Measles / MMR Vaccine Developments last 6 months Dr.Sanjay Srirampur [email protected] 1/16/20141IAPCOI Measles/MMR - Dec 2011

Measles / MMR Vaccine Developments last 6 months

Dr.Sanjay [email protected]

04/10/23 1IAPCOI Measles/MMR - Dec 2011

1. Measles Surveillance

2. Measles/MMR Vaccine

3. Second Dose of vaccine

4. Vaccine Delivery - Status Update

Agenda



NTAGI recommendations 2009: Surveillance and CFR estimates

• Surveillance:

– Serve the data needs of the immunization programs

– IDSP-lead role with technical support from WHO-NPSP and other partners

• Geographic expansion in consultation with the states:

– Preceding the phased implementation of measles SIAs• 2009-2010: Rajasthan, Madhya Pradesh and Orissa

• 2010-2011: Bihar, Chhattisgarh, Jharkhand, Uttar Pradesh (UP) and Assam

• Estimates of case fatality ratio (CFR):

– Through outbreak surveillance system in one high burden state

– Technical support from partners

Source: National Technical Advisory Group on Immunization (NTAGI); 3 August 200904/10/23 4IAPCOI Measles/MMR - Dec 2011

2006

2007

2009-10

2010-11

2011

2009

Surveillance Planned

Surveillance Initiated

Measles Surveillance India: Current Status and Future Plans



148 outbreaksMeasles outbreaks confirmed

Rubella outbreaks confirmed

Mixed outbreaks confirmed

1113639

585238

2008 2009 - 2010*

186 outbreaks

* data as on 15th Jan, 2010

Serologically confirmed measles, rubella and mixed outbreaks


Measles / MMR VaccineUpdate





Second Dose of Measles VaccineRationale


Immune response to second dose of MMR vaccine in Indian children

Sunil Gomber1, Shilpa Khanna Arora1, Shukla Das2, VG Ramachandran2

1 Department of Pediatrics, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India

2 Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India

Year : 2011 | Volume : 134 | Issue : 3 | Page : 302-30604/10/23 13IAPCOI Measles/MMR - Dec 2011

Response to second dose of Measles Vaccine

•Gomber et al after 2 year vaccination 20% had detectable antibody

•Multicentric study 100% antibody conversion on 2nd dose

•Single dose Mumbai – 93%, Pune – 82%, Indore – 50%

•Effect of 3rd dose ??? – 65% ? IAP

Gomber S, Arora SK, Das S, Ramachandran VG. Immune response to second dose of MMR vaccine in Indian children. Indian J Med Res. 2011;134:302–6

Bhargava I, Chapparwal BC, Phadke MA, Irani SF, Chapparwal D, Dhorje S, et al. Imunogenicity and reactogenicity of indigenously produced MMR vaccine. Indian Pediatr. 1995;32:983–8


Vaccine Delivery Status Update


Measles Coverage (DLHS-3)


Background• MYP for Universal Immunization Program (UIP) in India

– Goal 2005-10: 67% reduction of measles related mortality by 2010

– Goal 2010-17: 90% reduction in measles related mortality by 2013

• Widely disparate MCV1 performance through RI in 35 states and UTs

– 99% in Goa vs. 47% in Uttar Pradesh*

• Variable improvement in MCV1 coverage through RI

– Bihar: MCV1, 46% (2006) to 54% (2008)

– Uttar Pradesh has remained static at 47%

Proposed and under consideration

Source: DLHS 3 (2007-08)04/10/23 17IAPCOI Measles/MMR - Dec 2011

Global Context: Worldwide measles vaccination delivery strategies, mid-2010

MCV1 & MCV2, no SIAs (40 member states or 21%)

MCV1 & regular SIAs (59 member states or 31%)

MCV1, MCV2 & one-time catch-up (36 member states or 19%)

MCV1, MCV2 & regular SIAs (57 member states or 28%)

Single dose (1 member state or 1%)

Data source: WHO/IVB measles database as of 26 January 2010

India national immunization programme introduced

second dose of measles in 2010


NTAGI recommendations, 2009:MCV2 delivery strategies

• MCV2 delivery strategies for states with low MCV1 coverage (< 80%)

– SIA targeting children 9 month to 10 years • 2009-10: Rajasthan and Madhya Pradesh

• 2010-11: Bihar, Chhattisgarh, Jharkhand, UP and Assam

• MCV2 delivery strategies for states with high MCV1 coverage (>= 80%)– 18 states and union territories identified

– MCV2 offered through UIP at 16-24 months of age

Source: National Technical Advisory Group on Immunization (NTAGI); 3 August 200904/10/23 19IAPCOI Measles/MMR - Dec 2011

>= 80% MCV1 CES 2006

MCV2 in UIP

2009-20102010-20112011

MCV2 through Measles SIA

NTAGI 2009: introduce MCV2

Delivery mechanism: UIP

Delivery mechanism: SIAs


MCV2 introduction: State-specific delivery strategies

• SIA in 14 states:– Target population (9 mo-10 years):

134 million – Vaccine doses and AD syringes: 147

million – Mixing syringe : 29.5 million

• MCV2 in routine immunization in 21 states: – Annual targets

• 1-2 year population: ~10 million• Vaccine doses: ~12 million

RI: MCV1 > 80%: 21 states

SIA: MCV1 <80%: 14 states


MCV2 introduction through catch-up vaccination campaign (MCUP) Phase 1

• In three phases– Target: 134 million in 351 districts

• Phase 1: – 45 districts from 13 states with ~13

million target children• 9 district from Chhattisgarh

• 5 districts from each of the 6 states (Bihar, Jharkhand, Rajasthan, Madhya Pradesh, Gujarat & Haryana)

• 1 district from each of the North-East states

• Phase 2 to take place from September 2011

• Phase 3 in 2012


State (No. of Districts covered in phase 1)

Administrative coverage achieved in MCUP1@

0

10

20

30

40

50

60

70

80

90

100

Arun

acha

l Pr. (1)

Assa

m (1)

Bihar (5

)

Harya

na (5

)

Mad

hya P

rade

sh (5

)

Man

ipur (

1)

Rajas

than

(5)

Chha

ttisg

arh (

9)

Jharkh

and*

(5)

Nagala

nd* (

1)

Tripu

ra* (

1)

% Co

vera

ge

10.2 million children vaccinated so far (92% coverage) in 39 districts across 11 states

* Provisional data @ From 39 districts where campaign completed04/10/23 23IAPCOI Measles/MMR - Dec 2011

Thank You


Documents

Measles / MMR Vaccine Developments last 6 months Dr.Sanjay Srirampur [email protected] 1/16/20141IAPCOI Measles/MMR - Dec 2011