NEW INNOVATIVE IDEAS TAKEN TO STRENGTHEN UIP IN UT OF PUDUCHERRY BY SEPIO CUM DD(IMM),PDY

1. RI Strengthening In UT of Puducherry with a focus
on measles Elimination
Dr. Sudha Goel
STATE EPI OFFICER cum DD(IMM)
MD(CHA),MPH(FE),
DNB(HEALTH&HOSPITAL ADM)

2. Introduction
MDG 4: Reduce child mortality
Millennium Development Goal
The millennium development
goal 4- only one target:
To reduce the under-five
mortality rate by two-thirds in
the period between 1990 and
2015

3. KEY FACTS(Magnitude of the problem)
• Measles is one of the leading cause of death among young
children though a safe and cost effective vaccine is
available
• Global Data WHO Fact sheet
1,14,900 deaths annually
314 deaths in a day
13 deaths in an hour

4.  As a result of Measles Vaccination ,there has been a 79% drop in deaths
due to measles from the year 2000 to 2014
 Measles First Dose vaccination coverage has increased from 73% in
2000 to 85% in 2014
 17.1 million deaths have been averted due to measles vaccination

5. World Health Assembly 2010(Targets)
World Health Assembly 2010 :Targets to be met by 2015
towards eventual global measles eradication
Raise routine coverage with the first dose of measles(MCV1) to
≥90% nationally, and ≥ 80% in every district
Reduce and maintain annual measles incidence to ˂ 5 cases
per million
Reduce measles mortality by ≥ 95%

6. Global Measles and Rubella Strategic
Plan(2012-2020) Components
• This plan aims to:
• 1.Achieve and maintain high levels of population immunity
through high coverage with 2 doses of measles and rubella
containing vaccines
• 2.Establish effective surveillance to monitor disease and
evaluate progress
• 3.Develop and maintain outbreak preparedness for rapid
response and appropriate case management
• 4.Communicate and engage to build public confidence in
and demand for vaccination
• 5.Conduct research and development

7. Sequential Phases of Measles Program
-10000
0
10000
20000
30000
40000
50000
60000
70000
80000
1 2 3 4 5 6 7 8 9 10 11 12
ELIMINATION PHSE
INTERRUPT THE TRANSMISSION OF VIRUS
MAINTAIN LOW INCIDENCE
PREVENT OUTBREAKS
REDUCE INCIDENCE
REDOUCE MORTALITY
CONTROL OUTBREAK PREVENTION ELIMINATION

8. Component .1
Achieve and maintain high levels of population immunity

9. THE GOAL OF UNIVERSAL IMMUNIZATION PROGRAMME IS TO
VACCINATE EACH AND EVERY ELIGIBLE CHILD AND PREGNANT
WOMAN AND THEREBY REDUCE THE MORBIDITY AND
MORTALITY RELATED TO VACCINE PREVENTABLE DISEASES

10. STRATEGIC IMPLEMENTATION PLAN
(RI DIVISION,GOVT OF PUDUCHERRY)
GOAL:TO STRENGTHEN ROUTINE IMMUNIZATION IN UT OF PUDUCHERRY
OBJECTIVES:
1.EACH AND EVERY CHILD LESS THAN 5 YR TO BE IDENTIFIED AND
IMMUNIZED AGAINST VPDs
2.INCREASE COVERGE OF ALL ANTIGENS
3.ACHIEVE AND IMPROVE FULL AND COMPLETE IMMUNIZATION
3.STRENGTHENING OF AFP,MEASLES AND AEFI SURVEILLANCE
4.INCREASE THE COVERAGE OF MEASLES 1 AND 2 VACCINATION
5.SUCCUSSFUL IMPLEMENTATION OF IPPI,MI,IPV, AND SOON TO BE
LAUNCHED MR VACCINE
6.TAKE NEW INNOVATIVE INITIATIVES

11. STRATEGY AND ACTIVITIES
• MICROPLANNING
• CAPACITY BUILDING
• REVIEW MEETINGS
• IEC
• MONITORING
• EVALUATION
• SWOT ANALYSIS

