Fw: [ IFANET- INDIA ] Do we need second dose of measles/MMR vaccination in Himachal Pradesh??

October 5, 2009

Dear Friends,

We have recommended MR immunzation on the basis of the outbreak investigations on measles and rubella followed by the confirmatory analytical studies in the state of Himachal Pradesh. The subsequent results were submitted by oral discussion and also in black in white to Governement of HP Through Proper Channel to Dr. Murari Lal Mahajan, (Ex DHS-HP) in July-August, 2007 which was further routed out to Government of India for further action into the matter. In one of the workshops at SIHFWTC, Shimla, Dr. Mahajan also acknowledged and appreciated the efforts of FETP.

Having attended the Epidemiological workshop for nine FETP_Graduates on 31st August, 2009-7th September, 2009 at State Institute of Health Family Welfare Training Centre, Parimahal, Shimla, Dr. Vinod Mehta, State Surveillancwe Officer, has gone to Goa for attending the conference on Communcable diseases . He has disclosed the good news in favour of the children of Himachal Pradesh that Governemnt of India has introduced MR vaccination and soon it will be in UIP with first booster.

The cost of the MR vaccine would be as low as Rs. 20/- per dose (while for MMR would be nearly Rs. 40/- to 60/- per dose.)

That is the great news!! A good work done indeed!! Congrats to all.

Thank you very much.

With warm personal regards,

Nikhil

Dr. Surender N. Gupta,

MBBS; PGDHHM;PGDMCH;PGCHFWM; FAIMS;MA (Phil);MAE (Epidemiology) Faculty, Regional Health and Family Welfare Training Centre, CHHEB, Kangra-Himachal Pradesh, India. Pin-176001.

01892-265472 (Fax); 01892-263472 (Office)Mobile: 094181-28634.

E-mail IDs: drsurendernikhil

drnikhilsurender

--- On Wed, 9/9/09, surendernikhil gupta <drsurendernikhil wrote:

surendernikhil gupta <drsurendernikhil[ IFANET- INDIA ] Do we need second dose of measles/MMR vaccination in Himachal Pradesh??"ifanet india" <ifanet-india (AT) googl (DOT) com>Cc: "Hospital management" <hosp_admn_india >, "Rational Vaccine Policy" <rationalvaccinepolicy, "Ayush Nagrota Bagwan" <info, "deepika pune" <deepika.pune, "Director NIHFW" <director, "Director SCTIMST Kerala" <director, "Diretor HIPA Shimla" <hipa-hp, "Dirtector Ayurveda" <ayur-hp, "Dr Govind PHMI" <drgovindbansal, "Dr Jammy PHMI" <jammyrajesh, "Dr KR Thankappan" <kavumpurathu, "Dr Rakesh Pandit OSD Ayurveda"

<osdayurvedhp, "Dr Sanjiv Chaudhary Tanda Medical College" <s_chaudhary, "Dr.SS Deepti IAPSM" <socialmedicine, "DrAshokMahajan Mahajan Hospital Amritsar" <drashokmahajan, "DrTejbir Singh" <gmc.cme2009, "PrincipalRHFWTCKGR" <epidrhfwtckgr, "Prof Deoki Nandan NIHFW" <dnandan51, "ramesh pune" <ramesh_puneWednesday, September 9, 2009, 12:37 AM

On the concluding day of Epidemiological workshop for mentoring and tutoring for nine FETP_Graduates on 31st August, 2009-7th September, 2009 at State Institute of Health Family Welfare Training Centre, Parimahal, Shimla, it was discussed in the larger interest of the children as to whether Himachal Pradesh is ready to go for either second shot measles or MMR vaccination for Vaccine Preventable Diseases-measles, mumps and rubella. Dr. Vidya Ramachandran, Deputy Director, National Institute of Epidemiology, Chennai also briefed to Dr. Sulakshna Puri, Director Health Services, Himachal Pradesh in her office on the basis of outbreak investigational reports on measles and rubella in the state. It was also suggested that Kangra

