TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.

Discussions tagged Measles

OPEN WEBINAR- 15/07/2019 - Enquêtes de couverture vaccinale post-campagne (après une ASV) - en français

L’événement: Enquêtes de couverture vaccinale post-campagne (après une ASV) Lundi 15 juillet 2019 à 16 heures de Genève (vérifier l'heure)
Lien d’inscription | Webinar ID: 146-979-176

Une ASV est toute activité vaccinale conduite en plus des services de vaccination systématique.

Les enquêtes de couverture vaccinale post-campagne: Quelles sont leurs spécificités? Comment utiliser le Manuel de référence de l’OMS pour les enquêtes de couverture vaccinale par sondage en grappes afin de mieux les préparer? Quelles sont les nouvelles ressources disponibles pour améliorer leur qualité? Avec la participation de:  Dr. Carolina Danovaro (OMS) Dr. Mamadou Diallo (UNICEF) Dr. David Koffi (ADS) et Dr. Carol Tevi-Benissan (OMS) Cet événement est ouvert à tous, sans condition. Il sera également diffusé via Facebook Live sur cette page.   Cliquez ici pour participer à l'événement…

Logistics of the vaccination campaign

Hello everyone, Mozambique, at present, uses only a simple measles vaccine in the Measles Routine for measles prevention.
However, with support from GAVI, Mozambique is preparing a campaign against Measles and Rubella for April 2018, then introducing the Measles and Rubella Vaccine into Routine Immunization. At this time, the country has already been prepared for the Anti-Measles and Rubella sufficient for Campaign and for introduction and routine use. But we have a problem: how the campaign data is already fixed; And still simple measles vaccine doses in districts and health units, including the National Vaccine Depot, which is difficult to create in three months. The question is:
How to manage the two types of vaccines, especially after a campaign without wasting one?
How to manage the simple measles vaccine that after the campaign we will not use and we will have in large quantities?

An example of improved performance at high levels of coverage through policy to address measles outbreak: California, USA

