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Measles catch-up campaign

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.

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