MEASLES CATCH-UP CAMPAIGN ACTIVITIES, INDIA

Handbook for field level workers

Operations and Interpersonal Communication

Ministry of Health and Family Welfare

Government of India
August, 2010

Handbook for field workers: Measles catch-up campaign 1

Handbook for field workers: Measles catch-up campaign 2
 Table of Contents

1. Foreword 3

2. List of Acronyms 4

3. Introduction 5

4. Objectives of the training 6

5. Session Plan for each module 7

6. Module-1 8

7. Module-2

8 Annexure

1) Baseline Information Form

2) Beneficiary Due List and Invitation Card

3) School Micro-plan

4) Outreach Micro-plan

5) High Risk Population Micro-plan

6) Communication Plan

7) Tally Sheet

8) Vaccination Card

9) Supervision Checklist

Handbook for field workers: Measles catch-up campaign 3

 List of Acronyms

Acronym Expanded Form

ADS Auto Disable Syringe
AEFI Adverse Events Following Immunization
ANM Auxiliary Nurse Midwife
ASHA Accredited Social Health Activist
AWW Anganwadi worker
BPHC Block Primary Health Centre
CES Coverage Evaluation Survey
CMO Chief Medical Officer (of district)
CPCB Central Pollution Control Board
DIO District Immunization Officer
GoI Govt. of India
HA Health Assistant
HI Health Inspector
HW Health Worker
ICDS Integrated Child Development Services Scheme
IEC Information Education and Communication
IMNCI Integrated Management of Neonatal and Childhood Illnesses
IM/IV Intra-muscular/Intravenous routes of injection
IPC Interpersonal Communication
LHV Lady Health Visitor
MCV1 Measles containing vaccine 1st dose
MCV2 Measles containing vaccine 2nd dose
MO Medical Officer
MO I/C Medical Office in Charge (Block PHC/PHC)
NGO Non Governmental Organization
OPD Outpatient Department
ORC Outreach Centre
PHC Primary Health Centre
PHN Public Health Nurse
RI Routine Immunization
SC Sub Center / Sub Cutaneous
TOT Training of Trainer
UHC Urban Health Center
VPD Vaccine Preventable Disease
VVM Vaccine Vial Monitor

Handbook for field workers: Measles catch-up campaign 4

 Introduction
This handbook is for use by field level health workers in the measles catch-up campaigns. The
primary target group includes ANMs, ASHAs, AWWs and volunteers. First line supervisors as LHVs
and HAs (M) should also be familiar with the contents.

This handbook has two modules. Module -1 is exclusively for ANMs and supervisors. Module 2 is
for ANMs, Supervisors as well as for ASHAs, AWWs and Volunteers.

Training for vaccinators and other support staff will be conducted at the Block / PHC level. All
vaccinators (ANM, HW(F), others) including their first line supervisors in a PHC area will be
trained in a one-day training workshop covering two modules in six hours.

Support staff, like the local ASHA, AWW and volunteers, if any, will be trained in the second half
of the day for three hours as outlined below. The Medical Officer in Charge of PHC will support
the trainer for both modules.

The participants in the training will use this handbook as a reference as well as workbook. They
should write freely, taking notes in the margins and complete the answers in the relevant
exercise boxes. They should always carry it with them and refer to it when in doubt.

Trainers will use this in conjunction with the facilitators guide.

The outline of the modules is as follows:

Module 1: Injection Skill and micro-plan module (3 hours): The first three hours will be used
exclusively to train the vaccinators and their supervisors in developing skills for safe injections
and formulate a detailed micro-plan for their area.

Module 2: IEC/IPC and session site module (3 hours): The ASHAs and AWWs will join the ANMs
in the second half of the day for a three-hour training session on communication, social
mobilization and their respective roles at measles session sites. Volunteers, if any will also join in
this session. Because there will be 5-10 ASHA and AWW to every ANM, the combined group
should now be split into two ensuring that the ANM is in the same group as the ASHA and AWW
from her area.

Handbook for field workers: Measles catch-up campaign 5

 Objectives of the training

Module 1: Injection Skill and micro-plan module (3 hours)

At the end of the training the vaccinator (ANM/Others) will be able to:

1. Describe the plan for introduction of second dose of measles vaccine in the district

2. Reconstitute and administer measles vaccine safely

3. Dispose off all injection wastes safely per CPCB norms

4. Refine the micro-plan for her sub-centre area

Module 2: IEC/IPC and session site module (3 hours)

At the end of the training the vaccination team will be able to:

1. List the respective roles of each member at the vaccination session site

2. Ensure ASHA/AWW to complete beneficiary listing and invitation

3. Develop a plan with ASHA/AWW to organize village level meeting for social mobilization
4. Motivate care givers of children (through IPC) for participating in measles catch-up
campaigns

Handbook for field workers: Measles catch-up campaign 6

 Session Plans
Module 1: Injection skill & micro-plan (3 hours): not more than 10 participants
Session Topic Method Time Teaching Aids
1 Introduction to measles catch- Lecture- 15 min Flip charts, Chalk
up campaigns discussion board, Marker pens
2 Demonstrate safe injection Lecture - 30 min Injection equipment
practices including safe demonstrati and demo vials ,
disposal of injection waste & on Equipment needed for
discuss AEFIs safe disposal of
3 Practice safe injection Individual 45 min injection waste
including safe disposal of practice
injection waste
4 Discuss session-site micro-plan Lecture 30 min Blank copy of formats
formats, tally sheet and
vaccination card
5 ANM refines micro-plans for Interactive 1 hour Formats for session
each sub-centre area site plan at school,
outreach and high risk
sites; facilitated by
Supervisor

