Roughly 2.5 million infants who were supposed to be vaccinated for their first doses of the measles immunisation did not receive the shots last year, a number that explains why the country is recording a surge in the viral disease that is highly contagious and at times leads to fatalities.
According to an estimate by the World Health Organization and the US Centers for Disease Control released late on Wednesday, India accounts for the second highest numbers of missed doses in 2021, with Nigeria recording the most at 3.1 million doses.
In recent weeks, at least four states have reported a sharp surge in measles infections and deaths. In Mumbai, there have been at least 13 fatalities, and 3,695 suspected infections, out of which 252 are confirmed cases. Kerala’s Malappuram district has reported 125 cases. The Union government has rushed teams to four states, including Maharashtra, Kerala, Jharkhand and Gujarat.
“There is no doubt that these outbreaks that we are seeing is fallout of the drop in routine immunization due to the pandemic as our energies were diverted towards immunising people against Covid-19.” said Dr NK Mehra, senior immunologist and former head, transplants immunology and immunogenetics department, All India Institute of Medical Sciences (AIIMS).
“Whenever there is a pool of susceptible population group, the infection will spread. And measles happens to be a highly contagious viral infection. That aside, there could be other factors also at play that we do not know of yet,” Dr Mehra added.
Measles has a basic reproduction number, or R-nought (R0), of 12 to 18 by most estimates, which means one infected person can pass it on to 12 to 18 others, and each of those to a similar number further.
Even in healthy children, measles can cause serious illness and can even require hospitalisation. But it can be particularly dangerous for children who are unvaccinated and malnourished. Nearly 1 to 3 of every 1000 children who become infected will die from respiratory or neurological complications.
The government has now decided to accelerate vaccinations for all children between the age of nine months and five years, following a review meeting on the situation on November 23.
“Since all the children who succumbed to the disease were either unvaccinated or partially vaccinated, it was decided to take up vaccination on a mission mode to fast enhance the coverage. States have been asked to conduct special drives to ensure the coverage is improved, which would effectively increase the protection,” said an expert from the committee, requesting anonymity.
In hard-hit Kerala district of Malappuram and nearby areas, officials said on Thursday that out of the 125 infected children in the age group of five to 17, only six were vaccinated.
Increasing immunization coverage is more important for India, as the government has set December 2023 as target for measles elimination.
According to WHO data, 84% of the children eligible for these shots were covered in 2019, before the Covid-19 pandemic struck. In 2020, a year when there were large numbers of lockdowns and pre-schools – where immunization drives are often held – were closed, the proportion plummeted to 81%. In 2021, the percentage recovered slightly to 82%, but was still lower than the pre-pandemic coverage levels.
The WHO said ideally, 95% coverage should be done.
“The paradox of the pandemic is that while vaccines against COVID-19 were developed in record time and deployed in the largest vaccination campaign in history, routine immunization programmes were badly disrupted, and millions of kids missed out on life-saving vaccinations against deadly diseases like measles,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus in a statement. “Getting immunization programmes back on track is absolutely critical. Behind every statistic in this report is a child at risk of a preventable disease.”
“Covid did have an impact for sure as children did not come to hospitals or clinics for their due shots. But now that the situation has improved people must take the all the vaccines that are due as per the national schedule as not taking vaccines could have serious consequences,” said Dr Anupam Sibal, senior paediatrician and group medical director, Apollo Hospitals.
“What we are seeing with measles tells us the importance of protecting against vaccine preventable diseases. And most of the vaccines that are administered under the government schedule will be relevant even if there has been a delay, which is why people should let the paediatrician take a call,” he added.