Dear Friends, I share the following story recently published in the New York Times on the leveraging of policy to bring about quick change in measles coverage in California, USA following the measles outbreak of 2014. The story can be obtained from here with all accompanying graphics: https://nyti.ms/2ELhglu The text of the story is pasted below for those who are in settings where the New York Times article may not open correctly on your computer. Enjoy. + + + + + + + + +  After a Debacle, How California Became a Role Model on Measles
Changing minds on vaccination is very difficult, but it isn’t so important when a law can change behavior. By Emily Oster and Geoffrey Kocks Jan. 16, 2018 In December 2014 something unusual happened at Disneyland. People came to visit Mickey Mouse, and some of them left with measles. At least 159 people contracted the disease during an outbreak lasting several months. This is more than the typical number in a whole year in the United States. The leading theory is that measles was introduced in Disneyland by a foreign tourist. That could happen anywhere. Medical experts generally agree that the fact that it took off was probably a result of California’s low vaccination rates, which in turn was a result of an inability to persuade a significant share of Californians that vaccines were important. The episode made national news, but in the next few years, another development was striking but attracted less national attention: Because of a policy change, California was able to turn it around. Data from a county-by county analysis shows that in many schools with the lowest vaccination rates, there was an increase of 20 to 30 percentage points in the share of kindergartners vaccinated between 2014 and 2016. One law changed the behavior of impassioned resisters more effectively than a thousand public service announcements might have. Limiting outbreaks of vaccine-preventable diseases relies on “herd immunity.” Essentially, if enough people are vaccinated, a disease cannot get a foothold. For measles, this number is around 90 percent to 95 percent. In other words, if 95 percent of people in an area are vaccinated for measles, an outbreak is unlikely even if the disease is introduced. Our best data on vaccination rates, in California and elsewhere, relies on records collected from schools at kindergarten entry. California requires these records from all schools, public and private, so they provide a comprehensive measure. In 2014, for California over all, about 93 percent of entering kindergartners were vaccinated for measles. This wasn’t bad. It could have been better — a place like North Carolina is at about 98 percent — but this was a high enough rate to be in the range of herd immunity. The trouble is that herd immunity is about the vaccination rate among the people you interact with, and you’re not interacting with the entire state of California. Local vaccination rates matter. If the overall state vaccination rate of 93 percent was because each area had a vaccination rate of 93 percent, that would be one thing. But if it’s because a bunch of areas had very high rates, and a bunch had lower ones, that’s quite another. And this second case was California in 2014. The accompanying chart gives a sense of the distribution of vaccination rates across counties in California in 2014. In 2014, there were a lot of areas of California with very low vaccination rates. If we take the herd immunity rate to be 95 percent, 70 percent of children were in counties below that rate. Even taking the bottom of the herd immunity range — 90 percent — found 36 percent of children in counties below that rate. A focus on individual schools was even more striking. At the Berkeley Rose School, in Alameda County, only 13 percent of kindergarten students were up to date on vaccinations in 2014. George De La Torre Jr. Elementary, in Los Angeles, was at 14 percent. The Community Outreach Academy, a large public school in Sacramento, was at 46 percent. These were on the lower end — but they were not the lowest rates. There were two ways a student could be unvaccinated in 2014 in the California public schools. Some students were admitted “conditionally” — that is, not fully vaccinated but planning to be soon. Other students had a formal “personal belief exemption.” That is, for religious or other reasons — often misplaced fears of vaccine injury — the parents could choose not to vaccinate their children at all. These varied greatly across schools. In the Berkeley Rose School, a private Waldorf school, all of the unvaccinated students (87 percent of the kindergartners) had personal belief exemptions. In elementary schools in poorer parts of Los Angeles, the lack of up-to-date vaccination was due mostly to conditional enrollment. In practice, in this period there was little follow-up on the vaccination of conditionally enrolled students, so conditional non-vaccination could easily turn into long-term non-vaccination. In the end, the result was the same: many schools with many unvaccinated children, and they were at risk. Measles is extremely contagious. If you introduce it into a school where only 13 percent of students are vaccinated, a lot of people will become ill. In response to the Disneyland outbreak, California suddenly went from a state with quite lax school vaccination standards to one with extremely strict requirements. The state passed Senate Bill 277, which went into effect in 2016 and eliminated all personal belief exemptions and tightened the approach to conditionally enrolled students. No longer could a parent say, “I’ll do it later”; there had to be a plan for vaccine completion over a period of about six months. The only remaining exemptions were for medical reasons. And since all schools, public and private, have to report the vaccination status of enrolled children, including documentation, the state has a way to monitor this. Without seeing your vaccination records, a school simply is not allowed to enroll you. And children have to be enrolled in school. Public health researchers have studied the relationship between state vaccination rules and vaccination rates, and have generally found that stricter vaccination laws generate higher vaccination rates on average. But these studies tend to focus on state levels over all, rather than on the distribution. In a place like California, with so many low-vaccination schools, we had a chance to ask: What would actually happen? What happened was that people got vaccinated. In 2016, 97 percent of children lived in counties with a kindergarten vaccination rate above 95 percent, and a full 99.5 percent in places over 90 percent. Looking at the school level, we can see which schools contributed to this change. We took schools in 2014 and divided them into 10 groups based on their vaccination rates. For each group of schools, we calculated their vaccination rates in 2014 and 2016. This provided a way to summarize which group of schools accounted for the changes over time. In the accompanying chart, we see the results. Schools in the bottom group had about 60 percent of their students up to date on vaccines in 2014. This is pretty abysmal, and this is an average, so many places were even lower. By 2016, this group had close to a 90 percent vaccination rate. It was an astonishing 25-percentage-point increase in vaccinations over a period of just two years. When we look at what drives this, one big factor is a huge decline in the conditional enrollment numbers. In George De La Torre Jr. Elementary, where 86 percent of children were conditionally enrolled with no measles vaccine in 2014, the vaccination rate in 2016 was 99 percent. But perhaps more striking are the changes for places where personal belief exemptions were high, places where there was concern that people were really committed to no vaccinations. In the Community Outreach Academy, the vaccination rate increased to 83 percent from 46 percent over this period. This was almost entirely a result of reductions in personal belief exemptions. And what about the Berkeley Rose School, with its 87 percent personal belief exemption rate? By 2016, 57 percent of entering students were vaccinated — a huge change, and that was only in the first year of the law. When SB 277 was passed, people worried about the possible effects: Would children be pulled out of school? This concern was misplaced. Over all, there has been no change in enrollment, even in schools with the lowest vaccination rates in 2014. People worried that parents would substitute (fake) medical exemptions for belief exemptions. This did happen, a little, but not nearly enough to offset the increases. In the end, the effect of the law was simple: More children were vaccinated, and the risk of disease outbreaks has gone down. Under-vaccination is a significant policy problem. As earlier generations knew, people die of measles, and of whooping cough, and of other diseases that vaccines can prevent. Figuring out how to increase vaccination is a challenge. We often rely on education, but it is hard to change people’s minds on this topic, as doctors and policymakers — as well as any parents who have engaged on an internet message board — know all too well. From a policy standpoint, these findings offer a ray of hope for vaccine proponents. Maybe changing minds isn’t so important. People may not have altered their attitudes about vaccination, but the fact is that these laws actually changed behavior. In Oregon, parents can opt out of getting their children immunized by completing a 15-minute online “education” module. Many of them do: The share of people in Oregon counties with kindergarten vaccination rates over 95 percent was close to 100 percent in 2000; in 2015, it was about 30 percent. Perhaps lawmakers there and in other states should consider a more stringent exemption policy before, not after, they have their own measles outbreak.  