Module 2: IEC/IPC and session site (3 hours): not more than 30 participants per group
Session Topic Method Time Teaching Aids
1 Introduction to measles catch- Lecture 10 min Flip charts, Chalk
up campaigns board, Marker pens
2 Description of tasks and roles Lecture & 30 min Flip charts, Chalk
in the campaign and at session discussion board, tally sheet
sites forms
3 Beneficiary listing and Lecture & 30 min Format for beneficiary
Invitation: Purpose and plan – Interactive listing
ANM and ASHA to frame a discussion
timeline
4 Plan for local level meetings: Interactive 20 min Communication Plan
ANM and ASHA to frame discussion format
schedule
5 Motivate care givers of Role play 1 hour Role play situations
children (through IPC) for 30 min
participating in measles catch-
up campaign

Handbook for field workers: Measles catch-up campaign 7

 Module 1

Target Groups to be trained

• Vaccinators (ANM/HW-F, HW-M)
• Supervisors (LHV, HA-M)

Handbook for field workers: Measles catch-up campaign 8

 Topic contents: Module 1, Session 1
Session Topic Method Time Teaching Aids
1 Introduction to measles catch- Lecture 15 min Flip charts, Chalk
up campaigns board, Marker pens

Measles (local name________) is a highly infectious disease. It is caused by a virus. The

clinical features are
o Fever and rash, plus cough or running nose or
redness of eyes
o Occurs usually in un-immunized children
o Disease spreads from person to person through
cough, sneezing etc.
o A measles case is infectious from 4 days before to 4
days after the rash

Measles can cause complications like
o Diarrhoea
o Pneumonia or Chest infection
o Mouth ulcers
o Ear Infection
o Damage to eyes – child may become blind
o Brain infection (encephalitis – rare)

Measles can cause death
o Through these complications
o Death can occur within 30 days after onset of rash. Rash may not be present at
time of death.

Measles kills nearly 100,000 children every year in India.

Measles can be prevented by measles vaccine. The first dose should be given at
completed 9 months of age along with vitamin A syrup. All children between 9 months
and 10 years of age will be immunized with measles vaccine during the catch up
campaign.

Measles vaccine gives long term immunity which is probably life-long.

The dose is 0.5 ml. It is given by the subcutaneous route. We will discuss this in detail in a
later session.

Handbook for field workers: Measles catch-up campaign 9


Govt. of India has decided to introduce a second dose of measles vaccine in the national
immunization programme.

States where 1st dose of measles vaccine coverage is below 80% will have catch-up
campaigns for the second dose of measles. The state of ______________ is one of them
because the coverage of measles 1st dose is ________.

What is a measles catch-up campaign? A measles catch-up campaign is a special
campaign to vaccinate all children in a wide age group in a state or a district with one dose
of measles vaccine. The catch-up campaign dose is given to all children, both immunized
and un-immunized, who belong to the target age group. The goal of a catch-up campaign
is to quickly make the population immune from measles and reduce deaths from measles.
A catch-up campaign must immunize nearly 100% of target age group children.

Who should be vaccinated? All children who have completed 9 months of age and are
below 10 years of age (completed nine months since birth but have not reached tenth
birthday). This is usually 20-25% or one-fifth to one quarter of the total population.
o A child in the target age group should always get the campaign dose of measles
vaccine even if the chid was immunized earlier.
o A child with a history of having measles in the past should also be vaccinated if the
child is in the target age-group.

Where shall we immunize the children? We shall immunize all children from fixed posts
only. There will be no house to house immunization. Since many children in the target age
group would be studying in schools, the campaign will cover the school-children in the
first week and then immunize the non-school going and left out children in the next two
weeks.

Who should not be vaccinated? Do not vaccinate if the child has
o High fever or serious disease (example: unconscious, convulsions etc.).
o Hospitalized children
o History of a severe allergic reaction to measles vaccine.

Malnutrition: Malnourished children should be immunized on priority. Malnourished
children have a higher risk of complications and death if they get measles. So they should
always be immunized. There is no added risk of side effects of measles vaccine if a child is
malnourished.

Minor illness: Children with minor illnesses like mild respiratory infection, diarrhoea, and
low grade fever for less than 3 days, should always be immunized.

Handbook for field workers: Measles catch-up campaign 10

 Frequently Asked Questions

A 2 year old child received one dose of measles vaccine through routine immunization
when she was 9 months old. Her mother now wants to know if the child should get
campaign dose of measles vaccine.
o Yes this child should get the campaign dose.

An 11 month old child received one dose of measles vaccine in RI one week before start of
campaign. Should she get the campaign dose now?
o Yes, this child should be immunized with the campaign dose also. There is no
added risk of side effects because of the second dose.

A 10 month old child has not received any measles vaccine dose in RI. His parents come to
get the child immunized against measles for the first time during the campaign. You
immunize the child with measles vaccine. How would you record this dose? And what
advise would you give the parents for subsequent measles vaccine doses?
o Record this dose as the campaign dose.
o Advise parents to bring the child to get the scheduled dose of measles through
routine immunization 4 weeks after the campaign dose.

Handbook for field workers: Measles catch-up campaign 11

 Let us answer the following questions now

Clinical features of measles are ____________________________________________ .

Common complications of measles are ______________________________________ .

Target age-group for measles catch-up campaign is ________________________ ____ .

