Dr. Pradeep Haldar – “Opportunities and Challenges in Adolescent Vaccination in India”
Chairperson – Dr. Raj Shankar Ghosh
Universal Immunization Programme India (Scope and Scale)
One of the largest Public Health Program.
Annual target: 2.6 crore newborns; 2.9 crore pregnant women
Vaccines against VPDs: 9 nationwide; 3 sub-nationally (JE, Rota, PCV)
~1.2 crore sessions planned per year
29,000 cold chain points for storage and distribution of vaccines
Rotavirus vaccine introduction in India:
Rotavirus vaccine was introduced in the UIP in March 2016 in a phased manner
Till 2018, 11 states had introduced covering 56.4% of India’s birth cohort
Around 5.0 crore doses of RVV have been administered to children till May 19
Rotavirus vaccine will now be expanded to the remaining 25 States/UTs by September 2019.
Pneumococcal Conjugate Vaccine (PCV)
Pneumonia is a leading cause of under-five mortality in India causing an estimated about 2 lakh deaths per year.
Around 50% of these deaths (1.05 lakh) are caused by Pneumococcal bacteria, against which safe and effective vaccines are available.
Recommended by NTAGI in dosing schedule of 2 primary doses at 6 weeks and 14 weeks, followed by a booster dose at 9 months.
Measles-Rubella (MR) Campaign
WHO-SEARO goal of achieving Measles elimination by 2020, also reiterated by Hon’ble Finance Minister in the budget speech of 2017.
Measles-Rubella vaccination campaign launched in Feb’17 targeting approx. 40 crore children aged 9 months-15 years across the country.
Need for Adolescent Immunization
Immunization is considered to be the most cost-effective disease prevention measure against VPDs
Vaccination protects from various VPDs and enables them to lead a healthy life
Adolescent immunization benefits in several ways- Boosting the waning immunity Developing immunity where no exposure to ‘natural’ agent/antigen occurred
Accelerate the disease control and elimination effort for certain disease (E.g. Measles & Rubella)
Protect high-risk individuals from certain infectious diseases (Hep-B/C, HPV, etc.)
The rationale for Td Vaccine
Globally >80% reduction in tetanus mortality since 1999, however, increase in diphtheria outbreaks reflects gaps in diphtheria protection
Immunity to diphtheria wanes following the primary series of DTP infant immunization
Diphtheria cases occurring in all age groups including older children & adults, the majority in unvaccinated
Booster doses of diphtheria toxoid containing vaccines needed for continued protection
Eastern Europe & South America experienced serious outbreaks in the early/mid-’90s. These regions changed to the Td vaccine resulting in a sharp decline in diphtheria outbreaks
Strategies for Td Immunization
Three proposed strategies for improving Td coverage among adolescent
Strategy 1 –Through Rashtriya Bal Swasthya Karyakram (RBSK) in government and government-aided schools
Strategy 2– Strengthen VHNDs/UHNDs to improve Td coverage
Strategy 3– Organize Td Immunization Week(s) to improve Td 10 & Td 16 coverage
High tea: 10.15 to 10.30 am
Session 2: 10.30 to 11.15 am
Dr. Pritu Dhalaria – “Addressing Vaccine Hesitancy in India”
Chairperson – (Brig. Rtd) Zile Singh
Current Scenario
Full immunization coverage is reaching about 62-65% in the country
Most of the improvement has happened in rural areas; surprisingly suboptimal improvement in urban areas
Disparities between the districts are huge e.g. 7% in Balrampur, Uttar Pradesh to 97.8% in Faridkot, Punjab.
Inequities across socio-economic groups are large
The national coverage gets affected with the pockets of lower vaccination coverage
To achieve 90% FIC, there is a felt need among program managers to identify the reasons for low immunization uptake
Global Evidence to Mitigate Vaccine Hesitancy
Strategies implemented and evaluated across diverse global contexts to address issues of vaccine hesitancy can be classified in
Aimed to increase vaccination knowledge and awareness using communication strategies
Supply-side interventions
Non-financial incentive in the form of a kind.
Strategies to Address Vaccine Hesitancy
“One size fits all” intervention is unlikely to work
Communication strategies need to be village/Mohalla centric
Multi-component interventions are more effective
Decision Coaching
Can be used to inform and engage caregivers with relevant information through activities like:
Community Coaching Through Health Workers
Social Mobilization involving Medical Colleges
In Aligarh (India), social mobilization activities by health workers and then by medical interns have converted 813 (79.3%) resistant families into accepters
An HPV educational session was found helpful by parents who completed the follow-up interview and 44.4% of them started vaccination in Appalachia, Eastern United States
Ways to rectify vaccine coverage:
- Immunization Counsellor / Facilitator
- Peer Mother Appraisal
- Media Engagement
- Reminder / Recall
- Non-Financial Incentives
- Tailoring Program Operations
Session 3: 11.15 to 12 noon
Dr. Saira Banu – “WHO- Role in Strengthening and Supporting UIP”
Chairperson – (Brig. Rtd) Zile Singh
Polio
India accounted for over 50% of the polio cases in the world
2014 Certified ‘POLIO FREE’ Maintained the status since then.
Rapidly changing landscape of Universal Immunization Programme
2015: Mission Indradhanush
2017: Intensified Mission Indradhanush
2018: Gram Swaraj Abhiyan (GSA) and E-GSA
Strategies for VPD Control/Elimination/Eradication
Strengthening of Routine Immunization
Mass Immunization campaigns (NID/SNID)
Disease Surveillance
Universal Immunization Program- Role of WHO
AFP & MR Surveillance
New Vaccine Introduction
Supplementary Immunization
Routine Immunization
New Vaccine Introduction
AEFI Causality Assessment
VPD Surveillance – Training of Medical Officers, Field workers & Front-line workers, Academic bodies, Medical Colleges, Private practitioners
Immunization Stress-Related Responses (ISRR)
Developed based on the outline of the “Immunization stress-related response – A manual for program managers and health professionals to prevent, identify and respond to stress-related responses following immunization”
Conclusion:
Selection of appropriate strategy/strategies for adolescent immunization
Planning of activities under the selected strategy with an adaptation of experiences from the Measles-Rubella campaign
Clear communication strategy
Engagement of different stakeholders for successful implementation
Monitoring and supervision of activities undertaken
Review of activities under adolescent immunization at district and state level.