12. Situational Analysis

13. Demographic profile (UT of Puducherry)
PARAMETERS Data source UNIT CURRENT LEVELS
INDIA UT OF
PUDUCHERRY
TOTAL POPULATION Census 2011
12,47,953
BIRTH RATE SRS Sept 2014 Per 1000 population 21.4 15.7
DEATH RATE SRS Sept 2014 Per 1000 population 7.0 7.0
IMR NFHS-4 Per 1000 Live Births 40 16
U5MR NFHS-4 Per 1000 Live Births 48 16
GROWTH RATE Census 2011 % 14.1 8.9
0-5 years
population
IPPI-2016 TOTAL POPULATION (7.6%)92892
0-1 years
population
House to House
survey
0-1 YR (1.16%)13621
Population under 15
years
NFHS-4 Total population 23.7%(2,95,764)

14. Resources

15. Health Care Delivery System
(Infrastructure)
DISTRICTS HOSPITALS CHCs PHCs Sub centers (R) Sub centers (U)
PUDUCHERRY 5 2 27 38 17
KARAIKAL 1 1 11 17
MAHE 1 1 1 4
YANAM 1 1 5
TOTAL 8 4 40 55 26

16. District Hospitals/Institutions (Public & Pvt.)
Receiving Vaccines From District Stores
1.Rajiv Gandhi Government Women and Children Hospital
2.Indira Gandhi Medical College & Research Centre
3.JIPMER
4.Pondicherry Institute Of Medical Sciences
5.Mahatama Gandhi Medical College
6.SriVenkateshwara Medical College
7. AVMC
8.St.Cluny Hospital

17. Manpower
• Deputy
Director(Yanam)
• Deputy
Director(Mahe)
• Deputy
Director(Karaikal)
• State Immunization
Officer
Medical
Officers
PHNs/LHV
ANMsHIs&HAs

18. Money
• State Fund
• NHM (PART C)

19. Material
• Vaccines-UIP Vaccines provided by RI Division ,GOI
• MMR procured by state
• UIP Cards as per the prototype given by GOI introduced in
2015
• Cold chain equipment- MOHFW, GOI
• IEC Material- MOHFW, UNDP, UNICEF, State innovations
• Documentation-As per the guidelines given by RI Division,
GOI

20. Micro plan of PHC

21. Compiled Micro plan

22. Activities
School
Immunizati
on
Routine
Immunization
AFP ,MEASLES
& AEFI
SURVEILLANCE
Campaigns
(IPPI,MI)
Monitoring
&
Evaluation
Launch of new
vaccines(PENT
A,IPV)
CAPACITY
BUILDING(MOs,
PHNs/LHVs/ANMs/HI
&HAs/

23. Micro planning
• Biannually House to House survey
• Micro planning
• Calculation of logistics
• Implementation

24. Vaccine
Safe immunization

25. Successful immunization
Vaccine
Trust in health
system
Info on vaccine
benefit
Cultural
acceptance
AEFIs
satisfactorily
resolved
Vaccine supply
Cold chain storage
and transportation
Availability of quality
vaccines
Vaccine stock
management
Safe handling during
vaccine delivery
In-service
training
Supportive
supervision

26. Vaccination schedule
before and after IPV introduction
Age Vaccination schedule before IPV introduction After IPV introduction
At birth BCG, OPV-0, Hep B-birth dose BCG, OPV-0, Hep B-birth dose
6 weeks OPV1, Penta1 OPV1, IPV1, Penta1
10 weeks OPV2/Penta2 or OPV2/DPT2/HepB2 OPV2/Penta2
14 weeks OPV3, Penta3 OPV3, IPV2, Penta3
9 months MCV1 MCV1
16–24 months
MCV2, DPT first booster dose; OPV booster dose MCV2; DPT first booster dose; OPV booster dose;
5-6 years DPT second booster dose DPT second booster dose
10 years TT TT
16 years TT TT

27. The Revised Immunization Portion in MCP card…
Branded with RI color &
logo
Includes Penta, IPV, MR, JE
Records details up to 16
years (NIS)
Counterfoil tracks reasons
for missed doses &
ASHA incentives

