Task 1: Flag all the suspicious values. (Outliers, repetitions, etc.)

• The report for the months of February and March are obviously duplicated except for district 13. This repetition is observe again in April /May and October/November (district 14) and in November/ December (district 1). Extreme values can be seen in District 3 (April, May and November) , District 4 (May), District 13 (November) and in Grandtown (May).

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 Nemo and the Westtan district are lacking behind with vaccination coverage with <80% coverage rate which is the target, except for Westtan that scored 82% in 2016. The Chello district performed below target but picked up since 2013. Grandtown and Remo districts were most performing scoring more than the set target. Generally, the national vaccination coverage was below target in 2015(89%)

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?

• A significant difference can be observed between the survey report and the rountine report especially in the Nemo region. This may be related to data quality issue either during data collection or entry. In comparing the survey coverage of 91% and 70% coverage for routine reporting, it can also be attributed to data manipulation by the data management team.

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

• The majority of cases are between the ages 1-4 years; this can be attributed to the fact that parents neglect immunization session for children 0-59 months. The closely followed majority of <30 years maybe due to ignorance on the importance of immunization

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

• Grandtown is becoming overwhelm in population increase from smaller neighboring towns. According to statistics, there is a measles outbreak in Vacciland amounting to 625 confirmed cases. The outbreak has been incriminated for reported cases of child death and around 80% of cases are unvaccinated or have unknown vaccination. Even though there was an outbreak in 2011(462 cases), the last major outbreak occurred in 2012 (3285cases). Emergency measures were taken to curb the incidence and reverse the trend.
• Recently, Grandtown has a record of faulty immunization data characterized with repetitive data values in various months and extreme values with very low/high vaccinated children different from the reality.
• Furthermore, national coverage for the MR1 is above 90% indicating the system is in the green Band. The question is, why is the outbreak?
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Task 6. Brief the Minister. Propose three actions to respond to the outbreak.

Simultaneously,

• Mass vaccination campaign should be implemented especially to children 0-59 months
• Commination for behavioral change should be implemented to increase awareness, importance of vaccination as a whole, pathophysiology of measles, treatment options and sites, andbenfit for immunization
• Stop the spread of measles should be done through setting up expert teams to detect and treat cases

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

• All health workers should be trained bi-annually on principles and quality data collection during which information on power of data in policy and decision making should be reiterated
• Set up a Monitoring and Evaluation system at all levels for data management in other to enhance the collection of quality data.
• Assign incentives for quality data disbursed after verification and penalty for faulty data in cases where there is laxity in the importance of vaccination data.
• Put in place health facility data review workshops for quarterly coordinating those responsible for immunization.
• Sentinel sites should be included to monitor the VPDs while active and passive surveillance system should be activated with a close eye on the data aspect.