Children in the target age-group who have got one dose of measles vaccine in RI should/should
not get campaign dose of measles vaccine. [Encircle the correct answer]

Malnourished children in the target age-group who have got one dose of measles vaccine in RI
should/should not get campaign dose of measles vaccine. [Encircle the correct answer]

An under-five child who has got the campaign dose, but has missed the routine dose of measles
should/should not get the due routine dose 4 weeks after the campaign dose. [Encircle the
correct answer]

Handbook for field workers: Measles catch-up campaign 12

 Topic contents: Module 1, Sessions 2 & 3

Session Topic Method Time Teaching Aids

2 Demonstrate safe injection Lecture- 30 min Injection
practices including safe disposal demonstration equipment and
of injection waste & discuss demo vials ,
AEFIs Equipment needed
3 Practice safe injection including Individual 45 min for safe disposal of
safe disposal of injection waste practice injection waste

Administering measles vaccine safely: Measles vaccine is available as dry powder which has to
be reconstituted using only the diluent provided by the manufacturer. The dry powder in one
vaccine vial must be dissolved using the entire amount of diluent in one ampoule. Proper cold
chain precautions must be maintained at all stages of vaccine handling and administration.
Reconstituted vaccine must be discarded within 4 hours or at the end of session, whichever is
earlier.

Each vial contains 5 doses. The dose is 0.5 ml for all ages. The vaccine is injected by the
subcutaneous route. The site of administration will be the right upper arm.

Before reconstitution

Check expiry date on label. Don’t use if vaccine has expired or label is not there or soiled.

Check VVM on seal of vaccine vial. Do not use if VVM has been removed from the cap or
VVM is not in usable stage.

Check expiry date on diluent ampoule. Do not use if diluent has expired.

Check that both diluent and vaccine are from same manufacturer and the label on diluent
vial states that the diluent is for measles vaccine.

T h e va c c in e vi al m o ni to r s a y s …

T h e in n e r sq u a re is lig h te r th a n th e o ut e r

c ircle . I f th e e xpiry d a t e h a s n o t p a ss ed , U SE
th e va cc in e .

At a la te r tim e the in n e r sq u a r e is still lig h ter

t h a n th e o u te r circ le . If th e e xp iry d a te h a s n o t
p a s sed , U S E th e va c cin e.

D is ca rd p o in t: t h e co lo u r o f th e in n e r sq u a r e
 m a tc h e s th a t o f th e o u te r c ircle .
D O N O T u se th e va c cin e .

B e yon d th e d isc a rd po int: th e inn e r sq u are is

 d a rk e r th a n the o ute r c ircle .

D O N O T u s e th e vac cin e .

NB: for measles vaccine, the VMM only indicates the heat exposure of the dry vaccine;
not after reconstitution.

Handbook for field workers: Measles catch-up campaign 13


Check that both diluent and vaccine vials are free from visible dirt outside and that no
extraneous particles are visible inside either vaccine or diluent
vials. Check for any visible cracks in the vaccine vial or diluent. If
you find any, then use a fresh vial / diluent.

Check that cold chain has been maintained for both vaccine and
diluent and both are at the same temperature.

During reconstitution

Reconstitute only one vial at a time.

Use a new reconstitution syringe (5 ml) to reconstitute each vial of vaccine maintaining full
aseptic precautions. Do not use the same syringe to reconstitute vaccine in another vial.

Dispose of needle cap and outer packaging in black plastic bag

Use full amount of diluent in the vial to reconstitute measles
vaccine.

Do not touch needle or rubber cap during reconstitution.

After reconstitution, the vial should not be rolled between the
palms. The vial should be shaken gently upside down few times,
holding the neck for mixing appropriately.

Cut the hub of reconstitution syringe with hub-cutter.

Dispose off plastic part of reconstitution syringe in red plastic
bag.

Record time of reconstitution on measles vaccine vial label.

Use only AD syringe to administer vaccine to every child.

Do not withdraw vaccine from vial to pre-fill AD syringes.

After reconstitution

Always keep reconstituted vaccine in the hole in the ice pack to
maintain temperature at +2 to +80 C.

Keep the reconstituted vaccine in shade.

NEVER USE RECONSTITUTED MEASLES VACCINE BEYOND 4
HOURS AFTER RECONSTITUTION. Using measles vaccine
beyond 4 hours after reconstitution may result in Toxic Shock
Syndrome (TSS) leading to death.

NEVER CARRY AND USE RECONSTITUTED VACCINE FROM ONE SESSION SITE TO ANOTHER.

Injecting measles vaccine:

Use only AD syringes to inject vaccine.

Dose is 0.5 ml for all ages.

Handbook for field workers: Measles catch-up campaign 14

 Steps for Correct use of AD Syringes
1. Select the correct syringe (0.5ml)for the vaccine to be
administered
2. Check the packaging. Do not use if the package is
damaged, opened, or expired.
3. Peel open or tear the package from the plunger side
and remove the syringe by holding the barrel. Discard
the packaging into a black plastic bag.
4. Remove the needle cover/ cap and discard it into the
black plastic bag.
5. Do not move the plunger until you are ready to fill the
syringe with the vaccine and do not inject air into the
vial as this will lock the syringe.
6. Invert the vial, and insert the needle into the vial
through the rubber cap, such that the tip is within the
level of the vaccine. If inserted beyond you may draw
an air bubble which is very difficult to expel.
7. Do not touch the needle or the rubber cap (septum)
of the vial.
8. Pull the plunger back slowly to fill the syringe. The
plunger will automatically stop when the necessary
dose of the vaccine has been drawn (0.5 ml).
9. Do not draw air into the syringe. In case air
accidentally enters the syringe, remove the needle
from the vial. Holding the syringe upright, tap the
barrel to bring the bubbles towards the tip of syringe.
Then carefully push the plunger to the dose mark (0.5
ml) thus expelling the air bubble.
10. If the injection site is dirty then clean it with a clean
water swab
11. Administer Measles vaccine in right upper arm.
12. Push the needle at an angle of 450 to the skin surface
to deliver measles vaccine by subcutaneous route.
13. Push the plunger completely to deliver the dose. Do
not rub the injection site
after you have injected the
vaccine.