28. Services
• Facility Sessions:
Puducherry has >133 facilities providing once a week RI– 133
X1X4X12=6384(excluding outreach sessions)
Out-reach sessions
• Subcentre-2000 approx.
• School immunization -900
• Grand Total of sessions =9204
• Total Reported Annual vaccinations administered=202488=Average Session
vaccination rate=20-22 injections/Session

29. Tracking of Beneficiaries

30. Immunization Monitoring Tool

31. My Village My Home

32. Supportive supervision

33. Training

34. COMPARATIVE ANALYSIS OF NFHS-4 & DLHS-4
BCG 3 DOSES OF
POLIO
3 DOSES OF
DPT3
MEASLES FULL
VACCINATION
RECEIVED A
DOSE OF VIT A
IN LAST 6
MONTHS
DLHS-4(2012-
13)
95.5% 85.7% 85.7% 92.3% 79.3% 79.2%
NFHS-4(2015-
16)
99.9% 95.4% 96% 95.4% 91.3% 89.7%

35. Strengthening of Routine Immunization
COVERAGE OF ANTIGENS (2013-14,2014-15,2015-16)
YEAR ANNUAL
TARGET
BCG OPV1 OPV3 PENTA1 PENTA3 MEASLES1 MEASLES2 VITA1 VITA9
2013-14 15233 35476 18903 16866 18672 15948 16493 14520 15878 4526
2014-15 14403 37019 18823 16619 18815 16604 16173 15374 15374 6277
2015-16 14150 47904 20674 17629 20674 17619 16740 16566 16566 10577

36. Comparative Antigen coverage(2013-16)
14403
37019
18823
16619
18815
16604 16173 15374 15374
6277
14150
47904
20674
17629
20674
17619 16740 16566 16566
10577
0
10000
20000
30000
40000
50000
60000
ANNUAL
TARGET
BCG OPV1 OPV3 PENTA1 PENTA3 MEASLES1 MEASLES2 VITA1 VITA9
YEAR WISE COVERAGE OF ANTIGENS
2013-14 2014-15 2015-16

37. Graphical Representation of Comparative
Coverage
0
100
200
300
400
BCG OPV1 OPV3 PENTA1 PENTA3
2013-14 2014-15 2015-16

38. SCHOOL IMMUNIZATION PROGRAM
 Under School Immunization, Students aged 5yrs,10yrs and 16yrs
are vaccinated by giving DPT, TT, Vaccines as per National
Immunization Schedule.
 Details of immunization sessions are uploaded on Education and
Health Department website two weeks before for the awareness of
parents and general public. The coverage in the program has shown a
steady increase.

39. School Immunization(2014-16)
0
5000
10000
15000
20000
25000
DPT (5 yrs) TT(10 yrs) TT(16 yrs)
2013-14 2014-15 2015-16

40. Analysis of Measles Vaccination
YEAR ANNUAL TARGET MEASLES1 MEASLES2 DROP OUT RATE
2013-14 15233 16493 14520 11.9%
2014-15 14403 16173 15374 7.9%
2015-16 14150 16740 16566 1.7%

41. Measles (MCV1 COVERAGE 2014-16)
8549
8325
8640
7944
7848
8100
7400
7600
7800
8000
8200
8400
8600
8800
2013-14 2014-15 2015-16
MEASLES Male
MEASLES Female

42. Measles (MCV2 COVERAGE 2014-16)
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
2013-14 2014-15 2015-16
7646
8112
9330
6874
5960
8398
MMR Male
MMR Female

43. Measles Coverage (2016)
MONTHS TARGET MCV1 MCV2 % Coverage % Coverage
April 1143 1396 1391 122.13 121.70
May 1143 1186 1350 103.76 118.11
June 1143 1554 1569 135.96 137.27
July 1143 1397 1274 122.22 111.46
August 1143 1444 1093 126.33 95.63
September 1143 1400 1302 122.48 113.91

44. COMPONENT 2:
Establish effective surveillance

45. Stakeholders for Surveillance
• Routine Immunization Division, Govt. of Puducherry
• WHO –NPSP ,Puducherry
• IDSP, Public Health Division ,Govt. of Puducherry
• At state level, weekly report regarding occurrence of all VPDs is being
collected from all 33 identified reporting units(Both Government and
Private)
• This information provides important details about disease spots and
help in predicting outbreaks

