MEASLES

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ELDERS

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PREVENTABLEDISEASESDEATH

NEWBORN

PERTUSSISRURAL

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KABAK TAMAR

SHIRISH TIWARI

SONU GUPTA

HRITUSHRIVASTAV

PURABI RATH

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A vaccine-preventable disease is an infectious

disease for which an effective

preventive vaccine exists.(1)

25 Diseases – WHO. (2)

VACCINE PREVENTABLE

DISEASES

Diphtheria

Pneumonia

Hepatitis B

Measles

Meningitis

Mumps

Pertussis

Poliomyelitis

Rubella

Tetanus

Tuberculosis

Yellow Fever 3

A CHILD DIES EVERY MINUTE FROM PNEUMONIA IN INDIA.(3)

1.4 MN – Children dies every year globally.

1.4 MN > (AIDS + Malaria + TB).(3)

436/1000 Live births – Under-5 children mortality due to Pneumonia.(4)

PNEUMONIAWHY IT IS AN IMPORTANT ISSUE??

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CAUSES- Infectious Agents- Bacteria- Virus- Fungi

COMMON SYMPTOMS- Cough- Chest Pain- Fever- Difficulty Breathing- Diarrhea

MODE OF TRANSMISSION

- Virus & Bacteria present in nose & throat

- Cough/sneeze- Blood

WHAT IS

PNEUMONIA?

Pneumonia is an infection or

Inflammation in one or both

lungs.(6)

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WHYPNEUMONIA IS

PREVALENT?

50% of World’s Pneumonia deaths occur in Indiawhich means approximately 3.7 lakh children die of Pneumonia annually in

India.(7)

VULNERABILITY OF CHILDREN

- Undernourished Children/ Less Breastfed.(8)

- Other illness like AIDS or measles.(8)

- NO/Low vaccine coverage.- Environmental factors like

slum, crowding, parental smoking.

SOCIAL DETERMINANTS

- Region – Urban or Rural- Gender – Male < Female(8)- Mother’s Education(9)- Income Level of Family(9)- Political Stand- Community Approach

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Fig. Pneumonia Proportional Mortality in

India.

Morris SK, Bassani DG, Awasthi S, Kumar R, et al. (2011) Diarrhea, Pneumonia, and Infectious Disease Mortality in Children Aged 5 to 14 Years in India. PLoSONE 6(5): e20119. doi:10.1371/journal.pone.0020119http://www.plosone.org/article/info:doi/10.1371/journal.pone.0020119

CONTRASTING CONDITION OF PNEUMONIA IN INDIA

Gender Bias – Girls mortality is more high than the boys.(8)

Geographical Inequities –North, West and North-East, Highly prevalent.(8)

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DESPITE MANY

EFFORTS,

WHY IT STILL

PERSISTS?

WHOUNICEF

GAPPIMNCI

IAPGoI-MOHFW

KEY POINTS UNADDRESSED- Lack of Social Awareness.- Lack of Proper Primary

Prevention.- No Vaccine Coverage(UIP).- Improper Implementation of

Prevention and Treatment Guidelines issued.

- Less attention from Government

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INTEGRATED EFFORTS

• IMNCI - Integrated Management of Neonatal and Childhood Illnesses - UNICEF

• UIP – Universal Immunization Programme - MOHFW

• GAPP – Global Action Plan For Pneumonia - WHO

WHAT

NEEDSTO BE DONE?

MEASURESPREVENTIONTREATMENT

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PRIMARY PREVENTION

CARE SUPPORT

TREATMENT

INSTITUTIONAL STRENGTHENING

STRATEGIC INFORMATION

SYSTEM

LOW COST & EASY PREVENTION

- Washing hands with soap- Controlling Indoor Air Pollution- Exclusive Breastfeeding- Oral Rehydration- Zinc Supplementation- Availability of Vaccines

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MEASLES

MEASLES:

CONTAINING THE

CONTAGIOUS

WHY MEASLES

NEEDS

ATTENTION?

A CHILD DIES IN EVERY FOUR HOURS IN INDIA

92,000 – Dies every year in India.

122 000 - Deaths globally.

330 deaths every day or 14 deaths every hour.

Less than 80% - First Dose Vaccine coverage.

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WHAT IS

MEASLES?

“Any person with fever ,maculo-papular rashes and coryza/cough/conjunctivitis.”- WHO

CAUSE- Myxovirus- Vitamin A deficiency- Malnourishment

SYMPTOMS- Fever- Rashes- Cough- Conjunctivitis- Diarrhea

MODE OF TRANSMISSION- Droplet, direct contact

with nasal and throat secretions.

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WHYMEASLES IS

NOT LEAVING

US?

Each year 60000-100000 children die of

measles in India.

EPIDEMIOLOGICAL DETERMINANTS

- Poor living condition.

- Poverty.

- Co-morbid disease

- Suppressed immunity

- Unvaccinated community leading to OUTBREAK

- Inaccessibility to healthcare coverage

- Onset of Winter season.

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WHATIS ITS

MAGNITUDEAND

TRENDS?

VACCINESIMMUNIZATION

PRE-VACCINATION ERA

- Prior to 1960: 8 MN children death/year

- 135 MN/year globally.

- 100-400 times - likely to cause death in developing countries than developed.

MEASLES VACCINATION PERIOD:

- Measles mortality reduces more than three-quarter in all WHO regions except SEAR.

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HOW

TO STOPMEASLES?

MEASURESPREVENTION

CONTROLSTRATEGIES

Planning and Coordination : central, state and DTF

Routine Immunizations : 9mnths of age(6mnths-outbreak)

SIA : catch-up + follow-up campaign

ACSM: multi-sectoral , NGOs , CBOs , professional bodies , religious institutions, media etc.

Human resource management : training, remuneration and capacity buildings 16

WHO STRATEGY: “CATCH-UP, KEEP-UP, FOLLOW-UP”

WHEREARE THE CHALLENGESLIES?

Lack of trained professional Lack of trust in MCV Poor health care delivery system Issues of Social Determinants Measles outbreak HARD TO REACH Population Unpredictable Funding

HOWCAN

WEMOVE

AHEAD?

Improve Vaccine coverage (quality and quantity) Effective treatment measures to prevent

complications Outbreak preparedness Targeted interventions –hard to reach

populations Ensure social equities Building trust to the communities through

multi-sectoral approaches 17

MILLENIUMDEVELOPMENTGOALS

MDG4 GOALS: FOR PNEUMONIA AND MEASLES

Reduce child mortality by two-thirds by 2015 (Vs. 1998).

More than 90% Immunization coverage.

Vaccination Coverage: 90% national and 80% district level.

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REFERENCES

1. http://www.cdc.gov/vaccines/vpd-vac/vpd-list.htm2. http://www.who.int/immunization/diseases/en/3. Times of India - http://tinyurl.com/pazhgme4. The Hindu - http://tinyurl.com/pnrl9zv5. http://www.nlm.nih.gov/medlineplus/pneumonia.html6. IAP Recommendations – Page 1. / www.iapindia.org7. WHO - http://www.who.int/mediacentre/factsheets/fs331/en/8. http://www.plosone.org/article/info:doi/10.1371/journal.pone.00201199. Pneumonia: The Forgotten Killer of Children by UNICEF (pdf)10. Indian pediatrics, vol.49-may16,201211. Global eradication of measles,WHO executive board ,126th session ,26th nov 200912. Millenium development goal India , country report 2011, www.mospi.nic.in13. Operational guidelines for measles catch – up campaign-MoHFW-GoI june 200914. Control of communicable diseases, David l heyman 18th edition p 379-385

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