Handbook for field workers: Measles catch-up campaign 15

After injecting measles vaccine

DO NOT attempt to re-cap / bend needle.

Cut the hub of AD syringe in hub-cutter. The cut needles should remain in hub-cutter until
disposed off at designated site.

Dispose off the plastic part of cut AD syringe in red plastic bag.

Mark left little finger of child.

Mark tally sheet.

Give vaccination card to child.

Child should wait at least 30 minutes after injection at session
site.

Remind about scheduled routine immunization doses, as
appropriate and inform about the nearest place and day of RI session in the
village.

Remember: Reconstituted vaccine must be discarded immediately if:

o There is visible evidence of contamination, such as change in appearance and floating
particles, and cold chain obviously broken.
o There is any suspicion that the opened vial has been contaminated, the vial dropped on the
ground, accidentally touching the rubber cap, and contact with water.
o If the cold chain has not been maintained at any point after reconstitution and prior to
administering the vaccine to the child.

Handbook for field workers: Measles catch-up campaign 16


How will you maintain cold chain at the session site during activity?

Only standard vaccine carriers with four icepacks should be used by vaccination teams during
measles campaign. Ensure that vaccines and diluents are kept cool during the whole day;
replace completely melted icepacks immediately. Each ANM will use two vaccine carriers for
each day of activity.

One vaccine carrier can be packed with 100-125 vaccine doses (20-25 vials) with matching
diluents. If only 100 doses with diluents can be packed in one vaccine carrier, the other
vaccine carrier will be stocked with balance vaccine doses (20-25) and diluents required at the
session site. This vaccine carrier will also be used as a back-up for ice packs.

During packing a vaccine carrier put the diluents with paper packing box or original blister
packs at the centre of the vaccine carrier and vaccine vials around. This is to avoid diluent
ampoules from freezing by coming in direct contact with frozen icepacks.

The vaccinator should take out one ice pack from the second vaccine carrier (with smaller
stock) to keep one vial of reconstituted vaccine in the hole of the ice pack. Once the ice pack
is fully melted, it should be replaced with a fresh frozen ice pack from the same vaccine
carrier. Supervisor will arrange to send another set of ice packs to each ANM by mid-day.

Once the reconstituted vial is finished, the next vial should be taken out of the vaccine carrier
for reconstitution only after arrival of another child in the vaccination session site or if
another child is waiting for vaccination.

At the end of the session, all vaccine carriers with all icepacks, unopened vaccine vials and
diluents inside, should be sent back to the vaccine distribution centre.

Maintaining Cold Chain during Vaccination Session

Measles vaccine is very sensitive to heat and sunlight. Never expose the vaccine carrier, the
vaccine vial or icepack to direct sunlight.

All vaccine vials and diluents should be kept inside the vaccine carrier with the lid closed
until a child comes to the centre for vaccination.

The VVM on the cap of the vaccine vial indicates whether the dry vaccine is usable or not.
Once reconstituted, VVM is of no use to indicate usability of the vaccine

At the time of reconstitution the diluent must have the same temperature as that of the
vaccine.

Measles vaccine becomes more sensitive to heat after reconstitution. Reconstituted
vaccine must be kept between +2 to +8 degrees Celsius and discarded 4 hours after
reconstitution or at the end of session whichever is earlier.

Handbook for field workers: Measles catch-up campaign 17


Are there any adverse effects of measles vaccine? If yes, what are they?
Measles vaccine is an extremely safe vaccine. But like all medicines including vaccines, it does
have some side effects or adverse effects. The commoner adverse effects are mild and have no
long term consequences. One very rare and serious adverse effect is anaphylaxis. A list of adverse
effects is given below.

Adverse Effect Interval Remarks

from
injection to
onset
Local reaction at 0-2 days Common but not serious. Recovers on its own. You
injection site may see 1 local reaction for every 10 doses.
Fever 6-12 days Common but not serious. One child in 20 may have
fever. Fever should be treated with paracetamol
per IMNCI guidelines.
Rash 6-12 days Common but not serious. One child in 20 may have
rash (and fever). Rash disappears on its own. Treat
fever. Reassure parents.
Febrile seizures 6-12 days Rare. Self-limiting with no long term effects. Refer
(convulsions) for medical help immediately.
Anaphylaxis* 0-1 hour Extremely rare (1 in 10lakh doses). You may not
even see one in your lifetime. But very serious
emergency. Child must get medical attention
immediately.
* See identification of anaphylaxis below.

How should the adverse effects be managed?

o Supervisor, ANM, ASHA, AWW should know name and telephone number of
nearest AEFI management centre
o For minor AEFI like fever etc. treat with paracetamol per IMNCI guidelines
o For serious AEFI e.g. convulsions or anaphylaxis

Give primary care: lay child flat; ensure airway is clear. If child is
unconscious, put in semi-prone position.

