Task-1: Highlighting suspicious values:

Task 2. Conclusion:

Overall national coverage is reported around 90% since 2011 however there is variation in the provinces. Individual provincial coverage reports are in the similar range over years. Grandtown and Remo have always reported more than 100% coverage indicating an excellent vaccination quality in these provinces.
Grandtown has a Measles outbreak despite more than 100% reported coverage which may be due to two reasons:

The adopted target for MR1 coverage in Grandtown is less than the actual number of children resulting in an inflated coverage figure despite a large proportion of children remained unvaccinated and susceptible to measles.
Looking at the outliers in the number of doses administered in Grandtown as well as same vaccination doses figures for 14 out of 15 districts for the months of February and March 2017 indicate data fudging / careless handling of data.

Task 3. Review of coverage evaluation survey data.

The survey in 2013 shows the coverage of 2012. Comparing the administrative data for the same year reveals

National coverage is consistent with admin coverage reports
At provincial level, there is over-reported admin coverage in Greatland, Alu and Remo.
On other hand, the assessed coverage is significantly higher than admin coverage in Chello, Grandtan and Westtan which may be due to incomplete reports of vaccination activities in these provinces.

Province

2013 DHS

Admin coverage2012

Alu

83.1%

102%

Eastan

92.5%

88%

Grandtown

89.0%

122%

Nemo

91.9%

72%

Remo

84.6%

116%

Chello

93.6%

75%

Grandtan

82.1%

67%

Westtan

92.4%

64%

National

89.2%

91%

Task 4. Age distribution of measles cases.

The largest age group affected by measles outbreak is 1-4 years comprising of 26% cases, however the age distribution is wide with 22% cases of age group 30 years of above. This indicates suboptimal vaccination coverage over previous several years.

Task 5. Briefing to the Minister.

There is a confirmed outbreak of Measles in the country with majority of cases reported in Greatland. 37% of the affected are children are below 4 years of age, however all age groups are affected including adults indicating a generalized immunity gap in the population.
The cause of outbreak is suboptimal vaccination coverage resulting in an unimmunized cohort of population. The age distribution of the Measles cases indicate sub-optimal vaccination coverage for last several years
The vaccination coverage reports do not match the epidemiological situation. There is over-reporting of measles vaccination in Greatland, Alu and Remo most likely due to inaccurate data management by the vaccination program. Moreover the data is not adequately handled resulting in inaccurate in inconsistent vaccination coverage reports.

Task 6. Proposed actions to respond to the outbreak.

Strengthening of Measles surveillance to assess the exact extent of Measles Outbreak.
A measles vaccination campaign needs to be conducted to respond to the outbreak. An emergency meeting of the National Immunization Advisory Group be called to discuss the situation and decide on the extent of the vaccination campaign as well as the age group.
An immediate assessment of the resources available for the vaccination campaign (Manpower, logistics, vaccines and supplies). Ministry of health should mobilize the required funds for conducting the measles vaccination campaign

Task 7. Recommendations specific to data strengthening for EPI and surveillance teams in Vacciland

Immediately after the Measles campaign completion conduct a data quality assessment according to the WHO standards.
Appropriation of the immunization targets. Data from Measles campaign may be utilized to update the targets.
Training of vaccination staff and supervisors to ensure accurate data is reported and compiled.
Develop a plan to introduce the district health information system to ensure data quality
Periodic reviews at regional and national levels to review vaccination performance as well as data quality. Activate a feedback mechanism on the monthly vaccination reports.
Update the VPD surveillance Guidelines and train the surveillance staff on the updated guidelines.