1. Measles / MMR Vaccine Developments last 6 months Dr.Sanjay Srirampur sanjaysrirampur@yahoo.com 1/16/20141IAPCOI Measles/MMR - Dec 2011

2. 1.Measles Surveillance 2.Measles/MMR Vaccine 3.Second Dose of vaccine 4.Vaccine Delivery - Status Update Agenda 1/16/20142IAPCOI Measles/MMR - Dec 2011

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4. 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 2009 1/16/20144IAPCOI Measles/MMR - Dec 2011

5. 2006 2007 2009-10 2010-11 2011 2009 Surveillance Planned Surveillance Initiated Measles Surveillance India: Current Status and Future Plans 1/16/20145IAPCOI Measles/MMR - Dec 2011

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7. 148 outbreaks Measles outbreaks confirmed Rubella outbreaks confirmed Mixed outbreaks confirmed 111 36 39 58 52 38 2008 2009 - 2010* 186 outbreaks * data as on 15 th Jan, 2010 Serologically confirmed measles, rubella and mixed outbreaks 1/16/20147IAPCOI Measles/MMR - Dec 2011

8. Measles / MMR Vaccine Update 1/16/20148IAPCOI Measles/MMR - Dec 2011

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10. 1/16/201410IAPCOI Measles/MMR - Dec 2011

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12. Second Dose of Measles Vaccine Rationale 1/16/201412IAPCOI Measles/MMR - Dec 2011

13. Immune response to second dose of MMR vaccine in Indian children Sunil Gomber 1, Shilpa Khanna Arora 1, Shukla Das 2, VG Ramachandran 2 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 Sunil GomberShilpa Khanna AroraShukla DasVG Ramachandran Year : 2011 | Volume : 134 | Issue : 3 | Page : 302-306 1/16/201413IAPCOI Measles/MMR - Dec 2011

14. Response to second dose of Measles Vaccine Gomber et al after 2 year vaccination 20% had detectable antibody Multicentric study 100% antibody conversion on 2 nd dose Single dose Mumbai – 93%, Pune – 82%, Indore – 50% Effect of 3 rd 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 1/16/201414IAPCOI Measles/MMR - Dec 2011

15. Vaccine Delivery Status Update 1/16/201415IAPCOI Measles/MMR - Dec 2011

16. Measles Coverage (DLHS-3) 1/16/201416IAPCOI Measles/MMR - Dec 2011

17. 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) 1/16/201417IAPCOI Measles/MMR - Dec 2011

18. 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 1/16/201418IAPCOI Measles/MMR - Dec 2011

19. 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 2009 1/16/201419IAPCOI Measles/MMR - Dec 2011

20. >= 80% MCV1 CES 2006 MCV2 in UIP 2009-2010 2010-2011 2011 MCV2 through Measles SIA NTAGI 2009: introduce MCV2 Delivery mechanism: UIPDelivery mechanism: SIAs 1/16/201420IAPCOI Measles/MMR - Dec 2011

21. 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 1/16/201421IAPCOI Measles/MMR - Dec 2011

22. 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 1/16/201422IAPCOI Measles/MMR - Dec 2011

23. State (No. of Districts covered in phase 1) Administrative coverage achieved in MCUP1 @ 10.2 million children vaccinated so far (92% coverage) in 39 districts across 11 states * Provisional data @ From 39 districts where campaign completed 1/16/201423IAPCOI Measles/MMR - Dec 2011

24. Haryana: 22 Nov 2010 Rajasthan: 29 Nov 2010 Gujarat: 8 March 2011 Chhattisgarh: 14-15 Dec 2010 Madhya Pradesh: 6 Dec 2010 Bihar: 13 Dec 2010 Assam, Arunachel Pradesh: 8 Nov 2010 Phase 1 calendar of catch-up campaigns Jharkhand: 31 Jan 2011 Nagaland 7 Feb 2011 Uttar Pradesh: ??? Manipur: 29 Nov 2010 Tripura 31 Jan 2011 Meghalaya 7 March 2011 1/16/201424IAPCOI Measles/MMR - Dec 2011

25. Thank You 1/16/201425IAPCOI Measles/MMR - Dec 2011