Children at risk: In 2017, 2.9 million children in India under one year of age were not vaccinated.   | Photo Credit: M_PERIASAMY

In 2018, measles caused an estimated 10 million cases and 1,42,000 deaths globally, according to a report published on December 6. The estimated cases and deaths are much more than what countries have reported to the World Health Organization and UNICEF. The number of measles cases reported in 2018 was only 3,53,000.

Measles can be prevented through two doses of vaccination. But the number of children who are not vaccinated against measles is alarmingly high in six countries. At 2.3 million, India has the second highest number of children who are not vaccinated against measles, the report published in Morbidity and Mortality Weekly Report (MMWR) says. With 2.4 million, Nigeria has the most number of unvaccinated children. The other four countries with the most number of unvaccinated children are Pakistan (1.4 million), Ethiopia (1.3 million), Indonesia (1.2 million) and the Philippines (0.7 million).

In 2017, 2.9 million children in India under one year of age had not been vaccinated with the first dose, according to UNICEF. In one year, the number of unvaccinated children in India had reduced from 2.9 million to 2.3 million. The corresponding reduction in the case of Nigeria has been much more — from nearly 4 million unvaccinated children in 2017 to 2.4 million in 2018.

There were nearly 70,000 cases of measles in India in 2018, the third highest in the world. In 2019, over 29,000 confirmed cases have been reported to the WHO.

The WHO recommends 95% coverage using two doses of measles vaccine to prevent outbreaks. Though vaccine coverage with first and second dose has increased globally since 2000, it has not reached anywhere near 95%. In 2018, only 86% of children globally received the first dose through routine immunisation. In the case of second dose, the coverage globally is just 69%.

In India, the first dose of measles vaccine is given at nine-12 months of age and the second dose is given at 16-24 months of age through the national immunisation programme. But it appears that millions of children in India do not receive measles vaccine through routine immunisation activities.

According to the MMWR report, in 2018, 19.2 million children globally worldwide did not receive the first dose through routine immunisation services. Nearly 163 million children in India received the measles vaccination during mass immunisation campaigns. India accounted for 47% of the 346 million children across the world who received measles vaccine during mass-immunisation campaigns.

Mass immunisation campaigns are an effective strategy for delivering vaccination to children who have otherwise been missed by routine services. But it does reflect how many children get missed by the routine immunisation programme.

The first dose of measles vaccine was introduced as part of the national immunisation programme in the 1990s. Based on the WHO’s recommendation to administer a second dose to prevent infection and death in 90-95% of vaccinated children, India introduced the second dose from 2010 onwards. India was one of the last countries to add a second dose of measles vaccine as recommended by the WHO.

The first mass immunisation campaigns for the second dose of measles vaccine were launched in 2010 in 14 States where the coverage for the first dose was below 80%. The campaign targeted children aged nine months to 10 years of age.

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Currently, children in India are vaccinated only at 9-12 months, leaving them open to infection

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