Universal Immunization

Program

in India

Outline of the Presentation

UIPScope

andScale

Immuniza2on

Coverage

trends

Scalingup

coverage

NewVaccines

Introduc2on

Universal Immunization Programme (Scope and scale)

India is the largest manufacturer of vaccines with a functional National Regulatory Authority

One of the largest public health programs in India

10 vaccines providing protection against 12 vaccine preventable diseases

>9 million sessions planned per year;

Around 30 million pregnant women and 27 million newborns targeted annually;

>27,000 cold chain points for storing and distributing vaccines

EPI launch

TT vaccine intro

UIP launch; Measles vaccine intro

Pulse Polio launch

JE vaccine intro

Measles 2nd dose intro Hepatitis B vaccine scale up

Last wild polio virus reported from India; Penta intro

Open vial policy; JE 2nd dose intro

India certified polio-free

-MNTE validated -IPV intro

- Mission Indradhanush

Rota intro

MR campaign

Major Programme Milestones

19781983

19851995

2006 2010

2014

EPI: Expanded Programme of Immunization, UIP: Universal Immunization Programme; MNTE: Maternal and Neonatal Tetanus Elimination

2015

20112013

2017

2002Hep-B pilot intro

JEvaccineforadultintroducedin2014

2016

*-Childrenconsideredfullyimmunizedwhentheyhavereceivedvaccina2onagainstTB,3dosesofDPT&Polio&adoseofMeaslesvaccine

43.5

53.5 61.0

65.2

0

14

28

42

56

70

NFHS 2005

DLHS 2007

CES 2009

RSOC 2013

% F

ull i

mm

unis

atio

n in

chi

ldre

n le

ss th

an 1

2 m

onth

s ag

e

Immunization coverage trend – India

Slowprogressduringrecentyears

A&N ISLANDS

A&N ISLANDS

Percentchildrenfullyimmunized(12-23months)

Coverage Evaluation Survey 2009

Rapid Survey of Children (RSOC) 2013-14

> = 80% 70% to 80% 60% to 70% 50% to 60% < 50%

61% 65%

Source : Routine Immunization house to house monitoring data

N = 1,01,381

Whyarechildrenbeingmissed?India,2015

Number of children monitored = 4,19,371

4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

India

22%

75%

FullImmuniza2on

Par2alImmuniza2on

Immunization status of monitored children, 12-23 months, India 2015

33%

32%

11%

13%

10%

Column1Awareness&Infoema2ongap

AEFIapprehension

Opera2onalgap

Childtravelling

Others

Source : Routine Immunization house to house monitoring data

N = 24,324

Whyarechildrenbeingmissed?India,2016*

Number of children monitored = 2,17,073

3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

India

18%

79%

FullImmuniza2on

Par2alImmuniza2on

Immunization status of monitored children, 12-23 months, India 2016*

* Jan16 – Jul 16

29%

35%

10%

15%

11%

Column1Awareness&Infoema2ongap

AEFIapprehension

Opera2onalgap

Childtravelling

Others

Scaling-up coverage

Improvingcoverage,ensuringequity“MISSIONINDRADHANUSH”

Reachingtheunreachedwithallvaccines

•  497districtsacross35States/UTscoveredinthreephases.•  201,352and216districtsinphase1,2and3respec2vely.•  Phase-4inNEstatesstartedfrom7thFebruary2017in68districts

•  FocusonunderservedpopulaQons/areas•  Fourintensifiedimmuniza2ondrivesheldduringeachphasetarge2ngallchildren&pregnantwomen

•  Ac2veengagementofStateGovernmentsandpartners

MISSION INDRADHANUSH-Key Achievements

Duringthethreephases:

•  Morethan2.1crorechildren

vaccinated

•  Around55lakhchildrenfully

immunized

•  Around55.9lakhpregnantwomen

vaccinatedwithTetanustoxoid

IniQaQvesinVaccineLogisQcs&ColdChainManagement

Capacitybuilding:–  Na2onalColdChainTrainingCentre(NCCTE),Pune–  Na2onal Cold Chain & VaccineManagement Resource Centre (NCCVMRC) -

NIHFW,NewDelhi–  Established toprovide technical training tocoldchain technicians in repair&

maintenanceofcoldchainequipment.

