1) Strategies for measles control in India include improving routine immunization coverage, providing a second opportunity for measles immunization, conducting outbreak surveillance, and investigating outbreaks. 2) India had a disproportionate burden of measles mortality, with an estimated 164,000 measles deaths in 2008. 3) A review of global vaccination strategies found that most countries employed routine immunization plus supplemental immunization activities or routine immunization plus catch-up campaigns. India decided to introduce a second dose of measles vaccine (MCV2) in 2010.

1. Strategies for Measles Control Progress and future plans

2. Principles of accelerated measles control strategies in India Improve and sustain routine immunization coverage Provide a second opportunity for measles immunization to all eligible children Sensitive, laboratory supported measles outbreak surveillance for case/outbreak confirmation Fully investigate all detected measles outbreaks and ensure appropriate case management

3. Disproportionate burden of measles mortality in India 67% 164,000 estimated Measles Deaths in 2008 = 1000 death Dots are randomly distributed in countries Data source: WHO/IVB, November 2009

4. Global Context: Worldwide measles vaccination delivery strategies, mid-2010 Govt of India decision in 2010 to introduce MCV2 MCV1 & MCV2, no SIAs (40 member states or 21%) MCV1, MCV2 & one-time catch-up (36 member states or 19%) MCV1, MCV2 & regular SIAs (57 member states or 28%) MCV1 & regular SIAs (59 member states or 31%) Single dose (1 member state or 1%)

6. All serious AEFIs reported and correctly managed

8. Presentation outline Global context Introduction of MCV2 Routine services Catch-up campaigns Scale-up of laboratory measles surveillance Summary and way forward

9. 2006 2007 2009 2010 2011 Scale-up of laboratory enhanced measles outbreak surveillance

10. Serologically confirmed# measles, rubella and mixed outbreaks, India(Andhra Pradesh, Gujarat, Karnataka, Kerala, Madhya Pradesh, Rajasthan, Tamil Nadu and West Bengal) 2009 2010* 68 56 41 196 16 4 216 outbreaks 165 outbreaks #Outbreak confirmation for Measles: 2009 ≥ 1 cases IgM positive for measles, Similarly for Rubella Outbreak confirmation for Measles: 2010 ≥ 2 cases IgM positive for measles, Similarly for Rubella * data as on 15th Apr, 2011

12. 85 % < 10 yrs of ageCases from serologically confirmed measles and mixed outbreaks * data as on 15th Apr, 2011