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

There are outliers District 1=142%, District 3= 255%, District 4=196%, District 10= 135%, District 11=115%, District 12 =103%, District 14=205%, District 15=142%.
Repetitions of values District 1= 142%, District 15=142%, District 6=100%, District 13=100%

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 table shows there are coverage less than 100% of MR1 like: District 2(48%), District 5(58%), District 7(88%),&District 8(84%).On other side, there are funny coverage are District 1=142%, District 3= 255%, District 4=196%, District 10= 135%, District 11=115%, District 12 =103%, District 14=205%, District 15=142%.

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?

As we see the MR1 survey coverage of 2013, There are different coverage, three (3) region have > or =100%(Alu, Grandtwn,Remo) that might be due to dominator challenge, whereas, the rest of the region have = or < 90% (Estan,Nemo,Chello,Grandtan & Westtan) these might be hard to reach or pocket area or inaccessible area.

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

Age distribution of measles cases

The majority of measles cases were at the age of 1-4years(26%) , 30+ years(22%) and 20-29years(16%) that may result from low coverage or cases are unvaccinated or have unknown vaccination status of MR1 at national and 5regional state of 2013 that are less than 95% coverage
I believe the second MR dose is mandatory to initiate herd immunity

Part 2. Brief the Minister

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

-Recent data shows some variance in coverage across these groups, the main challenge identified in recent years has been that of fast-growing urbanisation Grandtown. Grandtown is now estimated to have ~19% of population with a large and growing number of poor and underserved people
-625 cases have been confirmed so far, more than half within Grandtown, the capital. 80% of cases are unvaccinated or have unknown vaccination status
-Most data collection and reporting is paper-based and a recent EPI and VPD surveillance review highlighted some issues related to outdated registries, weak capacities among lower level staff and denominator challenges

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

-Strengthen routine immunization services at local community level(hard to reach area including)
-Improve immunity by National immunization day(NIDs) or supplementary campaign
-Make strong active and passive surveillances systems

Task7. Formulate recommendations. List your top 3-5 recommendations specific to data strengthening you would prioritize as the EPI and surveillance teams in Vacciland

-HMIS and DHS2 skill and knowledge transfer to shift traditional way of data management to modern method
-EPI and VPD surveillance should be integrated and managed according to WHO guide line
-Conduct integrated supportive supervision for lower level health care worker
-Develop capacity of lower and middle health worker by training on data management

-Organize and manage performance Review Meeting(PRM) on EPI and Surviellance,it creat opportunity for peer learning