Refer immediately to the nearest AEFI management centre

Call (telephone) the AEFI management centre and inform them of the
referral.

Inform immediate supervisor

Handbook for field workers: Measles catch-up campaign 18


What are adverse events due to programme errors?
o Adverse events are caused by errors in vaccine preparation, handling, or
administration. They may give rise to serious reactions and even death.
o This is not due to the vaccine, but due to human error and must be prevented at
all costs.
o Two common causes of programme error with measles vaccine are

Use of wrong diluent and

Using reconstituted vaccine beyond the recommended time of four hours.
o Programme errors must be prevented at all costs.

Identification of anaphylaxis
Clinical Progression Signs and symptoms of anaphylaxis
Mild, early warning signs Itching of the skin, rash and swelling around injection site. Dizziness,
general feeling of warmth

Painless swelling in part of the body e.g., face or mouth.

Flushed, itching skin, nasal congestion, sneezing, tears.
Hoarseness of voice, nausea, vomiting
Swelling in the throat, Difficult breathing, abdominal pain
Late, life-threatening Wheezing, noisy, difficult breathing, collapse, low blood pressure,
Symptoms irregular weak pulse

How will you ensure injection safety and safe waste disposal

o Use a new sterile packed AD syringe for each injection for each child.
o DO NOT ATTEMPT TO RECAP the needle. This practice can lead to needle stick
injuries.
o Cut the hub of the AD syringe immediately after administering the injection using
the Hub cutter.
o Store broken vials in the same hub cutter.
o Segregate and store the plastic portion of the cut syringes and unbroken (but
discarded) vials in the red bag.
o Send the Immunization waste generated in the outreach sessions to the PHC, for
further disposal.

Handbook for field workers: Measles catch-up campaign 19

 Let us now answer the following questions
1. Measles vaccine comes as a dry powder which must be reconstituted with diluent before
administration. True/False [Encircle the correct answer]
2. What is the dose of measles vaccine for a) 9 month old child and b) five year old child?
a) ___________________ b) _________________
3. What is the route of administration of measles vaccine?
_____________________________________
4. What is the site of administration for the catch-up campaign?
___________________________
5. What precautions should we take while reconstituting a vial of measles vaccine?
________________________________________________________________
________________________________________________________________
6. You have reconstituted a vial of measles vaccine at 10 AM. How will you keep this
reconstituted vial at the session site? How long will you keep this vial before discarding it?
____________________________________________________________
7. How will you dispose of a) plastic wrapper of syringe, b) syringe-needle c) vaccine and diluent
vial at the vaccination site?
a) ______________________ ,
b) ____________________ c) _______________________

8. Mention two common but not serious adverse effects of measles vaccine.
1.___________________________ 2) __________________________________
9. What is programme error? What are two common sources of programme error with measles
vaccine?
1) ______________________________ 2) ____________________________
10. After immunization, how long should the child wait at session site?
____________________________________________________

You should now practice skills of giving a subcutaneous injection following all safety norms.

Handbook for field workers: Measles catch-up campaign 20

 Topic contents: Module 1, Sessions 4 & 5

Session Topic Method Time Teaching Aids

4 Discussion on session-site micro- Lecture 30 min Blank copy of
plan formats, tally sheet and formats
vaccination card
5 ANMs refine micro-plans for Interactive 1 hour Formats for
each sub-centre area session site plan at
school, outreach
and high risk sites;
facilitated by
Supervisor

You must have started the basic micro-plan for your area. Here we will recapitulate basic
principles of the micro-plan and then refine the micro-plans developed so far.

Remember: You must achieve 100% coverage of target age group children (9 month-10 year
old) in your area.

Remember we shall immunize all children in the immunization campaign from fixed posts
only. There will be no house to house immunization.

Only trained vaccinators (ANM, HW (F), Supervisors, LHV etc.) will give injections to children
during catch-up campaigns.

1st week of campaign will cover the target age group children in schools. Children from
different villages may come to the school. You will immunize all of them.

2nd and 3rd weeks of the campaign will cover non-school going and left out children in the
villages or urban areas through outreach sessions, fixed sites and mobile teams for high-risk
populations.

When you do the outreach sessions some children in the village will already have been
immunized in schools. ASHA should update her due list and mobilize the un-immunized
children to the outreach session. If school coverage is high, the injection load in outreach
sessions would be less.

During the campaign period, ANM/HW(F) will conduct immunization activities for the
campaign on 4-5 working days of the week without disturbing the routine
immunization/Village Health & Nutrition days of the week.

An ANM/HW(F) will be able to vaccinate 200 children in a day in a school based session and
150 children in a day in an outreach session in a village or urban area.

Handbook for field workers: Measles catch-up campaign 21

 o If you organize the school session correctly, you can vaccinate more children in a
school session because you do not have to wait for the children to turn up from their
homes. They are already in the school for the day.

One village or an urban area will be covered in 1 day by one or more teams. Therefore, you
can calculate
o Number of teams needed to cover a school in one day = Target population/200.
o Number of teams needed to cover a village/urban area in one day = Target
population/150.

A Vaccination team will have
o 1-2 vaccinators* (ANM/Male HWs/LHV/ retd. ANMs,
LHVs/pharmacists/nurses/doctors)
o 1 ASHA /Link worker or similar staff (for urban areas)
o 1 AWW
o 1 volunteer
*Note: In case the beneficiary load is 150-300 at outreach site or 200-400 at school site, the team
will have two vaccinators.

