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

Task 1. Answer.

• The red color indicates repeated values from the previous year in the same district within the region that have been recopy, the green color is an outlier because looking at District 4, the target population is lower than the vaccinated population for May and the yellow color indicate even number that have multiple of five.

Task_201.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?

Task 2. Answer

Task_201.xlsx

• After going through the coverage per district at the subnational level, it was observed that some districts have coverage level more than 100% which is far above the coverage range at the national level (between 89% and 95%) during the reporting period. The present of coverage more than 100% indicate that there is factitious problem with the reported data.
• For the case of grand town and Remo, it can be that the numerator is over reported at the level of the facilities without the children been vaccinated.
• At the administrative data, the denominator (the target population) is underestimated that influence the high coverage more than 100% without vaccinating all the children.

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?

Task 3. Answer

1. The reliability of the county data as a whole is normal because when we look at the national coverage of the survey and that for the field, there are within the 95% confidence interval
2. Yes, there are regions which have huge discrepancies with the survey evaluation data compared to the administrative survey for immunization coverage. This can be attributed to the fact that some regions have fictitious data.
3. No, there is huge discrepancies between the administrative survey data and the evaluation survey data because majority of the outbreak data are out of the range of the evaluation survey confidence interval.

• Yes, the poll in data in 2013 has an influence on the measle vaccine national coverage. This is because the data are suspicious when it comes to coverage in the case of Alu and Remo, the coverage are alarming that can be due to over reporting by the health facility staff. Also, the administrative survey coverage denominator for Grandtown is under estimated despite the high influx of peoples from other regions into Grandtown.

Task_201.xlsx

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

Task 4. Answer

• Yes, this is because although vaccination coverage was high, the highest cumulative incidence cases was among age group 1-4 years. This confirm that the MR1 vaccine that was administered in some of these children within this age group have already attenuated within their system or they must have missed vaccination at their early years of life. Also, cases of infections in adult age groups were diagnosed despite having been immunized against measles at young ages, which may be as a result of attenuated of their immunity over the years since their vaccination time.
• Though few cases of children under the age of one were also infected. This could be children that were from hard to reach areas or migrant children from other region that happen to be out of town during vaccination period

Task_204_20_20answer.xlsx

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

Task 5 Answer

Introduction

Good morning Mr. Minister, it is with a great pleasure for us to meet you today to present the prevailing situation of measles outbreak in our country. Despite the high coverage of measles vaccination both at the national and regional level, cases of measles still occur in Grandtown. I and my colleagues will like to present the situation.

Task_202.xlsx

• Despite the high coverage of MR1 vaccine at Grandtown, it is observed that only 2 in 10 children were vaccinated against measles in the entire region. This was the main reason why 80% cases of measles were diagnosed.
• Though the 2017 national coverage was high, it still occurs that region like Westtan have lower coverage that were below the survey coverage of MR1 immunization at the regional level. This implies that 4 in 10 children that were within the cohort of immunization were not vaccinated which can be attributed to the fact that some of the caregiver refused the children from taking the vaccine.
• The MR1 vaccine were for children below the age of one but It was also observed that the recent measles outbreak also occurs among adult age groups despite been immunized against measles at young ages, which may be as a result of attenuated of their immunity over the years since their vaccination time or decrease potency of the vaccines at the time of administration .

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

Task 6 Answer

• Performed active surveillance in the entire region that have higher coverage of immunization to identified all cases of measles.
• Organized mass campaigned against measles in all age group that cases were diagnosed in the region and nearby regions.
• We will Ensure that all human resources, materials, cold chain, syringes and vaccines are in good state during the vaccination period

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

Task 7 Answer

• Organized micro-planning activities that will permit the revision of catchment population in order to fine tune fixed site and outreach services for routine immunization activities.
• The surveillance system should ensure that during vaccination campaign, active surveillance is done to ensure that all children and household within the catchment population are vaccinated.
• The EPI team ought to safeguard that the tally sheet, children card and health facility register are in accordance with the number of children vaccinated so that realistic target can be attend.
• The surveillance system should construct reference laboratory that will ease the diagnosis of measles cases in order to avoid severity of the disease.
• Capacity building workshop should be organized to trained healthcare worker on how to filled the tally sheet and register while reconciling with the number of children vaccinated.