46. Reporting Units
Puducherry(22) Karaikal(6) Mahe(4) Yanam(1)

47. Reporting units in Puducherry

48. Reporting units in Karaikal, Mahe & Yanam

49. Trend of Cases AFP Surveillance
PONDY
TN &OTHER STATE
TOTAL
0
10
20
30
40
50
60
2014 2015 2016
20 15 9
35
44
24
55 59
33
PONDY TN &OTHER STATE TOTAL

50. AEFI SURVEILLANCE
0
2
4
6
8
10
12
2013 2014 2015 2016
TOTAL CASES

51. Trend of Measles Cases
2014 2015 2016
13
18
4
19 20
6
32
38
10
PONDY TN &OTHER STATE TOTAL

52. RGGWCH JIPMER MGMCRC SVMC GH YANAM
DISTRIBUTION OF CASES REPORTING UNIT
WISE(2015)

53. 2015 (AGE WISE DISTRIBUTION)
0 5 10 15 20 25
<1YR
1-2 YRS
2-5YRS
>5YRS
NO OF CHILDREN

54. 2016 (AGE WISE DISTRIBUTION)
6-9 M 9-12M 1-2YRS 2-5YRS >5YRS
2 2
0
4
1

55. State Wise Distribution(2015)
18
20
PONDY TN

56. State Wise Distribution(2016)
55
PONDY TN

57. 2015 (AGE WISE DISTRIBUTION)
0 5 10 15 20 25
<1YR
1-2 YRS
2-5YRS
>5YRS
NO OF CHILDREN

58. Immunization Status(2016)
6
1
3
1
0
1
2
3
4
5
6
7
VACCINATED UNVACCINATED DUE FOR VACCINATION LESS THAN 8 MONTHS

59. Gender Wise Distribution
MALE FEMALE
6
4

60. COMPONENT 3.Develop and maintain outbreak preparedness

61. Definition of an outbreak
•Occurrence of more than
expected number of cases of a
disease:
• in a given area
• among a specific group of people
• over a particular period of time

62. Steps of an outbreak
investigation
Verification of diagnosis
Confirmation of the existence of outbreak
Define population at risk
• Search of all cases
• Data analysis & interpretation
• Formulation of hypothesis
• Testing of hypothesis
• Action
CONTD.....

63. Notification, Verification & Active Search

64. Detection
To recognize an increase in measles cases significantly above the
number normally expected.
Based on routine surveillance system collects either summary
or
case-based information on clinical and confirmed cases of measles.
This threshold value is usually a number of cases in a defined
period in excess of (a predetermined) expected number.
The attainment of a threshold value should be considered as signal
of an outbreak and should trigger specific responses.

65. CASE DETAILS (SEPTEMBER &OCTOBER 2016)
• REPORTING UNIT-MGMC&RI
• AGE-4 YRS
• SEX-MALE
• R/O-TN(VILLUPURAM)
• DOO-31.8.16
• DOA-2.9.16
• DOR-9.9.16
• DOI-9.9.16
• S/S-Fever Rash ,Cough, Conjunctivitis
,Ear discharge
• Clinical Diagnosis-Measles with ASOM
• H/o vaccination-VACCINATED both
MCV1 &2
• REPORTING UNIT-RGGWCH
• AGE-3 ½ YRS
• SEX-FEMALE
• R/O-TN(TINDIVINAM)
• DOO-6.10.16
• DOA-7.10.16
• DOR-7.10.16
• DOI-8.10.16
• S/S-Fever, Rashes, Cough,
Conjunctivitis, Ear discharge
• Clinical Diagnosis-Measles
• H/o vaccination-VACCINATED
both MCV1 &2

66. COMPONENT. 4
Demand Generation for Vaccination

67. Health Talk On Routine Immunization

68. SUCCESS STORIES,UT OF PUDUCHERRY(2015-16,16-17)
• HIGHEST COVERAGE DURING IPPI IN LAST TWO YEARS
• SUCCESSFUL IMPLEMENTATION OF MISSION INDRADHANUSH
• LAUNCH OF NEW VACCINE(INACTIVATED POLIO VACCINE)
• VACCINE DELIVERY VANS
• NEW UIP CARDS
• NEW INNOVATIVE TRACKING TOOL
• UT SELECTED FOR MR SURVEILLANCE
• UT OF PUDUCHERRY AMONGST THE TOP POSITIONS IN FULL
IMMUNIZATION COVERAGE AS PER NFHS-4 SURVEY

