Sri Lanka has been declared measles-free by the World Health Organisation (WHO), indicating that there have been zero new cases of the disease in the last three years. However, its neighbouring country India, is yet to achieve its resolve to eliminate the disease and control rubella/congenital rubella syndrome (CRS) by 2020.
As a highly contagious viral disease which affects mostly children, measles is one of the leading causes of death and disability among them. The country reported 47,056 cases between May 2018 and April 2019 as per the provisional data in the latest Global Measles and Rubella Update.
WHO recommends immunisation for all children with two doses of measles vaccine, either alone, or in a measles-rubella (MR) or measles-mumps-rubella (MMR) combination. In India, measles vaccination is given under Universal Immunisation Programme at 9-12 months of age, with the second dose at the age of 16-24 months. Notably, according to WHO, one-third of all measles-related deaths worldwide occur in India.
Although India initiated the Expanded Program of Immunisation in 1978, measles vaccine was introduced in the National Immunisation Program only in the year 1985 as a single dose for infants aged nine months or above.
Measles-containing-vaccine first-dose (MCV1) immunisation coverage among one-year-olds, that was just 56 per cent in 2000 climbed to 87 per cent in 2015. This prompted Ministry of Health and Family Welfare to initiate MR vaccination campaign in 2017 for children in the age group of nine months to less than 15 years in a phased manner across the nation.
India was one of the last countries to introduce MCV2 in the national immunisation schedule.
The campaign, which aims to cover approximately 41 crore children, has till now attained 81.1 per cent coverage, according to the National Family Health Survey-4 of 2015-16 — far lower than the WHO ask of, at least 95 per cent to achieve elimination and prevent future transmission of the virus.
In addition, the coverage is unevenly distributed with several large and populous states such as Madhya Pradesh, Assam and Rajasthan having MCV1 coverage that does not exceed 80 per cent.
Experts believe that the target of complete elimination, or when a country has reduced the number of cases of a disease to a low enough level to stop its spread through the population for at least three years, is achievable if certain roadblocks including proper surveillance and myths related to injections can be debunked with a far greater speed.
“Like Polio, measles can also be eliminated. The vaccine is good, the campaign’s intent is good and the goal can be achieved if challenges like parents’ hesitance or no-show of parents with their children to the vaccination centers can be overcome,” Dr Rakesh Tiwari, senior consultant, Paediatrics, Paras Hospital tells indianexpress.com.
Since lack of awareness and socio-cultural beliefs play a major role in the decision-making of families getting their children vaccinated, overcoming these social barriers by improving female literacy and addressing lack of awareness or motivation through “bridging the gap between parents and physicians” can help, says Dr Neha Joshi, consultant, Pediatrics, Sitaram Bhartia Institute of Science and Research.
In addition to enhancing the infrastructure for providing better immunisation services, efforts should also be made to address vulnerable households within urban settlements through community-based outreach programmes.
“Anganwadis, community health workers, booster drives in schools and increased information sharing can enable a faster rate of achieving the target,” Dr Joshi tells indianexpress.com.
“We have certainly made progress as compared to previous years. But what we immediately need is that surveillance needs to pick up speed along with timely intimation to the medical community to curb the spread of the disease in case a child is infected,” she adds.
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