One team-One day-One site
o Plan to complete measles immunization in one day in a village or an urban area
(mohallas) or in a school by 1 or more teams as required. To ensure injection safety no
team will conduct sessions at two different sites in one day.
o For larger villages, separate teams may be strategically placed in different areas of the
village to maximize coverage.

So, several ANMs will work in a large village or urban area to complete the activities in the
same day. Local ANM will always be a member of one of these teams.

ASHA or AWW will work in her usual area of work. The ASHA or AWW will be different for
different days of the activity.

No vaccination team will conduct activities at two different session sites in any one day.

Types of session sites: Four types of session sites during the catch-up campaign.

Session sites at Educational Institutes

Outreach site (regular RI sites and additional sites in village/urban mohalla)

Mobile team (to cover hard to reach areas, nomadic population, temporary
settlements)

Facility based session site (at PHC / CHC / Hospital/ Private clinic)

Handbook for field workers: Measles catch-up campaign 22


Duration of Session
o Sessions in educational institute will run as per school timing and complete all
immunizations in one day.
o Catch-up campaign sessions at outreach and fixed sites will run from 8:00 AM to 2:00
PM. The vaccinators and ASHA/AWW will then perform their other routine activities
until 4:00 PM at this site.
o Mobile teams may have to work at unusual hours to reach special population groups.
The time of activity for each day and area should be specifically recorded on the
micro-plan for such activity.

What are the formats that you will use for micro-planning, recording and reporting?
[Ask facilitator for one copy of each format]

Name of Format Purpose Who will fill Complete by

Base-line Collect base-line information Each ANM/Urban At least 8 weeks
Information for each sub-centre /urban health worker for her before campaign;
area. Each ANM should area. Senior staff at
come to the training with PHC will check for
this form completed. completeness.
Beneficiary Due ANM will guide ASHA to list ASHA (AWW if ASHA At least 4 weeks
list all beneficiaries in her area not selected) before campaign
School micro- Session site plan for school ANM and 1st Line At least 6-8
plan phase (1st week); each supervisor; senior weeks before
school and number of teams staff at PHC/Block campaign
needed must be listed. will guide
Outreach micro- Session site plan for ANM and 1st Line At least 6-8
plan outreach session; Check that supervisor; senior weeks before
all villages in base-line info staff at PHC/Block campaign
format have been included. will guide
High Risk Session site plan for special ANM and 1st Line At least 6-8
population areas/high risk groups. supervisor; senior weeks before
micro-plan Check that all areas have staff at PHC/Block campaign
been included. will guide
Communication Communication plan for ANM and 1st Line At least 4 weeks
plan school and outreach sessions supervisor; senior before campaign
staff at PHC/Block
will guide

Handbook for field workers: Measles catch-up campaign 23

Invitation Card Invite all target age-group ASHA (AWW if ASHA Distribute in
children individually not selected) week before
campaign
Tally sheet Tally marking of children Vaccination team at On days of
immunized session site activity
Vaccination card Record of catch-up campaign Vaccination team at On days of
dose session site activity

Basic information will you need to fill in the formats.
Remember that for larger villages, more than one vaccination team will work together in one day.
This means that local ANM and other ANMs plus ASHA and AWW will work together in the larger
villages on the day of activity. Therefore the micro-plans will be developed at the PHC level as a
group exercise to fix up names of persons and village specific dates of activity.

The first step is to collect and compile the following background information.

Reliable estimates of village / mohalla wise target population (9 months to 10 years) in sub-
centre /urban area that you serve. Use the highest of the available estimates.

Names and location of schools (Govt., Private, Madarsa, Kindergarten or Montessori schools
etc.) and number of students enrolled in each school who are within target age-group.

What are the high risk population groups in your area? Are there street children and other
high-risk populations that may not attend school or community vaccination sites? Shall we
need special plans to reach these groups (e.g. night visits) etc.?

Estimate requirement of logistics (vaccine/diluents, ADS etc.) per norms by session site (see
wastage multiplication factor etc. below).

Finally after completing the formats draw a map of session site plan with dates as shown for
the PHC area.

Handbook for field workers: Measles catch-up campaign 24

Calculation norms to be used in macro and micro-planning

Activity / Unit Norm

Target population 9 months - <10 years; This can vary between districts.
Take the highest of the available estimates for
planning.
Number of children 1 ANM can = 200 children per vaccinator per day (SVD)
vaccinate in 1 day at school session
Number of children 1 ANM can = 150 children per vaccinator per day (OVD)
vaccinate in 1 day at outreach
No. of supervisors 1 supervisor per 3 teams
Vaccine doses required = Target population X 1.1 (WMF)
Vaccine vials required = Vaccine doses / 5 (for 5 dose vials)
Diluent vials required = Vaccine vials required
Auto disable syringes (ADS) = Target population X 1.1 (WMF)
required
Reconstitution syringes (5 ml) = Vaccine vials
required
Hub cutters = 1 per vaccinator;
Maximum number required = Maximum number of
vaccinators working in any one day
Red plastic bags = 1 per 50 syringes
Black plastic bags = 2 per session site per day
COLD CHAIN
Daily ice pack requirement = (Number of vaccinators X 12) + (Requirement for
supervisors and cold boxes)
Total ice pack requirement = Daily ice pack requirement X 3
(including freezing cycle)

Handbook for field workers: Measles catch-up campaign 25

 Let us now answer the following questions
New Age school in Rampur village in Suti PHC has 600 children in the target age group.
1. How many ANMs will be needed to vaccinate all the children in this school in one day?
_________________________________
2. How many vaccine doses will you need?
_________________________________
3. Calculate the logistics – Number of vaccine vials, diluent ampoules, AD syringes, mixing
syringes that will be needed for the school activity.
______________________________________________________________