69. INTENSIFIED PULSE POLIO IMMUNIZATION

70. INTENSIFIED PULSE POLIO IMMUNIZATION -2016
Districts 0-5 years Target Final Achievement in %(First
phase)
Final Achievement in
%(Second phase)
2015 2016 2015 2016 2015 2016
I II III
PUDUCHERRY 70651 70784 95.7 97.4 102.19 104
KARAIKAL 15362 14702 102 100.2 108.64 107.57
MAHE 2437 2356 83.2 89.5 103.2 114.09
YANAM 4442 4467 83.9 80.6 100.96 97.85
Total 92892 92309 95.8 96.85 103.23 104.52

71. MISSION INDRADHANUSH

72. CONCEPT
• GOI-Identified 201 high focus districts (list annexed) across the
country based on a composite indicator, considering
 Full immunization coverage,
 Partially vaccinated ,
 Unvaccinated children

73. MISSION INDRADHANUSH
Government of India launched Mission Indradhanush
on 25th December 2014
• A special drive to vaccinate all Unvaccinated and
Partially vaccinated children and Pregnant women by
2020 under UIP
• The Mission identified 201 high focus districts across
the country.
• Yanam was identified as one of the High Priority
District in the UT of Puducherry in the first phase.
Launched on 7th APRIL 2015

74. Conti…
• The phase II of “Mission Indradhanush” was launched
in Puducherry and Mahe districts
• PUDUCHERRY & MAHE on 7th OCTOBER 2015
• The mission was conducted for 7 consecutive days
and continued for another three months
consecutively in both first and second phase
• A total of 598 children were identified, verified and
reached for immunization in the whole UT of
Puducherry
• SUCCESS STORY-YANAM REMOVED FROM LIST OF
“HIGH PRIORITY DISTRICTS”

75. IPV LAUNCH
 UT of Puducherry introduced two fractional dose schedule
of IPV into the Routine Immunization Program as per the
directions of GOI.
 INACTIVATED POLIO VACCINE along with OPV provides
Dual protection to the child and mitigates the risk of Re-
introduction of poliovirus
 The launch was inaugurated on 21st April 2016 at Rajiv
Gandhi Government Women and Children Hospital by
Director Health in the presence of State Officials.

76. VACCINE DELIVERY VANS
• UT of Puducherry has been issued 3 Insulated vaccine
Delivery vans by MOHFW,GOI
• These vans are used for transportation of vaccines under
proper cold chain condition
• The 2 vans for Districts, Karaikal and Yanam were Inaugurated
by Hon’ble Health Minister on 25.7.16

77. SWOT ANALYSIS
STRENGTHS WEAKNESSES OPPORTUNITIES THREATS
1.Very strong &high
political commitment
1.UIP still considered a small
program
1.Private institutions in
Puducherry to be
encouraged more
1.Importation of diseases from
nearby districts of Kerala at Mahe
and from TN at Karaikal
2.Strong leadership 2.HMIS data not able to
project the hard work done by
staff
2.Public Health promoted by
HLG now
2.IPV supply may get interrupted
3.Rich and Robust health
care delivery infrastructure
3.Puducherry given more
funds by mohfw in last two
PIP
4.Uniterrupted inputs,
logistics support and
guidance from mohfw
4.Puducherry selected for
fractional dose of IPV,MR
Surveillance and all other
new initiatives
5.Dedicated team of
doctors and paramedical
staff
5.Verbal consent given for
developing a software for
data management during PIP
6.All initiatives as
introduced by SEPIO

78. Way forward…
• UT of Puducherry is committed to MR Elimination by the year 2020
• A strong and sensitive surveillance system though in place at
Puducherry ,other districts also need to be more proactive
• Efforts will be made to improve reporting and investigation
• Already started collecting information on each case in detail
• Ready to take a transition from Outbreak based MR Surveillance to
Case Based MR Surveillance

79. Thank You
•Meetings
•Microplanning
•Mobilization
•Monitoring