 1-2
weeks prior to the SIA in each phase.
• Volunteer orientation: At PHC level will be done by the
Medical Officers and supervisors. This will be 2-3 hours
training and should be completed at least 1 week prior to

34. MICRO-PLAN: BASIC NORMS
• Target population:Enumeration/reliable estimate of target
population (9months - <10 years).
• Estimation of children enrolled in schools
• Take the highest of the available estimates for planning.
• Vaccine doses supplied to school session (1st week) =
No. of beneficiaries in school X 1.1
• Vaccine doses supplied to outreach session (2nd & 3rd
weeks) = No. of beneficiaries in village X 1.1 X 75%.

35. MICRO-PLAN: BASIC NORMS
• Vaccine vials required=Vaccine doses / 5 (for 5 dose vials).
• Reconstitution syringes (5 ml) Required = Vaccine vials
• Hub cutters=At least 1 per vaccinator
• Marker Pens = 1 pen per 300 children. At least 1 per
session site.
• Red plastic bags = 1 per 50 syringes
• Black plastic bags = 2 per session site per day

36. MICRO-PLAN: BASIC NORMS
• Number of teams needed to cover a school in one day =
Target population/200.
• Number of teams needed to cover a village/urban area in
one day = Target population/150.
• 1 supervisor per 3 teams.
• Plan to complete measles immunization in one day in a
village or an urban area (mohallas) or in a school by 1 or
more vaccinator teams as required.
• DIO is accountable for completeness, timeliness and
quality.
• PHC will be the unit of micro-planning.

37. MICRO-PLAN: BASIC NORMS
• 1 litre of cold chain space for vaccine storage= 200 doses of
measles vaccine (excluding diluents)
• Cold chain space required for vaccine (in litres)= measles
vaccine doses required /200.
• 1 litre of cold chain space for diluent storage = Diluents for
250 doses of measles vaccine
• Minimum Cold chain space required for diluents (in litres) =
Diluent doses required for 1 day/250.
• 1 ILR small with net vaccine storage volume of 45 litre can
store 9,000 doses of Measles vaccine without diluents.
• In case of inadequate space, vaccines can be supplied in
aliquots (50% before activity, 25% at end of first week and
25% at end of second week).
• During the campaign, only large standard vaccine carriers
with four icepacks will be used for carrying vaccine.

38. MICRO-PLAN: SUB-DISTRICT LEVEL
• Micro-plans at the Block/PHC level should have the
following components
1.Session site and human resource plan with vaccine and
logistic estimates by session sites
2.Map showing location of session sites.
3.Cold chain plan including ice pack freezing plan
4.Logistics distribution plan with route charts on map
5.Waste management plan
6.Training plan
7.Communication Plan
8.AEFI management plan
9.Supervision plan
Plan for covering missed children
Contingency plans for human resources, logistics and cold
chain

39. VACCINATION TEAM
• A Vaccination team will have
• 1-2 vaccinators (ANM / Male HWs / LHV / retd. ANMs, LHVs
/ pharmacists / nurses / doctors).
• In case the beneficiary load is 150-300 at outreach site or
200-400 at school site, the team will have two vaccinators.
• 1 ASHA / Link worker or similar staff (for urban areas).
• 1 AWW
• 1 volunteer
To ensure injection safety no team will conduct more than
one vaccination session in one day.
 Zero tolerance to AEFI due to program errors (TSS or
wrong diluent)

40. COMMUNICATION AND SOCIAL MOBILIZATION
Proper communication will help to
• Build and maintain confidence in immunization.
• Create an enabling environment for vaccine introduction
and demand.
• Improve quality of interaction between health workers and
caregivers.
• Manage controversies.