district can be chosen as one of districts for pilot study. In this connexion, certain facts are listed below: 1. That WHO and UNICEF adopted a three-phase strategy for global measles elimination. The three phases of the strategy are (1) Measles control (2) Outbreak prevention and (3) Measles elimination. The three phases of the strategy are (a) Measles control through reaching coverage higher than 80%, (b) Outbreak prevention, the second phase,

is based upon strengthening surveillance to detect and investigate outbreaks; © Measles elimination strategy includes three objectives (1) a routine immunization coverage of exceeding 90% (2) a second opportunity for measles vaccination to be administered through the routine system or through supplementary immunization activities and (3) enhanced surveillance and case management. In recent years, three WHO regions â€“ the Americas , the Eastern Mediterranean and Europe have had notable success in eliminating measles using a variety of vaccination strategies. Finland , Hungary and United States have eliminated indigenous measles transmission with a routine two-dose schedule by reaching coverage of over 95%. A similar result has been achieved in Canada , Oman and the United Kingdom by following a catch-up campaign with a routine two-dose

schedule 2. That in India , measles was the major cause of mortality and morbidity in the prevaccination era. Measles was the 6th vaccine preventable disease to be included in the Universal Immunization Programme in 1984-85. Measles immunization coverage in India from 42.2% (NFHS-1) to 50.7% (NFHS-2) to 58.8% (NFHS-3) suggests that there is gradual rise over the years while in Himachal Pradesh, it satisfactorily ranges from 71.8% (NFHS-1) to 89.1% (NFHS-2) to 86.3% (NFHS-3). But in the country, Delhi state has higher vaccine coverage since it has taken the lead

and initiative of the two dose schedule of measles and measles, mumps, rubella (MMR) at 9 months and at 15 months respectively. Goa, Maharashtra , and Tamil Nadu reached 84-88 per cent coverage. Our state can enter proudly in the list of developed countries where elimination phase of measles is going to take over successfully.

3. That generally speaking, measles outbreaks follow a cyclic pattern and occur every 3-4 years as a result of buildup of the susceptible. As the coverage increases, inter epidemic interval increases as well as a shift towards older age groups may be observed as in outbreaks of measles in Thailand and Sri Lanka . High reported measles immunization (95%) in Himachal Pradesh have brought down the incidence of the measles cases from 19.28 to 11.4 to 7.86/lac from 2001-2003. In 2007 year, an outbreak of laboratory confirmed rubella was also detected and investigated in the Shahpur-Samote blocks of Chamba-Kangra districts.

4. That one of our remarkable achievements in district Kangra of Himachal Pradesh are the recommendations about the second dose opportunity for measles at the age of 16-24months, the first dose to be administered at 9 months of age of child under UIP. Secondly, the circulating measles strains in the district have been detected to be genotyped as D4 by Laboratory of National Institute of Virology, Pune. We have investigated laboratory confirmed outbreaks of measles and German measles in district Kangra, Himachal Pradesh. Their findings

have been discussed, documented not only with Sh. Deepak Sanan, Principal Secretary Health and also with Dr. Sulakshana Puri, Director Health Services and Mr. B.M. Nainta, Mission Director, National Rural Health Mission, Shimla. On the basis of remarkable observations derived from laboratory confirmed measles/rubella outbreaks in district Kangra of Himachal Pradesh, the recommendations are put forward about the second dose opportunity for measles/MMR at the age of 16-24months. Secondly, the circulating measles strains in the district have been detected to be genotyped as D4 by Laboratory of National Institute of Virology, Pune. The file in this regard has been submitted to Dr. Naresh Goyal, Assistant Commissioner, Govt. of India, Ministry of Health, Nirman Bhawan, New Delhi vide letter no. HFW-H (RCH) Training/2008. Vol-1, dated 13th Feb., 2009. In one of workshops at SIHFWTC, Shimla,

Dr. M.L.Mahajan, Ex-DHS, Shimla also appreciated these findings in July-August, 2007.

5. That Government of India is signatory to WHO global measles elimination program, as recommended by WHO global strategy for measles elimination. It is a matter of great privilege that on account of the hard work of team of Himachal FETP graduates under the consistent and dedicated support from the Department of Health and Family Welfare for the children of Himachal Pradesh that the state is rightly on the verge of second dose of measles/MMR vaccination.