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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?

The national and subnational coverage have increased from 2011 to 2012 but start to decrease from 2013 to 2015 yearly. The denominator used for the calculation of the MR1 coverage is surviving infants and numerator MR1 doses therefore this cannot give an accurate coverage. The data manger should have had another table for total infants of Vacciland so that number of infants vaccinated could have been used as numerator and total infants denomerator.

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?

My view about the coverage at the national level has not changed because the evaluation was done in 2013 but most data repetition, inaccuracies and inconsistencies occurred after 2013. The low quality data seemingly occurred due data entry errors, denominators and other calculations issues.

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

Children within aged 1-4 years old were most affected with measles cases with 26%. However, Age d 5-9 years, 10-14 years and 15-19 years all had relatively low cases but there was a rise in 20-29 years and 30+ years with 16% and 22% respectively.

By observation from the table there were accumulated missed children and that accounted for high percentages age groups of 20-29 and 30+ most likely that children were not captured and vaccinated during the schedule period.

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

Firstly, the minister will be made to know that the 625 were confirmed cases and that has been established.
The specific areas which recorded the outbreaks, the minister will be made to know that the capital of Vacciland is the most affected region representing more than half of the cases confirmed. It is also observed that, 80% of confirmed measles cases were not vaccinated.
The last measles SIA conducted in 2011, there has been an accumulated missed child over the years accounting for significant number of unvaccinated children couple with poor data management, documentations and the system inability to detect poor vaccination coverage over the years. This has led to the outbreak of the measles in the Vacciland region.

TASK 6: Brief the Minister. Propose three actions to respond to the outbreak.

Yearly SIAs need to be conducted covering all children and even some young adults because about 51% cases were between the ages of 10 years and above.
Health workers should be trained on data capturing and management to prevent future errors in data processing as well as monitoring of vaccination data at national and subnational levels.
Surveillance should be intensified at all health service delivery points to increase index suspicion of cases and early manage them to prevent the spread of the outbreak

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

National and subnational vaccination targets should be set for all levels
Quarterly monitoring of EPI and surveillance data should be implemented at all levels of service delivery points
Yearly coverage evaluation surveys should be organized to improve the vaccination coverage
Refresher trainings should be organized for all data managers at all levels