Archive for October, 2011

Doctors of Manipur Health Services furious over due salary

October 28, 2011 Leave a comment

Imphal, October 27: The newly absorbed 282 medical officers and dental surgeons of Manipur Health Services, who were recruited through MPSC, have not been paid their salaries for the last 9 months. Highly agitated over this negligence of the state government, they are all set to approach the High Court.

Speaking to media persons at a press conference held at Manipur Press Club, Dr Noren, President, Medical Officers and Dental Surgeons Association, said that the salary of the 282 newly recruited Medical Officers and Dental Surgeons of Manipur Health Services have not been given for the last 9 months on the ground of non completion of MGEL.

The doctors and surgeons have been posted in different CHCs and PHCs of the state and have been performing their duties hence. But, they have not paid their salaries so far. They have lodged a complaint with the CM in this regard and the CM had given a one time relaxation on MGEL and arranged the salary for 6 months.  However,  the salary was also not given based on the status of an employee, but on a lump sum basis as wages.

He further went on to say that after a writ petition was filed in the Gauhati High Court, the court had directed the state government to complete the formation of MGEL for the doctors by March 31. Concern officials never gave a satisfying answer when they were enquired about the non completion of MGEL. On some occasions, they said that it would be completed in a month’s time and on other occasions the officials said that the documents furnished by the doctors are insufficient for its completion.

There were even instances where the office doors of the Health services remained closed from inside and the concern staffs were busy playing cards inside, keeping aside the work for the completion of MGEL, he further alleged.

He further  informed that the process of MGEL is not completed till today and the salary of the doctors have not been released because the Health services is not under the organized services recognized by the state government. Manipur Finance Services, IAS, IPS, MCS and IPS etc are all under the organized services. Hence, even police constables, as soon as they get recruited, receive their salaries without any problem. So looking at all these, the Health Services need to be placed under organized services recognized by the state government and the MGEL of doctors be completed at the earliest possible time.

Sources: Hueiyen Lanpao

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Medical Officers’ and Dental Surgeons’ Association, Manipur to approach Court

October 28, 2011 Leave a comment

IMPHAL, Oct 27 : Peeved with the failure of the State Government to allot MGEL (Manipur Government Employees’ List) number till date, doctors and dental surgeons appointed in Health Services in January this year have decided to approach law Court.

Speaking to media persons at Manipur Press Club here this afternoon, president of the Medical Officers’ and Dental Surgeons’ Association Manipur Dr Noren said that 282 medical officers and dental surgeons were appointed in January and they were posted to different places by an order issued by the Health Directorate in February this year.

However, MGEL numbers have not been allotted to the medical officials and dental surgeons till date. On account of this, the doctors and dental surgeons have been facing many inconveniences while drawing monthly salaries.

An order passed by the Guwahati High Court on March 30 this year directed the State Government to allot MGEL numbers to all the medical officers and dental surgeons within one month of joining service, Noren said.

Repeated appeals to the relevant authorities on the matter have yielded no positive result till date.

In case the MGEL numbers are not given at the earliest, the association would take help of law Courts, Dr Noren said while urging the Government to bring Health Services in the  organised service sector.

Sources: The Sangai Express

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HIV/AIDS Scenario in JN Hospital—A perspective

October 25, 2011 1 comment

HIV/AIDS Scenario in JN Hospital—A perspective

Dr K Priyokumar Singh

HIV/AIDS once a dreaded and fatal disease to start with has now become a chronic manageable disease. This disease which was detected from the gay persons in LOS Angles in 1981 has been showing continuous and progressive medical achievements in regards to its effect on human body on diagnosis of complications and in its treatment modalities. With the availability of ART/HAART (Anti-retroviral Therapy/Highly active anti-retroviral treatment) from 1996 onwards this disease has changed from a medical challenge to a socio-economic human problem.

Manipur had the first HIVV/AIDS in the year of 1989-90 from a female IDU patient. The spectrum of the disease was then very confusing. There was no proper awareness of the disease amongst the medical professionals and the health authorities. There were no proper NGO/CBO’s working in HIV/AIDS. NACO gradually came into being and then the disease has been put under its strict vigilance.

