Added value of the measles-rubella supplementary immunization activity in reaching unvaccinated and under-vaccinated children, a cross-sectional study in five Indian districts, 2018-20.

INTRODUCTION: Supplementary immunization activities (SIAs) aim to interrupt measles transmission by reaching susceptible children, including children who have not received the recommended two routine doses of MCV before the SIA. However, both strategies may miss the same children if vaccine doses are highly correlated. How well SIAs reach children missed by routine immunization is a key metric in assessing the added value of SIAs. METHODS: Children aged 9 months to younger than 5 years were enrolled in cross-sectional household serosurveys conducted in five districts in India following the 2017-2019 measles-rubella (MR) SIA. History of measles containing vaccine (MCV) through routine services or SIA was obtained from documents and verbal recall. Receipt of a first or second MCV dose during the SIA was categorized as "added value" of the SIA in reaching un- and under-vaccinated children. RESULTS: A total of 1,675 children were enrolled in these post-SIA surveys. The percentage of children receiving a 1st or 2nd dose through the SIA ranged from 12.8% in Thiruvananthapuram District to 48.6% in Dibrugarh District. Although the number of zero-dose children prior to the SIA was small in most sites, the proportion reached by the SIA ranged from 45.8% in Thiruvananthapuram District to 94.9% in Dibrugarh District. Fewer than 7% of children remained measles zero-dose after the MR SIA (range: 1.1-6.4%) compared to up to 28% before the SIA (range: 7.3-28.1%). DISCUSSION: We demonstrated the MR SIA provided considerable added value in terms of measles vaccination coverage, although there was variability across districts due to differences in routine and SIA coverage, and which children were reached by the SIA. Metrics evaluating the added value of an SIA can help to inform the design of vaccination strategies to better reach zero-dose or undervaccinated children.

Labial reduction in adolescent population--a case series study.

STUDY OBJECTIVE: To find the primary referral reasons for labial reduction in adolescent girls. DESIGN: A retrospective review of six case notes of patients from July 2003 to January 2007. SETTING: Pediatric and adolescent gynecology clinic. INTERVENTIONS AND OUTCOME: Unilateral or bilateral labial reduction. The procedure was done by standard trimming of the protuberant edge of the labia minora and over-sewing the edge with 3-0 vicryl rapide. RESULTS: The age ranged from 11 to 16 years old. The reasons for requesting labial reduction were labia getting caught in underwear, being prominent under swimwear, causing vulval irritation, and its appearance causing embarrassment. All the patients were satisfied with the outcome. CONCLUSIONS: Two groups requested labial reduction. In the first group the enlarged labia caused physical discomfort. In the other group the procedure was carried out for cosmetic reasons. It is important to carefully choose the patients in the later group, because it can otherwise lead to dissatisfaction and regret later on in life. The child can give consent if Gillick competent, but it is a good practice to involve person with parental responsibility in the process of making a decision.