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November 25, 2023 12:45 am | Updated November 26, 2023 10:42 am IST
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A child receives a vaccine shot at a measles and rubella vaccination camp in Mumbai. File | Photo Credit: The Hindu
The story so far: A new report from the World Health Organization and the U.S. Centers for Disease Control and Prevention (CDC) said measles cases in 2022 have increased by 18%, and deaths by 43% globally, compared to 2021. This, the report states, takes the estimated number of measles cases to nine million and deaths to 1,36,000, mostly among children. The Union Health Ministry has refuted a part of the report which said that globally 22 million children did not get their first measles shot in 2022 and that half of them live in 10 countries including India, where an estimated 1.1 million infants did not get the first dose of the vaccine. India’s Universal Immunisation Programme is one of the largest public health programmes in the world targeting close to 2.67 crore newborns and 2.9 crore pregnant women annually.
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The Health Ministry maintains that just over 21,000 Indian children did not get the shot and said that the WHO data is based on an estimated number, reported under the WHO UNICEF Estimates National Immunization Coverage (WUENIC) 2022 report, which covers the time period from January 1, 2022 to December 31, 2022. A total of 2,63,63,270 children out of the eligible 2,63,84,580 children received their first dose of measles vaccine in FY 2022-23, according to the Health Ministry. It added that 21,310 children missed their first dose in 2022-23; and that initiatives have been undertaken by the Centre in coordination with the States to ensure that all children receive all missed/due doses of the measles vaccine.
Explained | India’s plan to eradicate measles, rubella
“The recent reports based on data released by WHO-CDC are not based on facts and don’t reflect the true picture,” the Ministry said. “The catch-up vaccination age for the administration of Measles Containing Vaccine (MCV) has been increased from 15months/2 years to 5 years. All unvaccinated/partially vaccinated children with missed/due doses of vaccines will be vaccinated,” said a Health Ministry official.
Measles outbreak: What it tells us about India’s vaccination coverage
Measles is a contagious disease caused by a virus, which spreads through the air when an infected person coughs or sneezes. Measles starts with a cough, runny nose, red eyes, and fever. Then a rash of tiny, red spots break out. It starts at the head and spreads to the rest of the body. According to the WHO, measles vaccination averted 56 million deaths between 2000 and 2021. “Even though a safe and cost-effective vaccine is available, in 2021, there were an estimated 1,28,000 measles deaths globally, mostly among unvaccinated or under vaccinated children under the age of five. Additionally in 2022, about 83% of the world’s children received one dose of measles vaccine by their first birthday through routine health services — the lowest since 2008,” it said.
Measles can be prevented with the MMR vaccine. The vaccine protects against three diseases — measles, mumps and rubella. Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective. “This viral disease affecting mainly children causes significant morbidity and mortality. In an unimmunised population, the disease can rapidly break into an epidemic,” cautioned Dr. Neeta Kejriwal, a paediatrician at Manipal Hospital, Dwarka. “Three doses are recommended at 9 months, 15 months and one dose through 4 to 6 years. Due to interruption of routine vaccination during and post-COVID pandemic, India did see several outbreaks of measles in different parts of the country. The stakeholders of children’s healthcare must take extra measures for routine and catch-up measles vaccination to contain the disease in India. Also vaccination campaigns are going on across the country in different States for catch-up vaccination to cover children from 9 months to 15 months for elimination of measles and rubella,” she explained.
The WHO notes that the pandemic has led to setbacks in surveillance and immunisation efforts across the globe leaving millions of children vulnerable to diseases like measles. “No country is exempt from measles, and areas with low immunisation encourage the virus to circulate, increasing the likelihood of outbreaks and putting all unvaccinated children at risk,” it notes. In India, as recently as late last year, Maharashtra and Kerala saw a spike in cases of measles. While Maharashtra recorded over 800 cases and over 10 deaths linked to the disease, Kerala’s Malappuram district reported 160 cases of measles. The spread caused enough alarm to prompt the Indian Academy of Paediatricians to step in and appeal for vaccination.
In 1998, after a now-discredited study was published, incorrectly linking autism to the measles-mumps-rubella (MMR) vaccine, in the U.K. — where the study originated — the rate of vaccination dropped to an all-time low of about 80% of all children by 2003 and 2004. In 2008, there were nearly 1,400 lab-confirmed cases of measles in England and Wales. According to data, in 2013–14, there were almost 10,000 cases in 30 European countries with most cases occurring in unvaccinated individuals and over 90% of cases occurred in Germany, Italy, the Netherlands, Romania, and the U.K.
In the U.S., a resurgence of measles occurred during 2019, which has been generally tied to parents choosing not to have their children vaccinated as most of the reported cases have occurred in people 19 years old or younger.
Medical literature explains that it is possible to get measles even if vaccinated, but it is unlikely. It notes that a teenager or adult who isn’t sure whether he or she has been vaccinated against measles, can take a blood test which can confirm if the person has immunity from a previous vaccine. If the test shows the person does not have immunity, doctors are likely to recommend two doses of the vaccine at least four weeks apart. Adults who don’t have immunity are advised to get at least one dose of the MMR vaccine.
Talking about adults being offered the vaccine, Dr Shuchin Bajaj, founder and director, Ujala Cygnus group of Hospitals, said adult vaccination may be needed in certain cases, especially if someone missed childhood vaccinations. It helps maintain immunity and prevent the spread of the virus, contributing to overall community protection. Experts add that adults may be given a dose of the MMR vaccine if there is no evidence that one has gained immunity either through vaccination or natural disease.
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