To start with the management of this disease came up first for its awareness and to manage the various O.I’s (Opportunistic Infection) specific to HIV/AIDS. And many OI’s were not diagnosed properly leading to many avoidable deaths in Manipur and elsewhere. The diseases like Cryptococcal meningitis, Penicilliosis, Toxoplasmosis, Pnenmocystis Carinii Pneumonia (P.C.P), Cytomegalovirun retinitis (CMV-retinitis), malignancies lilie Kaposis Sarcoma, Lymphoma, Progressive muItifocal Leucoencephalopathy, (PMLE), etc were not properly diagnosed due to lack of knowledge and awareness, leading to many deaths which nowadays are being cured or prevented.

With the coming of ART, first with Zidovudine and followed by other drugs which are able to control HIV multiplication by various combinations of them called the HAART (Highly Activc Anti-Retroviral Treatment) has changed the very outlook of HJV/AIDS from fatal disease to a chronic manageable disease ARV drugs in the beginning was scantily available and were very costly. It was beyond the reach of common people and many persons succumbed to the disease. With the effort of various NGO/CBO’s and the NACO (National Aids Control Organization) started free ART roll out from April 2004. In Manipur, the first centre of free ART was at RIMS (Regional Institute of Medical Sciences). Then the free ART came to J.N. Hospital in the Dec. 2004. Since then this dreaded disease has been under medical control, but many new areas came up for further attention by various Government and NGO’s.

From the hospital records of J.N. Hospital Porompat a 5 year data was prepared which shows the trend and challenges in the management of HIV/AIDS in Manipul’.

Table 1 Hospital Admission 2003-2007

The table shows the decrease in male admission from78.68% in 2003 to 64% in 2007 whereas the female admission increasing from 21.32% in 2003 to 36% in 2007. The trend shows the importance of HIV/AIDS in the whole population particularly to the female population.
Table 2. Risk Factors

In Manipur, the most common mode of HIV transmission is through sharing of injecting equipments by people who inject drugs. Manipur being on the cross road of “Golden Triangle” of drugs trafficking route, it became the main route of transmission. Other routes of HIV transmission are also prevalent in the State as given in the table 2.

Manipur shows the heterosexual route being from 20.32% in 2003 to 27% in 2007, an increasing trend showing the importance of this route in HIV/AIDS transmission. The IDU spread has shown a downward trend from 62.08% in 2003 to 52.11 % in 2007. This shows the various importance of AIDS Awareness programmes by the Govt. & various NGO’s. But a lot more are to be done to bring down the rate of transmission.

Another serious situation in Manipur is about the Mother to Child Transmission (MTCT) which has shown rapid upward trend from 1.89% in 2003 to 11.1 % in 2007. This area should be given proper attention and the PPTCT programme need more effective application so as to bring down this rapid increase.

The mode of transmission by Blood transfusion has considerably declined in the coming years from a figure of 4.26% in 2003 to a figure of 0.79% by 2007. This is due to mandatory testing of blood for viral bodies before Blood transfusion.

Another area where we need a closer counseling for all patients of HIV-reactive route of transmission-“Non-specific” where no reason was given by the person. The figure varies from 10.2% in 2003 to 8.20% in 2007.

Coming to deaths from HIV/AIDS in J.N. Hospital, it is seen comprising from a figure of 18.95% in 2003 to 17.46 % in 2007, showing, no apparent increase in deaths, but a slightly decreased ratio. The figure is only from the Hospital records but the unreported deaths after discharging from hospital when terminally ill, are not in the record. This high death rate is mainly from the HIV/HCV co-infection which is a major challenge nowadays.

The opportunistic infection (O.I) in HIV/AIDS, which has seen recorded in the Hospital admission are shown as below:
1) Tuberculosis (both nulmonarv & extra-pulmonary)Table 3.

It shows that T.B. infections vary from 38.3% in 2003 to 32.27% in 2007. It is seen that TB is the commonest O.I. in HIV/AIDS as found by other outside studies. The programme needs more effective application to bring from the % of infection.
2) Cryptococcal Meningitis:

The figure shows that cryptococcalmeningitis is the O.I. next to T.B. and the % has shown a slight downward trend, but still very persistent in our Hospital.