41. COMMUNICATION AND SOCIAL MOBILIZATION
Engaging religious leaders Briefing media
IPC with community Engaging school children Using mid-media

42. COMMUNICATION AND SOCIAL MOBILIZATION
Communication campaign
• The communication campaign begins with advocacy and
social mobilization, and includes both IEC
(information, education, communication) and IPC
(Interpersonal communication).
• Apart from advocacy at state and district levels, all
functionaries at the service delivery level
(ANM, Supervisor, ASHA, AWW, volunteer) should be
trained to deliver the right messages through IPC.
• This will include focus group discussions at the village level
(involving opinion leaders and parents/caregivers) prior to
the campaign to address their concerns and questions

43. COMMUNICATION AND SOCIAL MOBILIZATION
Advocacy
• Success of a campaign will depend on strong advocacy with
related Government departments, civil society including the
press and professional groups (IMA, IAP etc.) at each level.
• A very strong partner is media (both at the state and local
levels).
• This calls for special advocacy with the media to gain their
support for the campaign – from planning stages to the end
of the campaign and after.
• Partnership with media will also be useful in the event of
AEFI.
• Advocacy Meeting should be held with all teachers and
Teachers union of schools having target children, local
religious and community leaders, among Government
departments, civil organizations, professional
bodies, partners and other organizations.

44. COMMUNICATION AND SOCIAL MOBILIZATION
• Inter personal communication (IPC)
• At least two weeks before the campaign ASHA (or AWW if
ASHA not designated) will visit all the households in her area
and complete a due listing of all target age group children.
• During the process of due listing ASHA will do IPC regarding
the campaign and inform parents/care-givers about dates and
session sites at schools and village as relevant.
• In the week before the campaign ASHA will revisit the
households.
• During the campaign after the school phase ASHA (or AWW)
will check and update her due list.
• On the campaign day in the village, by mid-morning ASHA (or
AWW) will track the un-immunized children from her due list.
• Urban areas will have to be covered in a similar manner in
coordination with staff from urban ICDS, municipalities and
other departments

48. IMPLEMENTING MEASLES CATCH-UP
CAMPAIGNS
• Phase I
• Phase II
• Monitoring & mid-course correction
• Haryana scenario
• Immunisation safety

49. Annual Target 1-2 year
Ongoing: 4 states (0.4 million)
2010: 3 states (1.2 million)
2011: 11 states (5.9 million)
To be decided: 3 states (2.2 mln)

50. MEASLES SIA PLAN, INDIA
Phase 1, 45 districts covered
Phase 2 A (144 districts)
Phase 2 B (81 districts)
Phase 3 (91 districts)
Target Population: 126,127,387
Target vaccine doses: 136,217,578

51. DISTRICTS IN PHASE 1
Gujarat Madhya Pradesh
Banaskantha Alirajpur
Tripura
States & Districts
Arunachal Pradesh
Bhavnagar Barwani West Tripura
Patan Jhabua
East Siang
Assam
Uttar Pradesh
Sabarkantha Shivpuri
Marigoan
Bihar Surendranagar Tikamgarh Ballia
Arwal Haryana Manipur Deoria
Aurangabad
Gaya Faridabad Imphal west
Jehanabad Gurgaon Meghalaya
Nawada Ribhoi
Chhattisgarh
Jhajjar
Bilaspur Mewat Nagaland
Champa Palwal Phek
Dantewara & Bijapur
Janjgir Jharkhand Rajasthan
Jashpur Deogarh Ajmer
Kawardha Bhilwara
Korba Gumla
Korea Jamtara Nagaur
Sarjuga
Khunti Rajsamand
Lohordaga Tonk

52. EXPERIENCES FROM PHASE 1 CATCH-UP
CAMPAIGNS
• GoI supported all logistic and operation costs of the activities
 Budget committed for subsequent phases
• Cold chain capacity and management met expectations
• No major issues with vaccine and injection equipment
management
• Large scale campaigns with injectable vaccines can be
conducted safely in India
 Medical officers in all SIA districts trained in AEFI
management, reporting
 No instance of AEFI due to programme error detected
 All reported AEFIs managed effectively
• Administrative coverage variable across states:
 39 districts completed campaigns so far
 49% (19/39) with >= 90% coverage

53. REASONS FOR NON-VACCINATION IN MCUP1
(FROM MONITORING DATA)*
Parents didn't know about campaign
9.1 Parents didn't know place or date of the
20.2
campaign Comm
Fear of injection
15.5 unicati
Fear of AEFI on
Parents didn't give importance to related
campaign
1.1 Child was sick
1.3 10.0
1.0 There was no vaccine at the site
There was no vaccinator at the site
8.6
11.3 Site was too far
Operat
ional
Child was traveling
1.8
19.9
Other Reason
Source: MoHFW, RCA monitoring
* As reported by caregivers to monitors