Systemstrengthening•  ElectronicVaccineIntelligenceNetwork(eVIN)rolloutfor:

–  Real 2me stock management and Real 2me monitoring of cold chaintemperatureusingmobiletechnologyanddatalogger(simbased)

–  Currentlyopera2onalin12states;phasedexpansioninotherstates.•  Na2onalColdChainManagement Informa2onSystem(NCCMIS) to trackcold

chainequipmentinventory,availabilityandfunc2onality.

AEFI Surveillance •  WellestablishedsystemforsurveillanceofAdverse EventsFollowingImmuniza2on

(AEFI)inthecountry

•  Sensi2vityofsurveillancehas improvedas indicatedby increasedrepor2ngofAEFI

cases

•  Na2onal,StateandDistrictAEFIcommieeesinplace

•  QualityManagementSystemdevelopedandisbeingimplemented

•  Causality Assessment reports of AEFI cases are available for public at MoHFW’s

website

•  AEFIguidelines revisedand trainingof stateAEFI commieeeshasbeendone in24

states;furthertraininginprocess

Expansion of VPD surveillance: Measles/Rubella

Measles outbreaks confirmed

Rubella outbreaks confirmed

Mixed outbreaks confirmed

Labsupportedmeasles/rubellasurveillancestartedin2005andexpandedtoallstates/UTsofIndiausingpoliosurveillanceasapla=ormLabsupportedsurveillanceforotherVPDsiniBatedin2013andexpandedtoHaryana,Bihar,KeralaandUJarPradesh

568

204

50

2016* (till Nov) 1258 outbreaks

# Outbreak confirmation for Measles: ≥ 2 cases IgM positive for measles, Similarly for Rubella

PGI, Chandigarh SGPGI, Lucknow PMC, Patna NCDC, Delhi SMS, Jaipur GMC, Bhopal BJMC, Ahmedabad NIV, Pune NIV, Bangalore KIPM, Chennai IPM, Hyderabad IOS, Kolkata MCG, Guwahati

12-NaQonallaboratories2-Referencelaboratories

ERC, Mumbai

2011 : Last polio case due to WPV (13 January, 2011)

2012 : Removed from list of polio endemic countries on 24 Feb

2014 : Receives polio-free certification on 27 March

Rukhsar, the last polio case due to wild poliovirus

(WPV) in India !

POLIO ERADICATION - MILESTONES ACHIEVED

•  Poliovirusdetec2on&interrup2on

•  OPVwithdrawal,IPVintroduc2on,RIstrengthening

•  Containment&GlobalCer2fica2on

•  LegacyPlanning

POLIO ERADICATION & ENDGAME STRATEGIC PLAN, 2013-2018

•  Globallysynchronizedovera2weekperiod16Aprto1stMay16

– Withinthese2-weekwindow,allcountriesswitchedononeday(na2onalswitchdate)

•  IndiaswitchedfromtOPVtobOPVon25thApril2016

•  bOPVvaccinesuppliedtwoweekspriortoswitchdate

•  Recall–disposal–ValidaQon

–  Duringthe2weeksfollowingthena2onalswitchdate

•  NouseofanytOPVa`erthenaQonalswitchdate

OPV TYPE 2 WITHDRAWAL (APRIL 2016)

•  Launchedon 30thNovember 2015,ini2ally introduced in 6 states;expandedtoallstatesinApril2016.

•  IPVwillbegiventoeachinfantat14weeks at OPV3 contact. 2 doses offIPV given at 6 and14weeks in 16states.

•  fIPVwill furtherreplacesingledoseIPVin20morestates/UTs.

