Task 1. Flag all the suspicious values. (Outliers, repetitions, etc.) (spend max 15 minutes)

FINAL_20Vacciland_20case_20study_20data..xlsx

Task 2. Review the national and subnational coverage for MR1. Your data manager produces the following tables. What can you conclude from the administrative data?

Conclusion1: The admin data shows that the national level coverage never reached 100%, beside the very high coverage in Grandtown and Remo (more than 100%).

Conclusion 2: The consistent high percentage of coverage in Grandtown and Remo show that there could be a problem in setting the target population (denominator).

Conclusion 3: The estimated population of the capital (Grandtown) is 19% of the whole population of Vacciland (25 Million). Below is some calculation for denominator of Grandtown

Total Population of Vacciland = 25000000

Population of Grandtown = 19% of 25 Million

Population of Grandtown = 4750000

Estimated Under 1 Children in Grandtown = 4% of poulation

Estimated Under 1 Children in Grandtown = 190000

Monthly target = 190000/12=15833

Actual Coverage : MR1 doses/Annual Target =97075/190000 = 51%

Task 3. Review coverage evaluation survey data. You remember that in 2013, there was a coverage evaluation survey. You pull up the data for that. Does this change your view about coverage at national level? For any of the regions?

Conclusion 1: Yes, the survey results show different coverage estimation for few regions such as Grandtown and Remo.

Conclusion 2: When this was the estimation for 2013, and recently Grandtown was witness of recent urbanization, the target should be went higher than stated here.

Task 4. Review the chart with the age distribution of measles cases. Does that tell you anything additional about coverage?

There are 3 vulnerable age groups from the measles outbreak – children aged 1 – 4 (accounting for 26% of the number of confirmed cases), adults 20-29 (16%) and adults 30+ (22%).

The high quality SIA implemented covering all children under 5 explains the low risk of contracting measles.

However the situation is alarming for adults aged above 20 years as they account for 38% of confirmed measles cases, which in turn might be transmitted to infants below 1 year through a case of not acquiring naturally passive immunity from breast-feeding, if the mother herself has not been vaccinated.

Coverage rates above 100% still remain suspicious as children aged (1-4) who ought to have been vaccinated (birth cohorts 2014-2017) are still vulnerable

Part II:

Task 5. Brief the Minister (spend max 1/2 hour on this section). Summarize the situation in three bullet points.

Coverage: The real coverage situation is different than the one shown in coverage data. Recent urbanization increased the population of Grandtown, but the denominator used is still the one set few years back based on census. Coverage survey also show different figures about the coverage of the Grandtown.

Recent Disease Data:

Last outbreak was in 2011where there were more than 3000 measles cases

Vaccination history of cases: 80% no vaccination or unknown status of vaccination

Age distribution of cases: 37% of cases are under 5 years old

EPI and VPD related issues: Outdated registries, weak capacities of lower level staff, denominator challenges, vaccine hesitancy.

Task 6. Brief the Minister. Propose three actions to respond to the outbreak.

• Planning and conducting supplementary immunization activities to cover all under 5 year children in Vacciland. Where MR vaccines will be given to all under 5 years children

• Community mobilization for addressing vaccine hesitancy and health education for observing preventive measures against measles (isolation of patients, vit A)

• Case investigation and treatment

Task 7. Formulate recommendations. List your top 3-5 recommendations specific to data strengthening you would prioritize as the EPI and surveillance teams in Vacciland

1. If it is established that the confirmed cases were unvaccinated, kindly institute a mini campaign for areas with which the cases comfirmed from
2. If those confirmed cases were vaccinated, follow-up with reasons associated with cold chain breakdown.
3. During every other campaign, ensure that those outbreaks areas are reached.