Eliminating measles, controlling rubella

The MR vaccination campaign is going to be the largest one in the world and will target 41 crore kids.

In 2014, Prime Minister Narendra Modi announced four new vaccines under Universal Immunisation Programme (UIP), of which three vaccines — Inactivated Polio Vaccine (IPV), Adult Japanese Encephalitis (JE) and Rotavirus — have already been introduced in the programme in 2015. The rubella vaccine is now being introduced in the country as measles-rubella (MR) vaccine.

Though health is a state subject and the state governments are responsible for delivering healthcare, the Central government provides significant technical and funding support under its flagship programme of National Health Mission (NHM).

Reducing maternal and child mortality are the foremost goals of NHM and it has significantly fostered plans for child health in decentralised manner up to the district level. Steady progress in curbing child deaths has been achieved, as made evident from the fact that the country’s under-5 mortality rate has declined from 126 per 1,000 live births in 1990 to 45 per 1,000 live births in 2014.

Of all the methods of preventing the under-5 mortality, immunisation is one of the most cost-effective public health interventions for protecting children from preventable life threatening conditions. During the past decade, UIP has been successful in reducing the mortality and morbidity due to vaccine preventable diseases, and has contributed to the rapid decline in under-5 mortality rate. India has achieved a remarkable success in immunisation coverage with an increase in full immunisation coverage from 35.5% in 1992-93 to 65% in 2013 as per the latest national survey.

During the 66th meeting of the South-East Asia Regional Committee in September 2013, all 11 member-states, including India, resolved to eliminate measles and control rubella/ Congenital rubella Syndrome (CRS) in the South-East Asia Region by 2020. India is fully committed to this goal and, therefore, is launching MR vaccine in the country.

Measles is a deadly disease and is one of the major causes of death in children. Globally, in 2015, measles killed an estimated 1,34,200 children - mostly under-5 years of age and an estimated 49,200 deaths occurred due to measles in India.

Measles starts as fever, cough, runny nose, conjunctivitis, and a red, pinpoint rash that starts on the face and spreads to the rest of the body. If the virus infects the lungs, it can cause pneumonia. Measles in older children can lead to inflammation of the brain, called encephalitis, which can cause seizures and brain damage.

Most measles-related deaths are caused by the complications associated with the disease. Rubella, also known as German Measles, causes a mild rash on the face, swelling of glands behind the ears, and in some cases, swelling of the small joints and low-grade fever. Most children recover quickly with no lasting effects.

But rubella infection during the first trimester of pregnancy can be devastating, leading to miscarriage, stillbirth or foetal death or set of birth defects known as Congenital Rub­ella Syndrome (CRS), causing blindness, deafness, heart defec­ts or mental retardation. Global­ly, more than 1,00,000 children are born with CRS each year. The lifelong complications and disabilities can have immeasurable emotional, social and financial cost for the families.

Remarkable achievement

In 2010, India introduced second dose of measles in the country. Fourteen states with measles vaccine coverage of less than equal to 80% introduced it through Measles Supplementary Immunisation Activity (SIA 2010-13).

As per WHO records, introduction of measles second dose led to nearly 50% reduction in measles cases and deaths in the country from 2011 to 2013. It was a remarkable achievement for the country. However, to achieve the aim of measles elimination, the country needs to achieve 95% vaccine coverage.

At present, population immunity within the country is insufficient to stop ongoing measles and rubella (MR) transmission as is evident from the surveillance data. The campaign impact on population immunity has waned over a period of years. The data also shows that majority of disease occurs in children up to 15 years of age. Keeping in mind the given factors, and in the direction of the regional goal, the Government of India is launching MR vaccination campaign which will target children of 9 months to below 15 years of age.

During the MR campaign, all the target age group children will be vaccinated irrespective of their previous MR vaccination status or MR infection. It has been seen that vaccinated children were also getting the disease, therefore, the additional dose during the campaign implies additional protection to the children. This campaign is going to be the largest one in the world and will target nearly 41 crore children across the country. Initiated in February 2017 from five states and Union Territories including Karnataka, it targets nearly 3.6 crore children.

India has achieved significant success in many areas of immunisation programme in terms of reaching high coverage via Mission Indradhanush, introduction of new vaccines, achieving maternal and neonatal tetanus elimination status and eradication of polio. Now, with launch of MR vaccination campaign, India is ready to eliminate measles and control rubella and CRS.

(The writer is Deputy Commissioner (Immunisation), Ministry of Health and Family Welfare, Government of India)