3) P.C.P (Pneumocytis Carinii pneumonia)

This O.I. once a serious problem often confused with pulmonary tuberculosis has been decreasing from a figure of 18.48% in 2003 to 5.55% in 2007. The main reason for this decreasing trend may be due to HAART and the primary prophylaxis of co-triamoxazole.
4) Penicillosis (P. marneffii)
Penicilliosis is also common in HIV/AIDS in Manipur. For the first time in India, Penicilliosis was diagnosed from Manipur in J.N. Hospital. This is mostly a skin manifestation, previously misdiagnosed as molluscum contagiosum because of its similarity in skin lesion. If not diagnosed in time, it is a fatal disease. The treatment by Intraconazole is very satisfactory.
Table 3

The figure shows a decreasing trend in Penicililosis infection from 5.69% in 2003 to 4.76% in 2007.

The main reason for this trend may be due to the timely initiation of ART before the patients CD4 count falls much below 200 cells/cumm.

The cerebral toxoplamosis found in PLHA as an 0.1. is not that urtcommon. Cases with headache or seizure disorder in the young must be looked for this disease and treated properly so that no residual neurological deficiets which can handicap them occur. The primary prophylaxis of co-trimoxazole has prevented cerebral toxoplamosis to a great extent.

Other O.I’s like cytomegalorium retinitis (CMV-retinitis), Kaposis Sarcoma and progressive multifocalleucoeucephalopathy(PMLE), have become much rarer after the advent of ART.

These co-infections are now a major negative prognosis factor in the management of HIV/AIDS. They have the same route of transmission – IDU and transfusion of infected blood. Transmission by heterosexual and mother to child in rare, but also seen’ in MSM. The latest figure of these co-infection in J.N. Hospital as on the 12th July, 2011 is as follows. (3983 ART Patients)


Sex wise Distribution

The figures shows that HCV co-infection comprises 18.52%, HBV co-infection of 3.33% and both HCV/HBV co-infection is 0.62% indicating the HCV co-infection is far more than others. Amongst the sex factors, male comprises much more than females having 89.83% in HCV, 77.44% in HBV and 76% both viruses.

Risk Wise Distribution
(From personal series from 2005 – 2008)

The figure show the main route of HCV infection both with or without HIV is IDU- having a figure of 94.02% is co-infection and 62.5% is mono-infection. B.T. incidence is present but is getting decreased nowadays.
In J.N. Hospital the total death from HIV/AIDS patients as on 31/08/2011 is as follows:

The figure shows that HIV/HCV and HIV/HBV co-infection comprises 22.31% amongst the total deaths in our ART centre. The figure indicates the importance of having HCV & HBV treatment in order to bring down the deaths from the co-infection.

As on today, there is no Govt or NGO/CBOs programme to diagnose & treat these co-infections. The treatment of HIV is too costly to be affordable. This is leading to increased deaths in PLHA’s. Nowadays, people are no longer dying from HIV become of ART. Hence need for HCV treatment.

The latest figure of PLHA admission in Pre-ART and On ART as on 31-08-2011 is shown as follows:­

The figures indicate the increasing number of female PLHA as compared to male PLHA’s though males are still more infected. The pediatric figure is not mentioned here because of having a separate paediatric ART centre. But the increasing trend of paediatric HIV/AIDS is a matter of great concern which needs a better effective and preventive strategies.

A very significant issue in ART programme is about the increasing number of clients who are LFU (Lost to Follow-up). The figure in our centre is about 248 clients on ART since the beginning of ART ie from Dec 2004. This may lead to increased number of first line ART failure as well as the increased transmission of resistant viruses in the community. The main back bone of ART success is the adherence factor. Once this is not kept, a lot of unwanted complications may come up which may hamper ART success. Every effort should be done to make minimurn number of LFU in any ART centre.

Conclusion and challenges
ART is now a success story in India and elsewhere. Nowadays, people are not dying from HIV/AIDS. It is seen that the number of deaths from HIV co-infection in our ART centre is increasing day by day because of the simple reason of not having HCY treatment. More people are dying from these co-infections. As on today there has been no commitment either from the Govt or the NGOs for HCV/HIV & HBV/HIV as regard to its diagnosis & treatment.

