Measles: two-dose regimen a must

Published in The Hindu on November 5, 2009

India has failed in controlling measles, an infection that afflicts children. According to mathematical modelling, nearly 1,30,000 deaths happen every year. This has been the main conclusion of a three-day consultation held recently and submitted to the government.

Though the government has projected only 35,000 to 60,000 suspected measles infections for the last decade, the WHO’s mathematical modelling, based on more data from the six States of Tamil Nadu, Kerala, Karnataka, Andhra Pradesh, Gujarat and West Bengal, has come out with a more realistic estimate.

The National Polio Surveillance Project has been used for gathering measles related information in these six States.

Primary reasons

The primary reasons for the high incidence is inadequate immunisation and poor surveillance. Except in the six States, where the immunisation coverage is above 80 per cent, all the other States have poor coverage.

Added to this is the fact that the vaccine’s effectiveness in preventing infection is only about 85 per cent. “So 15 per cent of children will still be susceptible even when all the children are immunised with a single dose,” said Dr. Manish Kakkar, Public Health Specialist (Infectious diseases) at the Delhi based Public Health Foundation of India (PHFI). The Public Health Foundation organised the consultation.

Way out

The only way to bring the infection under control and finally eliminate it is by going for a second dose of the vaccine. The single dose of the vaccine is currently given to children when they are 9-12 months old.

“It is well proven that it is possible to bring down mortality if you sustain the second strategy,” said Dr. Kakkar. In fact, the two-dose regimen was recommended by the WHO about three years ago.

According to Dr. Kakkar, African countries have been able to bring down mortality by 75 per cent by adopting the two-dose regimen. These countries may eliminate it if there is over 90 per cent coverage. In fact, Latin America has been able to eliminate it some 4-5 years ago.

According to Dr. Parthasarathi Ganguly, Clinical Epidemiologist at the Indian Institute of Public Health, Gandhinagar, the second dose can be given as part of the regular immunisation schedule when children are 18-24 months old and time to get the DPT booster dose.

The good news is that the two-dose regimen will soon become a reality in some of the States.

“The government has approved the two-dose regimen on principle in States where routine measles immunisation is above 80 per cent,” Dr. Ganguly said. “The second dose will be through routine immunisation programme. It will be undertaken in 18 States.”

But in those States where the routine immunisation coverage is only 40-50 per cent, the recourse will be to adopt a campaign mode as in the case of polio immunisation.

Campaign mode

“If the coverage is only 50 per cent, then even the second dose will not help,” said Dr. Kakkar. “So a campaign mode is necessary.”

One of the reasons for the poor measles coverage is ignorance and misconceptions about the infection. Though rashes subside, the infection can cause other complications such as pneumonia and diarrhoea that could be life threatening. “People are unable to relate such deaths to measles,” said Ganguly. “That is the reason why the community does not perceive measles as a life threatening disease.”

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