Supplementary Immunization Activities Quality, Coverage of high risk populations/ areas, proposed plans for IEAG Meeting 15 March 2011

Outline of presentation SIAs – July 2011 to April 2012 Quality of SIAs in high risk areas/populations Status of Emergency Preparedness & Response Plans Proposed SIA plans for

Areas/ Populations at highest risk of polio Historic reservoir areas

Areas/ Populations at highest risk of polio Areas with recent polio transmission Historic reservoir areas

Areas/ Populations at highest risk of polio Historic reservoir areas Areas with recent polio transmission Areas with high migrant populations

Polio SIAs, July to December 2011 SNID Aug Sep Nov bOPV

Polio SIAs, January to April 2012 JanFeb JanFeb SNID NID bOPV tOPV MarApr SNID NID MarApr

SIA quality in high risk areas/populations

Percent unvaccinated children – end of round survey West UP Bihar ~40,000 children checked for vaccination status each round in 107 high risk blocks High polio vaccination coverage sustained in 107 highest risk blocks of UP and Bihar 66 HR blocks 41 HR blocks 2012

Lot Quality Assurance Sampling (LQAS), Findings: HR blocks, UP SNIDs: Aug 11 – Feb 12#% 66 HR blocks # lots accepted 26085% # lots cautioned 3913% # lots rejected 72% Hypothesis: “The SIA coverage in this LOT is > 95%.” N=54 Reasons for unvaccinated children Child was not at home at time of team's visit Refused immunization Team failure Non-resident child visiting house after team’s visit

Percent unimmunized children in field huts in Kosi riverine area Source of data : NPSP monitoring Coverage in field huts of Kosi area, Bihar ~ 3,000 children checked each round > 300,000 clusters of field huts (basas) visited by vaccination teams each round Intensive supervision and monitoring

Percent unvaccinated children: End-of-round survey Percent N=20,68321,52424,17822,39221,04633,1497,8058,9899,27110,430 West Bengal Jharkhand N=2,9453,2139,7798,3984,1635,5096,1515,242 Percent 3,4224,981 Percent missed children < 5 yrs (average from Nov11, Jan12 & Feb12 SIAs), HR districts Jharkhand West Bengal 5,202 23,535 (Pakur & Sahibganj)

Malegaon Municipal Corporation – Resistance still an issue # houses with reluctance to accept OPV, End-of-round Number Maharashtra

Mapping and reaching migrants, India, 2011 Number of sites with migrants identified : ~162,000 Number of children < 5 yrs in these sites : ~ 4.2 million Number of sites identified by type = 10 migrant sites

Coverage of migratory communities in states with large migratory population Special vaccination drives at social- religious congregations: ~1 m children vaccinated in 2011 Historic reservoir areas: ~ 1 m migrant children vaccinated during SNID Other states with large migratory population: ~2.5 m children vaccinated during SNID

Percent children < 5 yrs found unimmunized during end of the round survey Punjab Percent N=6,1638,421N=8045,943 Gujarat 5,4546, ,988 Delhi Percent N= 6,028 4,432 Gr. Mumbai 3,214 6,1898,4909,366 5,2975,320 11,4308,0308,590 6,3096,698 6,0846,6055, ,466 5,352 6,646 1,025 7,960 6,9855,808 5, ,5706,1053,0543, ,3672,6081,201 2,2692,3772,7122,785

SIA quality - Summary Historic reservoir areas of UP and Bihar sustaining high SIA coverage Areas with recent transmission –West Bengal quality variable; pockets with gaps in quality remain –Malegaon: reluctance to accept OPV continues; Need to study role of social networks in vaccine avoidance behaviour Quality of coverage of migrants improving, consistency of quality over rounds an issue

Status of Emergency Preparedness and Response Plans in India

Emergency Preparedness & Response Plans (EPRP) National Plan prepared Formation of State plans in process Key components of State plans –Constitution of Emergency Preparedness and Response Groups –Identification and training of Rapid Response Team members (RRTs) –Identification of high risk districts, blocks and sub block areas/populations –Plans to strengthen Routine Immunization & SIA quality –Communication risk assessment and social mapping –Preparedness of the state for undertaking urgent mop ups within 7-10 days of WPV isolation

EPRP : State Preparedness Emergency Preparedness & Response groups (EPRG) constituted State EPRG constituted 31 blocks Haryana Punjab 24 blocks HR blocks being identified for intensification of SIAs & RI ~ 170 RRT members identified and trained

Identification of sub block High Risk Areas, India ~ 162,000 Migrant sites Migrant sites High risk areas in settled population ~ 64,000 HR areas in settled population = 10 Migrant sites = 10 HR sites

EPRP components that need strengthening in State plans Plans for overcoming staff vacancies in HR areas Systematic inclusion of high risk areas for RI strengthening Timeline for harmonization of SIA and RI microplans in high risk areas Assignment of HR districts to RRT members for regular review of RI and preparedness Assessment of communication risks and social mapping Identification of media spokesperson Plans for procurement of logistics and IEC materials for undertaking urgent mop ups

Proposed SIA plans for 2012 – 2014

Proposed SIA calendar, 2012 conducted planned NID with tOPVSNID with bOPV

Proposed SIA schedule NID with tOPVSNID with bOPV

Questions for consideration of IEAG Is the proposed number and scope of SIAs from 2012 – 14 sufficient to maintain high population immunity? Which vaccine types and in what quantities should be maintained as buffer stocks?

Thank You