Management of HIV/AIDS must be a holistic approach. The ART drugs are to be available all the time. The CD4 testing and Hb% & ALT are also necessary for a proper follow up of this disease. The CD4 testing is far from satisfactory in the two ART centres of Imphal E & W. The CD4 testing at Urkhrul, Chandel, CCpur & Thoubal are also having a lot of difficulties—it is either not done because of lack of infrastructure or lack of manpower. PLHA’s are suffering a lot in these centers.

The MTCT (Mother to Child transmission) needs to be geared up. There is lack of awareness about ART initiation in pregnant women in-respective of CD4 count. The prescription of Nevirapine both to the mother and infant is not properly followed. Moreover the institutional delivery of pregnancy is very low. It is known that mother to child infection is mostly during the birth of the baby less so during the pregnancy and at breast feeding. Thus the increasing number of MTCT should be brought down to a minimum.

The management of side effects of ART drugs has to be improved. The early detection of side effects of drugs and its timely replacement by the alternative drug has to be properly implemented. So also for the management of first line ART failure patients need proper functioning without any inconvenience to the client.

Now time has come for the treatment necessity for HCV/HIV co-infection. The treatment is too costly to be done by the majority of PLHA’s. This is giving an increased number of deaths from the co-infection, rather than HIV  alone. For HCV/HBV, there is need for HBsAg screening for all risk persons as well as the general population because HBV vaccination of 3(three) doses in the HBsAg negative person will prevent future infection. The programme is not yet fully practiced but stress is necessary for proper vaccination.

To conclude, all the treating doctors, nurses, the public health workers and the NGO/CBOs are to be fully aware of the various factors and co-factors regarding HIV/AIDS so that the people remain free of any HIV or Hepatitis viruses in our population.

Sources:- The Sangai Express

All India Public Health Service Cadre: Special cadre for health services mooted

October 24, 2011 Leave a comment

NEW DELHI: India must put in place a new army of health workers – the Public Health Service Cadre – to fight the public health threats.

The Planning Commission’s high-level expert group (HLEG) on universal health coverage (UHC) says, a national and state-level Public Health Service Cadre and a specialized state-level Health Systems Management Cadre needs to be put in place. This will help provide greater attention to public health and also strengthen the UHC system’s management.

A new cadre, comprising public health professionals with multi-disciplinary education, would improve the functioning of the system by enhancing the efficacy, efficiency and effectiveness of healthcare delivery.

“We recommend the creation of an All India Public Health Service Cadre that should be responsible for all public health functions starting at the block level and going up to the state and national level. This cadre should be supported by a state level public health cadre. This would be akin to the civil services, which provide for both all India and state-level officers,” the HLEG’s final report, submitted to the government on Saturday, said.

The state-level cadre will provide the operational framework of public health services, the All-India cadre will not only health strengthen state services with a high level of professional expertise, but also provide strong connectivity between state and Central planning.

The HLEG has recommended the creation of a new Health Systems Management Cadre.

Quality assessment and assurance for health facilities will be a key function for the cadre. The health system managers would take over many of the administrative responsibilities in areas such as IT, finance, human resources, planning and communication that are currently performed by medical personnel.

“We further recommend the appointment of appropriately trained hospital managers at sub-district, district hospitals and medical college hospitals so as to improve the managerial efficiency and also enable medical officers to concentrate on clinical activities. Appropriate training of these new cadres is likely to significantly enhance the management capacities at all levels and end the practice of untrained personnel being assigned to manage health institutions,” the report added.

India faces an acute shortage of allopathic doctors. HLEG’s estimates say the number of allopathic doctors registered with the Medical Council of India has increased since 1974 to 6.12 lakhs in 2011 – a ratio of 1 doctor for 1,953 people or a density of 0.5 doctors per 1,000 population.

It will take India at least 17 more years before it can reach the World Health Organization’s recommended norm of one doctor per 1,000 population.

The HLEG has predicted the availability of allopathic doctors to one doctor per 1000 population by 2028, which can be achieved by setting up of 187 medical colleges in 17 high focus states during the 12th and 13th Five Year plan.

Sources:- Times Of India

Bad weather affects routine operations in JN hospital, Porompat, Manipur

October 21, 2011 1 comment

Imphal, October 20: Routine operations in JN Hospital could not be conducted today, the reason? As the sun god refused to come out, washed clothes which were to be worn by the doctors, patients and other staffs during an operation, could not be dried. No dry cloths no operations, as simple as that.