54. AREAS FOR IMPROVEMENT
• Coordination and planning
 Better coordination among the departments of
Health, Education and ICDS
 Flexible approach with states for timeline; but
stringent adherence to agreed upon timeline
• Communication and advocacy
 IEC and interpersonal communication at grass-root
level
 Civil society and professional bodies: Indian Academy
of Pediatrics, Indian Medical Association, Others
 Private schools
• Vaccination in urban areas poses special challenges
• Injection waste management needs strengthening
• Supervision needs to be improved at all levels.

55. PLANNED PHASES OF MEASLES CATCH-UP
CAMPAIGNS
Phase 1 Phase 2A Phase 2B Phase 3 Total
Dates Q4 2010 – Q3 – Q4 Q1 2012 Q4 2012
Q2 2011 2011
No. districts 45 144 81 91 361
Target population 14.0 41.5 33.4 47.0 135.0
(9m-10yrs)
millions
Children 12.0
vaccinated
(millions)

56. IMPLEMENTING MEASLES CATCH-UP
CAMPAIGNS

57. CATCH-UP CAMPAIGN
• 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: All health facilities at PHC level and
above will function as session sites throughout the campaign

58. CATCH-UP CAMPAIGN
• Key operational strategies
1. Measles immunization will be given from fixed sites and each
session site will remain open from 8:00 AM to 2:00 PM.
2. Routine immunization will continue uninterrupted per weekly
schedule.
3. ASHA/AWW will mobilize target children to session site and also
help ANM in organizing the session and manage crowd control.
4. Three weeks campaign (12 working days)
1st week in educational institutes;
2nd and 3rd week in existing UIP outreach sites.
5. Only trained vaccinators will be used for vaccination.
6. Volunteer support will be required at each vaccination post.

59. CATCH-UP CAMPAIGN
7. Within national guidelines certain flexibility will be allowed at
local level considering local limitations and constraints.
8. Strong monitoring of cold chain system to ensure vaccine
potency and safety.
9. Only the large vaccine carrier with four ice-packs will be
used during campaign for transporting vaccines.
10. All components of immunization safety will be adhered to.
11. Throughout the campaign period (3 weeks) one fixed
vaccination centre in block and municipality will remain open
to vaccinate the children missed during day-to-day
campaign activities.

60. CATCH-UP CAMPAIGN

62. MONITORING & MID-COURSE CORRECTION
• Supervisors will monitor areas immediately on completion of
activity and check at least 20 target age-group children.
• BMO should review supervisors‟ checklists and monitoring
feedback on a daily basis to identify areas requiring action as
below.
• Rapid assessment of coverage by Supervisors & independent
monitors on a daily basis:
• If according to either supervisors‟ independent monitors‟
observations
 2 or 3 children found „missed‟ (un-immunized): motivate and
mobilize missed children to the nearest campaign or routine
immunization session site.
 4 or more children found un-immunized: Vaccinator team
should revisit the area to immunize all missed children.

63. Haryana – Phase 1, 2A and 2B
95
Phase 1
Phase 2 A
Phase 2 B
DATA OF 2011 IS UPTO WK 38

64. HARYANA SCENARIO
• Measles Catch-up Campaign Phase-1 was conducted in
2010 in 5 districts of Haryana namely
Faridabad, Guragaon, Mewat, Palwal and Jhajjar, wherein
13 lakh children were vaccinated.
• Phase 2-A: was conducted from November 14 to December
5, 2011 in six districts
(Rohtak, Bhiwani, Sonipat, Panipat, Mahendragarh and
Rewari) with a target population of 13 lakh children.
• Rohtak – Target population – 190,822
Coverage – 185042 (96.97%)

65. HARYANA SCENARIO
• The phase 2-B of Measles catch up campaign will be
launched in 10 districts of Haryana from January 9.
• The campaign will be launched in Ambala, Fatehabad,
Hisar, Jind, Kaithal, Karnal, Kurukshetra, Panchkula, Sirsa
and Yamunanagar.
• Haryana would be the first state in the country to complete
Measles catch-up campaign in all its districts.