The next week, Dilari village in Suti PHC will have the catch-up campaign. The ASHA and the AWW
who work in this village have enlisted 300 target age group children in Dilari village.
4. How many vaccination teams will be needed for the activity?
_________________________________
5. Calculate the logistics – vaccine doses, vaccine vials, diluent ampoules, AD syringes, mixing
syringes that will be needed for the outreach activity in Dilari.
_________________________________
[Remember: In actual practice the injection load in outreach activity in Dilari village may be less
depending on the number of children from Dilari who have been immunized in the school phase
of the campaign.]
6. How will you dispose of the accumulated injection wastes from the vaccination sites?
_____This question should go to previous section
____________________________________________________________________

The participants will work on the formats for the rest of the session.

Handbook for field workers: Measles catch-up campaign 26

 Module 2

Target Groups to be trained

• Vaccinators (ANM/HW-F, HW-M)
• Supervisors (LHV, HA-M)
• ASHA
• AWW
• Volunteers

Handbook for field workers: Measles catch-up campaign 27

 Module 2: IEC/IPC and session site (3 hours): not more than 30 participants per group
Session Topic Method Time Teaching Aids
1 Introduction to measles catch-up Lecture 10 min Flip charts, Chalk
campaigns board, Marker pens
2 Description of tasks and roles in Lecture & 30 min Flip charts, Cards,
the campaign and at session sites discussion Chalk board, tally
sheet forms,
Vaccination cards
3 Beneficiary listing and Invitation: Lecture & 30 min Formats for
Purpose and plan – ANM and ASHA Interactive beneficiary listing
to frame a timeline discussion and invitation card
4 Plan for local level meetings: ANM Interactive 20 min Communication
and ASHA to frame schedule discussion Plan format
5 Motivate care givers of children Role play 1 hour 30 Role play situations
(through IPC) for participating in min
measles catch-up campaign

Handbook for field workers: Measles catch-up campaign 28

 Topic contents: Module 2, Sessions 1
Session Topic Method Time Teaching Aids
1 Introduction to measles catch-up Lecture 10 min Flip charts, Chalk
campaigns board, Marker pens
The topic contents are given in module 1 session 1.

Topic contents: Module 2, Sessions 2

Session Topic Method Time Teaching Aids
2 Description of tasks and roles in Discussion 30 min Flip charts, Cards,
the campaign and at session sites and Chalk board, tally
exercise/game sheet forms,
vaccination cards

1. TASKS OF VACCINATOR
Pre-campaign tasks

Provide accurate information regarding her sub-centre area including new settlements
(permanent or temporary) and hamlets which have come up after last review of RI micro-
plan. She should also provide information about schools in private and public sector in her
area.

Assist block level person to prepare micro-plan for her sub-centre area including plans for
vaccine delivery and logistics.

Participate in trainings and coordinate with all ASHA, AWW and volunteers in her area to
attend the appropriate training sessions

Liaise with community leaders in the catchment area and ensure that ASHA prepares the
due list and distributes invitation cards to beneficiaries.

Coordinate with local ANM regarding location of measles session sites, ASHA, AWW and
local leaders etc.

Check that appropriate plans have been made for delivery and pick-up of vaccines and
other logistics during campaign days.

To ensure safety and accountability, when two vaccinators are working they will work in
parallel, that is, each will administer the vaccine independently.

On the day of activity

Organize measles session site with help from ASHA/AWW and volunteer. Ensure that all
IEC materials are displayed at the session site properly

Check that she has received all logistics in appropriate quantity and quality (vaccines,
diluents, tally sheets, immunization cards, marker pens, cotton-wool etc.)

Check that measles vaccine and diluents are from same manufacturer and within expiry
date;

Administer vaccine following all safety norms. Dose is 0.5 ml and should be administered
subcutaneously in the right upper arm. The site is important for survey purpose.

Handbook for field workers: Measles catch-up campaign 29


Record campaign dose in tally sheet. Check that tally forms are correctly completed and
summarized at the end of each day;

Ensure that every immunized child gets a catch-up campaign card.

Supervise and guide ASHA, AWW and volunteers in her team.

Ask each beneficiary to wait for at least 30 minutes after vaccination.

Respond to AEFIs;

Wait for one hour after vaccinating the last child at the site to respond to AEFI, if any.

Dispose of all immunization waste materials following proper guidelines.

After the activity in one village:

On the RI session days during the campaign, when ANM goes to the village where she
usually works, she should ask ASHA to mobilize those children (9 months to 10 years) who
were missed in the catch-up campaign and complete their measles immunization.

2. TASKS OF ASHA/AWW
Pre-campaign

Participate in trainings arranged at PHC or Block level.

Arrange for proper site and facilities for a session site if it is located at a site where no RI
sessions are held.

Prepare a due-list for all beneficiaries in her area.

IPC to all families through invitation card to target age group children at least 3 days
before the activity in the block.

Mobilize community: Get PRI representative to convene a meeting of the VHSC at least
one week before the activity in village

On the day of activity

Assist ANM to set up and manage the session site.

Arrange local village leader to inaugurate the session site

Mobilize children to the session site. If turnout is low by mid-morning, she should visit
households with children in the target age group and persuade them to get their children
immunized.

Assist ANM in running the session site – welcome families to the session site, assist
mother to hold their children properly and generally assist in crowd control.