Supplement recently published - The Expanded Program on Immunization in Ethiopia

A Supplement on EPI in Ethiopia recently published in the Pan African Medical Journal. http://www.panafrican-med-journal.com/content/series/27/2/

Supplement The Future of Immunization in Africa - is still open for submission

The upcoming supplement "The Future of Immunization in Africa Supplement", guest-editored by Bob Davis (Am Red Cross) , Helen Rees (Wits U) and Steve Cochi (GID, CDC), is still open for submission. The supplement will be published in mid 2017 in the Pan African Medical Journal. Submit your manuscript now for consideration. Follow the link below for more about the supplement http://www.panafrican-med-journal.com/mailalert/MA02122016.htm

Supplementary Immunization Activities for Injectable Vaccines Using an Example of Measles and Rubella Vaccines- Field Guide

Planning and Implementing High-Quality Supplementary Immunization Activities for Injectable Vaccines Using an Example of Measles and Rubella Vaccines- Field Guide: This is a field guide that is intended for immunization programme managers and their partners. The focus of this guide is ensuring high quality Supplementary Immunization Activities (SIAs) that are able to reach the hard to reach populations. The guide contains newly developed and improved tools for monitoring and assessing readiness. It also clearly outlines different options for vaccination strategies for different settings. It outlines the best practices for planning, organization, implementation and monitoring of SIAs for injectable vaccines, and in making use of opportunities to strengthen routine immunization and surveillance. This guide uses measles-rubella SIAs as the main examples throughout, but the information in this document aims to be applicable to SIAs for delivery of any injectable vaccine.
The Field Guide as well as the excel versions of the SIA Readiness Assessment tool can be found in:
http://www.who.int/immunization/diseases/measles/en/ . Under “Further information” An eLearning course based on this field guide will be launched early 2017. Any questions and comments on this document should be addressed to
Dr Alya Dabbagh (dabbagha@who.int)

Introducing UNICEF's Measles Control in Emergency Settings e-learning course

UNICEF is pleased to announce the availability on-line of the “Measles Control in Emergency Settings - (MCES)” course module under the Immunization e-Learning Initiative. This module is an ideal introduction for anyone with interest in immersing themselves in the theory and practicalities of immunization and particularly Measles in the humanitarian emergency context. It is intended to assist public health practitioners to align their knowledge with and be up-to-date on the latest immunization methods and protocols. MCES course is highly user friendly, illustrated, engaging and flexible, and consists of sub-modules covering - measles epidemiology during emergencies, - risk assessment and outbreak investigations. - planning, management and monitoring of mass vaccination campaigns. Once a user has completed the first basic sub-module, subsequent ones can be taken in any order of preference and users can start and stop without losing progression. It includes a certificate of completion at the end. MCES is available both in English and French. Access starts with registration as a guest at https://agora.unicef.org/. (Enter “immunization” in the search window to locate the course). English version: https://agora.unicef.org/course/info.php?id=3771 French version: https://agora.unicef.org/course/info.php?id=6716

Region of the Americas is declared free of measles

Washington, D.C., 27 September 2016 (PAHO/WHO) – The Region of the Americas is the first in the world to have eliminated measles, a viral disease that can cause severe health problems, including pneumonia, blindness, brain swelling and even death. This achievement culminates a 22-year effort involving mass vaccination against measles, mumps and rubella throughout the Americas.