66. IMMUNISATION SAFETY
• It may be more difficult to maintain immunization safety
standards during campaigns than during routine services.
• To ensure the safety of injections during campaigns and
outbreak control activities, WHO and UNICEF recommend
that sufficient quantities of auto‐destruct syringes (which
cannot be reused) and safety boxes be provided for every
fixed or temporary post and every outreach team.
• Injections must not be given during campaigns if adequate
quantities of these syringes are not available.

67. IMMUNISATION SAFETY
• Use a new sterile packed AD syringe for each injection for
each child.
• Use the same syringe to draw and administer the vaccine.
• Do not pre-fill syringes.
• Do not attempt to recap the needle.
• Immediately after injecting the child, the AD syringe must be
cut.
• Safe disposal of injection waste.

68. IMMUNISATION SAFETY
• In order to ensure immunization safety, health workers must
be particularly aware of the need to ensure that the vaccine
vial monitor does not indicate that the vial has been
exposed to high temperature at some point, to keep
reconstituted measles vaccine cool, to use an AD syringe for
every injection, even if this means ending a session early.
• Proper injection procedures should be observed at all times.
• Reconstituted vaccine should be discarded after four hours
or at the end of a session, whichever comes first. A VVM is
not of use after the vial is open.

69. Using the Hub-cutter Correctly
Cut
here
Handle Hub
Needle
Insertion
Hole
Puncture
proof
container
•Cut needles and hub
• Broken vials and ampoules

71. ADVERSE EVENTS FOLLOWING IMMUNISATION
(AEFI)
Causes of AEFI Description
Programmatic These are events caused by an error in vaccine handling,
errors preparation or administration. Programmatic errors are the
most frequent cause of adverse events and can be avoided.
Vaccine reaction Caused by the vaccine even when given correctly. This is
caused by inherent properties of the vaccine itself or by an
individual‟s response to the vaccine
Coincidental The event occurs after immunization, there is no association
between the immunization and the medical
incident following the immunization.
Injection Reaction An event from anxiety about, or pain from, the injection itself
rather than the vaccine.
Unknown cause

72. RISK OF COMPLICATIONS AFTER NATURAL MEASLES INFECTION
AND SELECTED AEFI AFTER MEASLES VACCINATION
Complication Risk after vaccination
(events/no. of doses)
Fever ≥ 39.4 C 1 in 9
Rash 1 in 10
Febrile convulsions 1 in 2500
Encephalitis/ Encephalopathy (and 1 in 1,000,000
other serious neurological disorders
Sub‐acute sclerosing panencephalitis 1 in 1,000,000
Anaphylaxis 1 in 1,000,000

73. ADVERSE EVENTS FOLLOWING IMMUNISATION
(AEFI)
• Anaphylaxis is are but severe and potentially fatal allergic
reaction.
• Vaccinators, paramedics and physicians should be able to
distinguish anaphylaxis from fainting (Vasovagal syncope),
anxiety and breath-holding spells.

74. ADVERSE EVENTS FOLLOWING IMMUNISATION
(AEFI)

75. CONTENTS OF AN AEFI TREATMENT KIT
• Injection adrenalin (1:1000) solution – 2 ampoules
• Injection Hydrocortisone (100 mg) – 1 vial
• Disposable Syringe (insulin type) having 0.01 ml
graduations and 26G IM needle – 2 sets
• Disposable Syringe (5 ml) and 24/26G IM needle – 2 sets
• Scalp vein set – 2 sets
• Tab Paracetamol (500 mg) - 10 tabs
• I/V fluids (Ringer lactate/Normal Saline): 1 unit in plastic
bottle
• I/V fluids (5% Dextrose): 1 unit in plastic bottle

76. CONTENTS OF AN AEFI TREATMENT KIT
• IV drip set: 1 set
• Cotton wool + adhesive tape : 1 each
• AEFI reporting form (FIR)
• Label showing: Date of inspection, Expiry date of Inj.
Adrenaline and shortest expiry date of any of the
components
• Drug dosage tables for Inj Adrenaline and Hydrocortisone
• At hospital setting, Oxygen support and airway intubation
facility should be available.