Assist in finger marking and tally sheet marking in coordination with ANM.

Remind parents of eligible children to complete routine immunization and inform about
the nearest place and day of RI session in the village.

Advise where to report in case of an AEFI and report to ANM if she is aware of any AEFI.

At the end of the day she should identify children in her area who have not been
immunized from previously prepared due list.

Mobilize children who have been missed in catch-up activity to get vaccinated during RI
session.

Handbook for field workers: Measles catch-up campaign 30

Post campaign day

In the next RI session day in her village, arrange with her local ANM to immunize children
who have been missed during the campaign.
3. TASKS OF THE VOLUNTEER

Pre campaign

Participate actively in trainings before the campaign.

During campaign day

Crowd control

Finger-mark vaccinated child

Tally sheet marking for vaccinated children under ANM guidance;

Give the campaign card to child

Roles of team members

Each member of the vaccination team has a specific role at the session site as below. oles of
Vaccinator

Vaccinator is the Team
Leader.

Maintain cold chain and
administer safe injections

Dispose of waste safely;

Check that tally forms are
correctly completed

Supervise and guide the team
(ASHA, AWW and
volunteers).

Wait for one hour after
vaccinating the last child at
the site to respond to AEFI, if
any.
ASHA/AWW Volunteer

IPC to all families with
target age group children

Mobilize community and
parents to bring target age
group children. If
necessary she will visit
households to motivate
parents.

Record campaign dose in
tally sheet.

Ask each beneficiary to
wait for half an hour after
vaccination.

Advise what to do in case
of an AEFI

Crowd control

Tally marking for
vaccinated children;

Remind parents of
eligible children to
complete routine
immunization.

Finger-mark
vaccinated child

Give completed
vaccination card to
child.

Handbook for field workers: Measles catch-up campaign 31

 Layout plan of a measles outreach session site

Flow chart of a measles session site

Layout of vaccination site

Handbook for field workers: Measles catch-up campaign 32

 Topic contents: Module 2, Sessions 3

3 Beneficiary listing and Invitation: Lecture & 30 min Format for

Purpose and plan – ANM and ASHA Interactive beneficiary listing
to frame a timeline discussion

ASHA should complete the beneficiary listing at least 4 weeks before the campaign. ANM should
finalize timeline with ASHA. MO I/C PHC will make alternate plans for villages/areas without
ASHA.

In consultation with ANM, ASHA should make a plan to deliver filled invitation cards with
information about the session site, date and time to every beneficiary in the week before the
campaign (before the school week).

Topic contents: Module 2, Sessions 4

4 Plan for local level meetings: ANM Interactive 20 min Communication

and ASHA to frame schedule discussion Plan format

Develop a plan with ASHA/AWW to organize village level meeting for social mobilization
Decide on the dates for the meeting in each village at least one month before the campaign so
that ASHA/AWW organizes the meeting and ANM also participates

Guidelines for holding community meeting before the catch-up campaign

Hold at a convenient time and place after
talking to the community leaders.

Identify local community representatives who
would participate in the meeting

Provide a comfortable and welcoming
environment for the discussion.

Handbook for field workers: Measles catch-up campaign 33


Listen to the community, find out what the community already knows about Measles disease
and immunization

Provide information on the importance of routine immunization including measles
vaccination and where and when services are available.

Dispel misinformation and doubts that surround the vaccination.

Encourage them to ask questions so that
everyone can be better informed.

Use stories, short plays, songs and visual aids
to hold the group’s attention and make
meetings interesting

Involve as many group members as possible
in the discussion and ask them to suggest
solutions to problems

Help mobilize resources for the catch-up
immunization sessions.

Below messages should be given to the attendees at village level meetings.

Handbook for field workers: Measles catch-up campaign 34

 Messages for village level meetings

Measles is a highly infectious disease which can cause complications and death.

Measles kills nearly 100,000 children every year in India. (local examples of cases and
deaths)

Measles can cause complications like: Diarrhoea, Pneumonia or Chest infection, Mouth
ulcers, Ear Infection, Damage to eyes (child may become blind) or Brain infection
(encephalitis – rare)

Measles can be prevented by two doses of measles vaccine.

We will immunize all children who have completed 9 months of age and are below 10
years of age with measles vaccine through a catch-up campaign.

The catch up campaign will run from __________ to ______ in the district of
___________ .

From __________ to ______________ school-going children (below 10 years) will be
immunized in schools across the district.

For this village __________, the catch-up campaign will be held on _________.

The immunization sites in this village will be ____________, ______________ , -

______________ , __________ . This is a one time opportunity.

We request your cooperation to make the campaign a success.

Any questions?

Handbook for field workers: Measles catch-up campaign 35

 Topic contents: Module 2, Sessions 5

Session Topic Method Time Teaching Aids

5 Motivate care givers of children Role play 1 hour Role play situations
(through IPC) for participating in 30 min
measles catch-up campaign

Role Plays to motivate the care givers of children (through IPC) for participating in measles
catch-up campaigns.
These role plays should give you an opportunity to practice your inter-personal communication
skills. The facilitator will organize roles plays according to following situations. You can also
suggest new situations to the facilitator.
Situations for the role plays:
1. During house visits for beneficiary listing and invitations

2. During the session day, organizing the session site and conducting the session

3. On session day, visiting the houses of missed children to mobilize them.

4. After the campaign visits to missed houses to call them for routine immunization session.

Handbook for field workers: Measles catch-up campaign 36

 NOTES

Measles catch-up campaign –planning and implementation guidelines 37