Although WHO South East Asia Region countries have resolved to eliminate measles by 2020, it doesn’t appear to become a reality in India, which has reported around 297 measles outbreaks in 2016, thus, exposing gaps in vaccination programmes as well as lack of surveillance system that detects all cases of virus-borne disease.
Measles is a leading cause of childhood mortality among vaccine preventable diseases in the country. Caused by Morbillivirus, the infectious disease affects an estimated 2.5 million children every year, killing nearly 49,000 of them in 2015.
As the WHO deadline for achieving elimination of measles is less than four years away, India will have to expand many of its programmatic components at a much quicker pace given that the measles outbreaks in the country has risen over the last three years from 191 in 2014 to 279 (1915) and 294 in the following year, as per the data available from the National Centre for Disease Control (NCDC) under the Union Health Ministry.
Pediatricians Dr SB Bavdekar and Dr S Karande from Department of Pediatrics, TN Medical College and BYl Nair Ch Hospital and Seth GS Medical College and KEM Hospital, both from Mumbai, in an editorial published in Journal of Postgraduate Medicine have noted that universal implementation of the MCV2 (providing a second opportunity of receiving a measles vaccines to children who may have missed the first dose) will give children one more opportunity to get vaccinated.
“The efforts for informing, educating and motivating communities and parents have to be much greater than that employed for polio eradication as measles vaccine will not be given at the doorstep, and it will be administered as an injection, which is considered as unpleasant.
“Hence, the Government and voluntary organisations will be required to run a sustained media campaign regarding the essentiality of the measles vaccine. Such campaigns will have to be further scaled up when supplementary immunisation activities (SIAs) are being planned,” they suggested.
Children over the age of 24 months should be routinely checked for missed vaccinations while it would be advisable to recommend multiple “checkpoints” (say, at school-entry, at high-school entry) wherein the child’s documented vaccination status against measles can be ascertained and parents of nonvaccinated children offered focused motivation to vaccinate, said the editorial.
As per the National Family Health Survey-4 (2015-2016) measles vaccine immunisation coverage is 81.1 per cent. This is low compared to the 95 per cent coverage level required for elimination, it noted.
In addition, the coverage is unevenly distributed with several large and populous States such as Madhya Pradesh, Rajasthan, and Assam having MCV1 coverage that does not exceed 80 per cent.
India was one of the last countries to introduce MCV2 in the national immunisation schedule and initially, this was implemented only in few States and was offered to children aged 16-24 months.
In 14 States, MCV2 was provided to 134 million children aged 9 months — 10 years through supplementary immunisation activities (SIA), noted the experts.
Though India achieved an estimated 51 per cent reduction in mortality (2000-2015), it was less when compared to that achieved in African (85 per cent reduction), Western Pacific (80 per cent reduction), European (79 per cent reduction) regions and in South-East Asian region excluding India (91 per cent reduction).
In fact, Bhutan and Maldives have already eliminated the highly infectious disease ahead of the 2020. Dr Poonam Khetrapal Singh, Regional Director of WHO South-East Asia attributed the achievement to strong political commitment, alongside the concerted efforts of health workers, officials and partners at all levels.
SR Vaidya, scientist from Measles Group, National Institute of Virology (Indian Council of Medical Research), Pune said that in order to succeed, active surveillance, trained staff would be required for vaccine delivery, and mobilise the community participation. More attention is needed in the tribal areas, hilly regions, and migrant population.