The declaration of measles’ elimination was made by the International Expert Committee for Documenting and Verifying Measles, Rubella, and Congenital Rubella Syndrome Elimination in the Americas. The announcement came during the 55th Directing Council of the Pan American Health Organization/World Health Organization (PAHO/WHO), which is currently underway and is being attended by Ministers of Health from throughout the Americas.

Measles is the fifth vaccine-preventable disease to be eliminated from the Americas, after the regional eradication of smallpox in 1971, poliomyelitis in 1994, and rubella and congenital rubella syndrome in 2015.

“This is a historic day for our Region and indeed the world,” said PAHO/WHO Director Carissa F. Etienne. “It is proof of the remarkable success that can be achieved when countries work together in solidarity towards a common goal. It is the result of a commitment made more than two decades ago, in 1994, when the countries of the Americas pledged to end measles circulation by the turn of the 21st century.”

My first experience at vaccinating a child...as part of a Vaccination Outreach Programme in Rural India

Hello everyone!
This is my very first post here. I am a 3rd year Student of Medicine(M.B.B.S) studying at KVG Medical College & Hospital, Sullia, India.
Attched is a PDF file which is the original document...Please go through that as it has pictures. Whatever text that follows this is a copy from the PDF file.

Thanks for your time and have a great day!

Cheers!




I feel elated to have been given an awe-inspiring opportunity to be a part of a vaccination outreach programme for which I shall be ever grateful to our PSM professor Dr.V.Narayana Holla, M.D who leaves no stone unturned in inspiring us and walks that extra mile to encourage us to evolve into better doctors. If not for him, none of this would have been possible.
It all started on the morning of 7th September during our PSM department posting hours, when Dr.Holla told us about the vaccination programme and emphasised on the importance of practical knowledge in the field of medicine. Motivated by his thought-provoking words, I was filled with enthusiasm to be a part of this trip. Upon approaching him, he was more than happy to see us eagerly coming forward for it and thus began the preparation for our amazing trip.
Thrilled by this exhilarating opportunity, I brushed up on the NIS and read up on the methods of administering the different kinds of vaccines and all the necessary details and equipped myself with the much needed knowledge on vaccinating a child as per the NIS.
The next morning, I was all geared up to go, my eyes gleamed with anticipation and I was excited to experience something new. Little did Iknow what was in store for me. On an honest note, a part of me died a little seeing the vehicle in which I was to travel. But nothing could waver my excitement, not even the thought of an edgy journey. I remained undeterred by the rugged roads, still charged. And my agony paid off when I reached my destination after a long tiresome travel.
The first place I went to was an Anganwadi Centre (in Koojimale estate) that filled me with awe, looking at the cheerful kids of 2-5 years of age. The Anganwadi Centre was located amidst the green, lush hilly area of Koojimale. Also present there were mothers waiting to get their infants vaccinated. This being a remote area and the outreach being held only once every month, there was a considerably large crowd that neededvaccinations. That moment of excitement, the noble feeling of being a doctor that crept in when I looked at the kids and their mothers, is something my words fail to explain. At the Anganwadi Centre, the Anganwadi worker, helper and the Teacher were present.
Under the guidance of a proficient ANM and Dr.Sharanya, I learnt the skill of administering vaccines (I.M, Subcut, I.D, and Oral). At the Anganwadi, we administered 10 vaccines to a total of 6 children. Vaccinations given here were – bOPV + Pentavalent1 – 1 Child, bOPV + Pentavalent2 – 2 Children, , Measles1 – 2 Children, DPT 1st booster + bOPV + Measles2 – 1 Child, 1 lakh units Vit.A + Measles1 – 2 children, and 2 lakh units of Vit. A+ Measles2 – 1 Child. After administering these vaccines, every child was given a routine general examination.
After vaccinating everyone at the Anganwadi, we left for the second destination – Kadamakallu Anganwadi Centre. Here we visited the Government School and found that there was just one 10 year old child to be vaccinated (TT10). Here, I vaccinated the child. As we were about to leave, an infant was brought who needed the bOPV + Pentavalent3 + IPV. This child was vaccinated by the ANM as well as Niranjan Murthy.
I took great pride in administering the vaccine (an injection) for the very first time. The feeling was inexplicable. I look forward to being a part ofsuch programmes in the months to come. It was not just an amazing experience but also an opportunity to learn a lot of new things and most importantly I got a peek into the life of a doctor and now I think I know what it feels like to be one. My heartfelt thanks to Dr.Holla for his persistent encouragement and I also extend my gratitude to the college for its support (I hope they add such trips to the curriculum!)
Lanson Brijesh Colaco
7th Term, Phase 3, MBBS
KVG Medical College & Hospital, Sullia.