•  IPV will not replace OPV, it willreduce risk associated with tOPV-bOPVswitch.

IPV introduction – a key component of endgame plan

2003 - 2013 2014 2015

19 states/UTs 30 states/UTs 36 states/UTs

India also achieves Maternal & Neonatal Tetanus Elimination..

15 May 2015: “WHO congratulates

India on achieving the milestone of MNTE”

Introduction & scale-up of new vaccines

Age VaccinesgivenBirth BCG,OPV-0,Hepa22sBBirthdose6Weeks OPV-1,Pentavalent-1,fIPV-1,Rota-1&PCV-110weeks OPV-2,Pentavalent-2&Rota-214weeks OPV-3,Pentavalent-3+fIPV-2/IPV,Rota-3&PCV-29-12months MR-1(MCV1),JE1**,PCV-B16-24months MR-2(MCV2),JE2**,DPT-B,OPV-B5-6years DPT-B210years TT16years TTP r e g n a n tMother

TT1,2orTTBooster***

**inendemicdistrictsonly***onedoseifpreviouslyvaccinatedwithin3years

Revised National Immunization Schedule

PlannedtobeintroducedBeingintroduced/scaledup

1

Tamil Nadu

Kerala

Pentavalent introduced in 2011 – 2 states

1

Pentavalent introduced in 2013 – 6 states

Jammu & Kashmir

Haryana

Gujarat

Karnataka

Goa

Pondicherry

1

Punjab Uttarakhand

Rajasthan

Madhya Pradesh

Chhattisgarh

Telangana

Andhra Pradesh

Delhi

Bihar

Jharkhand West Bengal

Assam

Pentavalent introduced in 2014 – 12 states

Pentavalent introduced in 2015 – 16 states

Pentavalent vaccine (DPT + HepB + HiB)

11.7croredoseadministereduptoOctober2016

Japanese Encephalitis (JE)

•  JE vaccination: One time campaign strategy à single dose JE vaccine targeting all children from 1 to <15 years of age àJE vaccination is included into RI.

•  215 JE endemic districts (17 districts identified recently) identified across 21 states – campaigns completed in 206 districts à JE now part of RI.

•  More than 14.5 crore children immunized during the campaign

•  31 high burden districts identified in 3 states for Adult JE vaccination in endemic blocks (Assam, UP, West Bengal)

•  Adult JE vaccination campaign completed in 21 districts of Assam, UP and West Bengal; 2.6 crore beneficiaries aged 15-65 years were vaccinated. Activity ongoing in remaining 10 districts.

•  Rotavirusvaccine(RVV)launchedon26thMarch2016.•  Introducedin4states

RotavirusvaccinaQon

•  HimachalPradesh

•  Odisha

•  Haryana•  AndhraPradesh

•  Sinceintroduc2on,33.37lakhdosesofRVVhavebeenadministeredtoinfantsinthesestates2llDecember2016.

•  PlantointroduceRVVinAssam,Tripura,MadhyaPradesh,Rajasthan&TamilNaduinlastquarterof2016-17.

MeaslesRubella(MR)Vaccine

•  Campaignsproposedtobeconductedinaphasedmanneracross

India,targe2ng420millionchildrenover3years

•  Campaignstartedin5states •  Karnataka•  TamilNadu

•  Goa

•  Puducherry•  Lakshadweep

•  MR vaccine to be integrated into rou2ne

immuniza2on fol lowing campaign

replacing both doses of measles vaccine

givenat9-12months&16-24months.

PneumococcalConjugatedVaccine(PCV)

•  ApprovalofMSGobtainedforintroduc2onofPCVina

phasedmanner

•  PCVwillbeintroducedintheiden2fiedStatesasperExpertGrouprecommenda2onsinthelastquarterofFY2016-17.

•  Inthefirstyear,vaccinewillbeintroducedinHimachal

Pradesh&partsofUP&Bihar.

India committed to achieving 90% full immunization coverage by

2020!

THANK YOU