The incident came to light when the family members of a patient whose operation was cancelled without giving proper reasons spoke to Hueiyen Lanpao.

Hueiyen Lanpao to its dismay found that the reason for cancelling the operation was because the clothes which were to be worn by the doctors and patients during the operation were still wet due to the cloudy weather which prevailed today.

When this reporter enquired about the incident, Okram Kirankumar, Supervisor of the Laundry, JN Hospital said that the clothes that are to be used in an operation are washed and sterilized and then passed on to the operation theatre after drying them up. The clothes are being dried in a drying comber machine. But unfortunately, this machine has been non-functional for the last three years as the transformer for this machine is out of order.

He further went on to say that there are no trained persons for the maintenance of the machine and  spare parts are also not available in the state. Complaints to concern authority have not brought any positive response till today. And when the the whether is cloudy and on rainy days the problem of cloths not drying comes up, leading to the cancellation of operations. But for emergency operations new cloths are being used.
The situation will get worse during the winter season as the clothes which usually dry in a day will take two days at least.

Due to the non completion of the newly constructed room of the Department of Mechanised Laundry, the Rs 90 lakh machine is still being kept unused for the last three years, he added.

Speaking to this reporter, Dr L Khomdon, Medical Superintendent, JN Hospital said that such type of case has never occurred in his term and is really a  matter of shame.

He asked for Okram Kirankumar, Supervisor of the Laundry, JN Hospital and discussed the matter openly. A bit of verbal argument erupted among the MS and the staffs of the Department of Laundry.

Later on the MS gave instructions for buying a big washing machine which has got a drying facility and place it in the Laundry. He further assured that there will be routine operation from tomorrow itself. Ten operations which was scheduled for today have been cancelled due to the problem.

Sources:- Hueiyen Lanpao

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Diabetes Mellitus

October 13, 2011 Leave a comment

By Dr. Chakshu
“The International Diabetes Foundation estimates there are 246 million adults worldwide suffering from diabetes today; by 2025, the figure is expected to reach 380 million.” Recent WHO calculations indicate that worldwide almost 3 million deaths per year are attributable to diabetes.

Diabetes Mellitus (DM) refers to a group of common metabolic disorders that share common phenotype of hyperglycemia. Several distinct types of DM exist and are caused by a complex interaction of genetics and environmental factors, Depending upon etiology of DM. factors contributing to hyperglycemia include reduced insulin secretions, decreased glucose utilization and increased glucose production.

The metabolic disorder associated with DM causes secondary pathophysiological  changes in multiple organ systems that impose a tremendous burden on individuals with diabetes. DM is the leading cause of end stage kidney disease, non traumatic lower extremity amputations and adult blindness. It also predisposes to cardio vascular disease.

DM is classified on the basis of pathogenic process that leads to hyperglycemia, as opposed to earlier criteria like age of onset or type of therapy. Two broad categories of DM are designated as type 1 and type 2. Type-1 DM is the result of complete or near total insulin deficiency. Type-2 DM is a heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion and increased glucose production.

Insulin is the hormone produced by pancreas and is the main regulator of glucose metabolism in the body. Other etiologies for DM include genetic disorders, gestational diabetes, drug induced etc.

Risk factors for developing type 2 DM include high cholesterol levels, high BP, high fat diet, high alcohol consumption, sedentary lifestyle, overweight, giving birth to a baby weighing 9 pounds and above. Ageing is significant risk factor for type 2 DM.

Diagnosis – Criteria for diagnosis of DM are (1) symptoms of diabetes + RBS equal to or greater than 200 mg/dl or (2) FBS equal to or grater than 126 mg/dl or (3) two hour plasma glucose equal to or greater than 200 mg/dl during an oral glucose tolerance test.

Symptoms of type – 1 are often dramatic and comes on very suddenly in childhood often in association with some illness like viral infection or urinary tract infections. But in case of type – 2 DM, symptom could be present a decade ago in the form of impaired glucose tolerance.

Common symptoms of diabetes are – fatigue, unexplained weight loss, excessive thirst, excessive urination, excessive eating, poor wound healing, infections, altered mental status, blurred vision etc.