77. STEPS IN MANAGEMENT OF ANAPHYLAXIS
Anaphylaxis?
Assess ABC: Airway/Breathing/Circulation
Diagnosis: Look for Acute onset of illness/Life threatening problems with A-B-
C/Skin changes
Call for help/Lie patient flat/Raise patient’s legs/Keep airway clear/If
necessary give CPR
Inj. Adrenaline IM
(1:1000 solution)
Inj Hydrocortisone
Refer to next level, as needed
In hospital settings: Establish airway/High flow oxygen/IV
fluids

78. MONITORING AND EVALUATION
• State and District level Officers should be allotted
districts/blocks/urban areas which should be meticulously
visited before the activity for monitoring the preparedness
and during the activity to monitor the implementation of the
activity.
• Qualitative and quantitative assessment on the
immunization activity from observers should be utilized for
mid-course corrective actions like retraining of vaccinators,
review of micro-plans etc. or immediate corrective actions
like repeating the activity in an area where significant
number of unimmunized children are found after completion
of activity.

79. MONITORING AND EVALUATION
• Following the campaign, review meetings should take place
at District, State and National levels to identify the strengths
and weaknesses of the activities.
• It is important that all stakeholders should participate in this
process to document best practices and lessons learned to
ensure the highest quality of campaigns in the future.
• The outcome of the catch-up campaign is measured by the
proportion of the target population (children 9 months to 10
years) who were vaccinated during the SIA.

80. MONITORING AND EVALUATION
• There are two approaches to estimate measles campaign
vaccination coverage:
1. Administratively based on campaign field reports and
estimated target populations.
2. Conventional household surveys using cluster sampling
methodologies.
• The second approach is often used to validate
administrative coverage and is seen as the gold standard for
assessment of the coverage attained during a measles
catch-up campaign.

81. MONITORING AND EVALUATION
• Evaluation of the impact of the campaign
• Impact of the campaign is related to the reduction in
measles related morbidity and mortality as a result of the
measles catch-up campaign and the increased immunity of
the population to the virus.
• This will be measured through sensitive laboratory
supported measles surveillance.

82. POST-CAMPAIGN REVIEW
• Criteria for the determination of the interval and age target during
follow up measles SIAs
1. After measles SIAs that achieve relatively homogeneous coverage rates
of >90%
• If routine measles coverage >60%‐79% ‐ an interval of 3 years is
recommended targeting children aged 9‐47 months.
• If routine measles coverage <60% ‐ an interval of 2 years is
recommended targeting children 9‐35 months of age.
2. After measles SIAs that achieve relatively homogeneous coverage rates
<90%
• If routine measles coverage >80% ‐ an interval of 3 years is
recommended.
• If routine measles coverage <80% ‐ an interval of 2 years is
recommended.
3. After measles SIAs with “relatively heterogeneous” coverage rates
• A decision should be made on a case by case basis after detailed
analysis of country data

83. POST-CAMPAIGN REVIEW
• New measles mortality reduction goal
• In May 2010, the WHA (World Health Assembly) endorsed
the following measles control targets for 2015 as milestones
towards measles eradication:
• Increasing measles immunization coverage to >90%
nationally and >80% in every district;
• Reporting an incidence of <5 cases/1 000 000 population;
and
• Reducing measles mortality by 95% compared with 2000
levels.

84. REFERENCES
• WHO/UNICEF Joint Annual Measles Report 2010.
• Measles Catch-up Immunization Campaign, Guidelines for
Planning and Implementation, Ministry of Health and Family
Welfare Government of India, June 2010.
• Measles SIAs Planning & Implementation Field Guide, World
Health Organisation Regional Office For Africa, April 2010.
• Measles Catch-up Immunization Campaign, Handbook for field
level workers, Ministry of Health and Family Welfare Government
of India, August 2010.
• iGovernment ,Haryana News.
• Measles Control in SEAR, Current Progress and Plans, Annual
Meeting of Partners for Measles Advocacy American Red Cross
National Headquarters .

85. • Facilitators‟ guide: Handbook for field level
workers, MoHFW, Govt. of India, August 2010.
• National Measles SIA Training of Trainers,16-17th August
2010, NIHFW.
• Office of Civil surgeon, Rohtak, Haryana.