Buoyed by the successful elimination of polio six years ago and maternal and neonatal tetanus and yaws in 2016, India has set an ambitious target of eliminating measles and controlling congenital rubella syndrome (CRS), caused by the rubella virus, by 2020.
While two doses of measles vaccine given at 9-12 months and 16-24 months have already been part of the national immunisation programme, it is the first time that the rubella vaccine has been included in the programme. Since the rubella vaccine will piggy-back on the measles elimination programme, there will be very little additional cost.
According to the World Health Organisation (WHO), “a single dose of rubella vaccine gives more than 95% long-lasting immunity.” All children aged nine months and 15 years will be administered a single dose of the combination vaccine.
Measles is highly infectious and is one of the major childhood killer diseases. Of the 1,34,000 measles deaths globally in 2015, an estimated 47,000 occurred in India. The introduction of the second dose of the measles vaccine and an increase in vaccine coverage have led to a sharp decline in deaths in India — from an estimated 1,00,000 deaths in 2010 to 47,000 in 2015.
Unlike measles, rubella is a mild viral infection that mainly occurs in children. But a woman infected with the rubella virus during the early stage of pregnancy has a 90% chance of transmitting it to the foetus. The virus can cause hearing impairments, eye and heart defects and brain damage in newborns, and even spontaneous abortion and foetal deaths. Of the 1,10,000 children born with CRS every year globally, an estimated 40,000 cases occur in India alone.
Why opt for a campaign?
With the target set for 2020 to eliminate measles and control CRS, there is a compelling need to create a solid wall of immunity in all children up to 15 years in one go at the earliest. That can be achieved only if immunisation is carried out in a campaign mode by targeting 410 million children nationwide within 18 months.
About 465 million doses will be required. Since the Pune-based Serum Institute of India is the only manufacturer of the vaccine, the measles-rubella vaccination campaign is being introduced in phases. Karnataka, Tamil Nadu, Puducherry, Goa and Lakshadweep are covered in the first phase.
The entire country will be covered in four phases in 18 months. Following the campaign, two doses of the combination vaccine will become a part of the national immunisation programme. All children will receive the vaccine free at 9-12 months and 16-24 months of age.
Is it possible to achieve the goal by 2020?
According to Dr. Jacob John, co-chairman of the India Expert Advisory Group for measles and rubella, it is eminently doable. Though the goal is only to eliminate measles and control rubella by 2020, both viruses can be eliminated if their transmission can be broken. For that to happen, the vaccine coverage has to be over 95% during the campaign and in the immunisation programme that follows it. Now the measles vaccine coverage for the first dose is about 87% and about 70% for the second dose. Under the routine immunisation programme, the reach of the first dose of the measles vaccine shot up from 56% in 2000 to 87% in 2015.
Besides increasing the ccoverage, India has to ramp up surveillance of both diseases, maintain outbreak preparedness, respond rapidly to outbreaks by vaccinating all children in a community and ensure effective and timely treatment of cases anywhere in the country. According to the WHO, elimination of measles will help to achieve Sustainable Development Goal’s target 3.2, which aims to end preventable deaths of children under 5 years by 2030.