Complications – both forms of DM ultimately lead to high blood sugar level, a condition called hyperglycemia. Over a long period of time, it damages the retina of the eye (diabetic retinopathy), which is the leading cause of blindness, the kidneys (diabetic nephropathy), a leading cause kidney failure, the nerves (diabetic neuropathy), leading cause of wounded foot ulcers which frequently lead to foot and leg amputations and the blood vessels because of usually associated high cholesterol levels and leads to increased risk of heart disease, raised blood pressure and stoke. Damage to nerves in autonomic nervous system can lead to gastro paresis or chronic constipation or chronic diarrhea and inability to control heart rate and blood pressure during postural changes.

Hypoglycemia or low blood sugar occurs from time to time in most people with diabetes who are on treatment. It may result from over treatment, missing a meal, doing excessive exertion, any acute illness. Common symptoms are headache, dizziness, poor concentration, tremors of hands and sweating.

Diabetic ketoacidosis is a serious acute complication in which uncontrolled hyperglycemia causes build up of waste products called ketones  in blood which can cause nausea, vomiting, altered mental state or even weakness of whole body. It is precipitated by infection, stress, trauma, other medical emergencies like stroke or heart attack.

Hyperosmolar hyperglycemic non ketosis syndrome is also an acute complication associated with very high level of blood glucose with severe dehydration.

Diabetes prevention – There is no proper way to prevent DM – 1 but DM – 2 can be prevented by controlling weight (normal/near normal weight), regular exercise for 20 minutes three times a week, quitting smoking and alcohol, decreased oil consumption. This is called lifestyle modification. Also some new drugs help in prevention up to some extent. If DM – 2 is diagnosed then 1st line of treatment is medical nutrition therapy I. E. diet as advised by a dietician and regular exercise. 2nd line of treatment is oral hypoglycemic agents like metformin, glimiperide etc.

3rd line is Insulin which is the 1st line of treatment for DM, type – I. Usually insulin are ultra short acting, short acting, intermediate, long and ultra long acting. Nowadays newer preparations are available which can be given once a day rather than 3 – 4 times a day.

Newer advancements – new drugs which may stop damage to insulin secreting cells and newer insulin like intranasal/oral. If patient has complications of diabetes (eye, kidney or nerves),it should be dealt accordingly. The skin should be taken care of by keeping it supple, hydrated to avoid sores and cracks that can become infected. See a dentist regularly to prevent gum disease. The feet should be washed and examine daily looking for small cuts, sores or blisters that may cause problems later. If you or someone you know already have diabetes, your focus should be on preventing the complications which can cause serious disabilities such as blindness, kidney failure requiring dialysis, amputation and death. Mainstay of treatment will be regular blood glucose monitoring and regular follow up with your physician.

Author is an MD (General Medicine)
Consultant Physician,
Shija Hospitals and Research Institute.