http://www.technet-21.org/en/resources/technet-resource-library/

Measles elimination and rubella control - Case based surveillance

Dear viewers
“Measles & Rubella (MR) case based surveillance” is being launched to achieve the goals of measles elimination and rubella control. For any vaccine preventable disease, vaccinating routinely with potent vaccine, uniformly throughout the country following a standard schedule is mandatory. For eliminatiing Measles, >95% coverage of first dose on completion of 9 months before 12 months and second dose along with booster dose of DPT and OPV between 16 to 24 months has to be achieved. Private sector is contributing to the vaccination service; % varies between rural and urban, rich and the poor. Our pilot study depicted an alarming gap with regard to 8 selected operational components of routine immunization. We conducted this study for all the antigens of National Immunization Schedule of our country and Karnataka specific as 2 fractional doses of IPV of 0.1ml intradermally administered. But in this post, giving importance to Measles and Rubella, we are sharing our finding with Measles vaccine where in "when to give and how many times to give" itself is known to 17.14 %!!!. Multi-dose Vial Policy / Open vial policy, type of VVM were not responded. But the solutions suggested are practiced in our college; easily operable and can be implemented in a revolutionary way with marginalized financial burden.
Please do view and contribute for further simpler operable solutions to mitigate the gap to save the children especially of elite group.
Best wishes
Holla and Team

Open Vial Use (operational guidlelines)

GoI is planning to put in place open vial policy at the facility level. In that context I would like to get comments from the members on a draft opertional guideline. This has been prepared from WHO and other resources on open vial policy. We intend to draft a pictorial guidlines covering following points. Please let us know if you have comments (please note these are India specific, so some points differ from standard guidelines e.g. keeping of reconstituted vaccines for 4 hrs etc).

1) Liquid DPT, TT, HepB, Hib and OPV opened in a fixed clinic may be used at more than one immunization session up to four weeks provided that
a) The expiry date has not passed.
b) The vaccines are stored under appropriate cold chain conditions.
c) The vaccine vial septum has not been submerged in water.
d) Aseptic technique has been used to withdraw all doses.
e) The vaccine vial monitor (VVM), if attached, has not reached the discard point.
f) Opened vials of measles, BCG and JE vaccine cannot be used after an initial immunization session, (even if the VVM has not reached the discard point.). BCG and Measles must be discarded within four hours of reconstitution and JE after two hours or at the end of the session, whichever comes first.
2) The revised policy applies only to OPV, DPT, TT, hepatitis B, and liquid formulations of Hib vaccines that:
a) meet WHO requirements for potency and temperature stability;
b) are packaged according to ISO standards (ISO Standard 8362-2); and
c) Contain an appropriate concentration of preservative, such as thiomersal (injectable vaccines only).
Note: Vaccines supplied via UNICEF meet these requirements.
3)
4) Multi-dose vials from which at least one dose has been removed may be at risk of contamination of the vial septum. These vials should never, therefore, be allowed to be submerged in water (from melted ice for example) and the septum should remain clean and dry. NOTE: Well-sealed icepacks should be used in vaccine carriers and water should not be allowed to accumulate where the vials are stored.
5) Discard vaccine vial
a) discard if expired
b) VVM reached discard point (for freeze dried vaccine, before reconstitution only)
c) no label or label not legible
d) Any vial thought to be exposed to non-sterile procedure for withdrawal
e) open vials that have been under melted water
6) If multi-dose vials must be used, always pierce the septum with a sterile needle.
7) Inspect for and discard medications with visible contamination or breaches of integrity (e.g. cracks, leaks).
8) Health workers must be able to distinguish between vials that can be used in subsequent sessions and vials that must be discarded. Training and supervision materials should be revised to reflect the policy change
9) Mark with date & time opened
10) Observe correct temperature storage, store in ILR at 2-8C
11) Monitor ILR temperature regularly (twice daily)
12) Dedicated ILR section fridge for opened vials
13) Observe first in first out policy –FIFO and stock rotation.
14) Keep stock up to date, don’t overstock or understock vaccines and diluents
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