Closing the immunity gap through the strategy of intensification of routine immunization using the offline tool immunogram and supportive supervision - experiences from the rural health training centre of KVG medical college, Karnataka

Narayana V. Holla, Satya Kishore Chivukula, Sharanya Kaniambady


Background: Since the inception of EPI in 1978, India is consistently trying to achieve and sustain high vaccination coverage.  The objectives were to detect population immunity gap in the catchment area of RHTC through the offline tool - immunogram and to evolve the shortest period required for closing this gap using immunogram and supportive supervision.

Methods: A short term interventional field study from December 2012 to April 2013 done in RHTC of KVG Medical College. Children born since 1st April 2010 were line-listed chronologically in the ‘immunogram’ which can both record vaccination data and measure programme indicators – hence the name. Data analyzed and baseline indicators obtained. Sustained Supportive Supervision provided was documented at the RHTC. The study ended on 31st March 2013 on clearance of the backlog coinciding with the launch of pentavalent - replacing DPT + HepB from 1st April 2013 in Karnataka.

Results: RHTC is a good performing planning unit with high baseline coverage; ~90% for primary vaccination. Significant impact was seen with measles 1, DPT/OPV booster dose and Measles 2nd dose which increased from 89 to 97%, 85 to 95% and 55 to 94% respectively in consecutive intensified regular sessions in 3 months.

Conclusions: Immunogram precisely detected the immunity gap in a good performing planning unit and rapidly closed the gap in just 3 months, realizing the theme of WHO world immunization week 2016 – close the immunization gap. The planning unit graduated from good to better forever.


Immunogram, Population immunity gap, Supportive supervision, Vaccine preventable diseases

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World Health Organization. Are you up-to-date? World Immunization Week: 24-30 April 2014, from last accessed on 14 March 2014.

Park K. Parks Textbook of Preventive Medicine. 23rd edition. Jabalpur: m/s Banarasidas Bhanot; 2014

District level house-hold and facility survey 2007-08, Ministry of health and family welfare. Govt of India.

UNICEF and Government of India, Ministry of Health and Family Welfare. Coverage Evaluation Survey report. 2009, 2-10.from last on 05 March 2013

UNICEF and Government of India, Ministry of Health and Family Welfare. Coverage evaluation Survey. Karnataka, 2009, 1-8. Last accessed from on 5 Mar 2010.

Government of India, Ministry of Health and Family Welfare, Immunization Division. Strategic framework for Intensification of Routine Immunization in India. Coverage Improvement Plan 2012-13, 1-40

Narayana HV, Vijaya Kiran M. Operationalizing Intensification of Routine Immunization: A simulation, interventional pilot study in four selected rural health sub-centers and one urban health sub center – experiences from Jharkhand; North India. MRIMS J Health Sciences. 2015;3(3):171-80.

Mother and child tracking system Notes available from dparar/ MCTS%20NOTES.docx last accessed on 10th April 2014.

WHO Measles Fact sheet Reviewed March 2016. From mediacentre/ factsheets/ fs286/en/ accessed on 08-09-2016

WHO SDG Goal 3.2 Ensure healthy lives and promote well-being for all at all ages from accessed on 08-09-2016.

WHO Global Health Observatory (GHO) data from accessed on 08-09-2016

http://www.technet content/ article?id=4741 As of November 26, WHO has confirmed a polio outbreak with a total of 17 cases caused by wild poliovirus type 1 in Syria, which had been polio-free since 1999.

CDC Morbidity and Mortality Weekly Report (MMWR) Pertussis Epidemic – Washington, 2012 weekly July 20, 2012 / 61(28);517-522 from on 07-09-2016.

Mission Indradhanush Concept Note, accessed on 18-03-2015.

Ministry of Women and Child Development Government of India Rapid Survey on Children 2013-2014 from default/files/RSOC%20FACT%20SHEETS%20Final.pdf accessed on 28 Aug 2016.

Ministry of Health and Family Welfare District Level Household and Facility Survey-4 State Fact Sheet Karnataka (2012-13) International institute for population sciences (Deemed University) Mumbai from accessed on 28 Aug 2015.

Ministry of Health and Family Welfare National Family Health Survey-4 2015 -16 State Fact Sheet Karnataka International Institute for Population Sciences (Deemed University) Mumbai from accessed on 28 Aug 2016.

WHO Global Vaccine Action Plan 2011–2020 Six Guiding Principles p 22 from file:///C:/Users/user/ Downloads/ 9789241504980_eng%20(1).pdf accessed on 07-09-2016.

Annual HMIS report 2014-15 Karnataka State.

Babu G, Singh V, Nandy S, Jana S, TN S, Sathyanarayana M. Supportive supervision and immunization coverage: Evidence from India. Internet J Epidemiol. 2011;9.

Holla N, Borker S, Bhat S. Vaccination sessions; challenges and opportunities for improvement: Experiences from Karnataka. Ann Trop Med Public Health. 2013;6:559-64.

7th Common Review Mission – Karnataka 9-15 November, 2013, Ministry of Health & Family Welfare, Government of India.