Sources:- Imphal Free Press

Measles catch-up campaign

October 8, 2011 Leave a comment

Measles is a highly infectious and potentially fatal viral infection mainly affecting children.
Immunization against measles directly contributes to the reduction of under-five child
mortality and hence to the achievement of Millennium Development Goal number 4.
Deaths from measles occur mainly due to complications of measles. Infants and young children, especially those who are malnourished, are at highest risk of dying. The immunization Strategic Advisory Group of Experts (SAGE-2008) and WHO currently recommend that two doses of measles vaccine should be the standard for all national immunization programmes.
With the introduction of measles vaccine in the National Universal Immunization Programme (UIP) from 1985, which is given at 9 to 12 months of age, the disease burden has reduced and this reduction can be further accelerated by improving the coverage of the 1st dose of measles which stands at 69.6% as per DLHS-3 survey and providing second opportunity for measles vaccination.
The Millennium Development Goal (MDG) 4 aims to reduce by two thirds between 1990 and 2015 the under-five mortality rate (U5MR) in the  world. One of the key interventions to decrease U5MR and accelerate achievement of MDG4 is to strengthen measles control activities. As per the draft comprehensive Multi Year Strategic Plan (cMYP, 2010-17) for immunization of India the country aims to reduce by 90%, measles related mortality by 2013 when compared to 2000.
Measles catch-up campaign in India:
India is conducting Measles Catch-up Campaigns as a part of global effort to reduce measles morbidity and mortality. Target age group of this campaign is 9 months to <10 years children irrespective of their previous measles vaccination status or measles infection. Estimated 134 million children will be immunized in 14 states. The 14 states included in the measles catch up campaign are Chattisgarh, Gujarat, Jharkhand, Haryana, Rajasthan, Arunachal Pradesh, Assam, Manipur, Madhya Pradesh, Bihar, Meghalaya, Tripura, Uttar Pradesh and Nagaland.
Along with other technical and operational issues, two major challenges in this campaign are huge target group and mass vaccination with injectable antigen. India has a unique health infrastructure at primary care level. These primary care level health facilities are the strength of this campaign. Another strength is availability of a large number of trained vaccinators in health and family planning wings of the Ministry of Health & family Welfare. Ensuring the participation of these trained vaccinators is crucial to overcome the challenge of mass vaccination with injectable antigen considering injection safety of very large target group.
The measles catch up campaign will be a three weeks campaign wherein the 1st week will be held at educational institutes; while the 2nd and 3rd week in existing UIP outreach sites.
The key strategies being followed to achieve the goal are:
• Improving and sustaining high routine immunization coverage;
• Providing second dose of measles vaccine through catch-up immunization campaigns and or routine second dose/follow up immunization campaigns;
• Establishing sensitive laboratory supported surveillance;
• Appropriate case management, including administration of vitamin A.
Rationale for Measles Catch-up Campaign
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. Although reported coverage for measles vaccination is high, previous CES revealed that it never exceeded 70%. As measles vaccination does not confer 100% protection and seroconversion rate is only 85% when given at 9 months of age, a substantial number of children remain unprotected even if they are vaccinated. Supplementary activities like measles catch-up campaign is required to sustain high measles vaccination coverage and also for providing a second opportunity for the unprotected children. Lessons learnt from this campaign will be useful for future immunization activities.

Measles catch up campaign in Manipur

A measles catch-up campaign, organised by District Health Society, Imphal East is currently underway in different parts of the district.

The campaign was kicked off on October 10 last and would continue till October 31.

With the opening of 606 session sites across the district, it targets to benefit 90553 children at the age group of 9 months to 10 years.

Whom to vaccinate?
• All susceptible children and adults for whom measles vaccination is not contraindicated.
• Asymptomatic HIV infection is an indication, not a contraindication, for measles vaccination. Ideally, the vaccine should be offered as early as possible in the course of HIV infection.
• HIV-infected infants should receive measles vaccine at 6 months of age, followed by an  additional dose at 9 months, in case they are not severely immune-compromised.
• The first dose is given through routine immunization between 9 and 12 months of age and a second dose is given after one year of age.
• In SIA campaigns all children in the target age group (9 months – <10 years) are vaccinated irrespective of previous immunization status or history of measles disease.
1. Overall strategy for catch-up campaign
The highest level of political, administrative ownership, commitment and support needs to be sustained for successfully implementing measles catch-up campaigns. The Central Government, the State Governments, and international and national development partners need to work together and complement each other’s strengths. Measles catch-up campaigns are a one time activity and therefore coverage must be near 100% in the target age-group to impact on disease transmission and rapidly build up population immunity.
State level
At the state level there will be two committees as below.
a) State Steering Committee (SSC)
At the state-level, the State Steering Committee for the campaign will be established under the chairmanship of the State Health Secretary. The role of the State Steering Committee is to mobilize human / other resources and coordinate planning and implementation of activities with other government departments and partner agencies. The State Steering Committee will coordinate activities among Government departments like Education, Women and Child Development (WCD), Social welfare, NRHM, Defence, Youth Affairs, Urban development, Commerce, Labour, PRI etc. to mobilize human and other resources. The SSC will also coordinate with civil society organizations like Rotary, Lions etc; professional bodies like IMA, IAP, IAPSM, etc and partners like WHO, National Polio Surveillance Project (NPSP), UNICEF, USAID, Red Cross and other organizations.
b) State Operations Group (SOG)
The SOG will lead planning and implementation activities at the state. The Mission Director/
DG /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.
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, Media, BDOs, VHCs, 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.
The Department of Health & Family Welfare appeals to all sections of the people including co-ordinating departments, partnering organisations, NGOs, churches, educational institutions, municipal bodies, professional bodies, media etc to join hands with the department in this state-wide effort to contain  measles infection in our state during the three week campaign.