NEW DELHI: Amid an increase in the number of measles cases, the Centre has asked states to consider administering one additional dose of Measles and Rubella vaccines to all children, aged 9 months to 5 years, in vulnerable areas.
The World Health Organisation (WHO) and the US Centers for Disease Control and Prevention (CDC), meanwhile said, measles immunisation has dropped significantly since the coronavirus pandemic began, resulting in a record high of nearly 40 million children missing a vaccine dose last year.
In India, increased numbers of measles cases were reported from certain districts of Bihar, Gujarat, Haryana, Jharkhand, Kerala and Maharashtra recently.
Areas under Brihanmumbai Municipal Corporation (BMC) and some other districts in Maharashtra have reported a rapid rise in infections and around 10 mortalities caused by the Measles virus.
A report said that Mumbai is struggling to control the outbreak of measles among children, as according to civic officials, eight deaths and 184 confirmed cases have been so far reported in the city.
Against this backdrop, the Union Health Ministry, in a letter to the Principal Health Secretary of Maharashtra that was also marked to all states and Union Territories (UTs), said this surge is of particular concern from the public health point of view.
"It is also clear that in all such geographies, the affected children were predominantly unvaccinated and the average coverage of Measles and Rubella Containing Vaccine (MRCV) among the eligible beneficiaries is also significantly below the national average," Health ministry Joint Secretary P Ashok Babu said.
In this context, he said a meeting of Domain Knowledge Technical Experts was held on Wednesday under the Chairpersonship of Member (Health), NITI Aayog to review the situation.
Based on inputs received from the meeting, the Centre said states/UTs are advised to consider administering one additional dose to all children of 9 months to 5 years in vulnerable areas, referring to the geographies which are showing a recent increase in numbers of Measles cases.
The special dose for Measles and Rubella for Universal Immunization Programme (UIP) reporting purposes is referred to as the one additional dose.
"This dose would be in addition to the primary vaccination schedule of first dose at 9-12 months and second dose at 16-24 months," he said.
The vulnerable areas are to be identified by the state government and UT administration in "Outbreak Response Immunization" (ORI) mode.
A dose of MRCV is to be administered to all children aged 6 months and up to less than 9 months in those areas where the Measles cases in the age group of less than 9 months are above 10 percent of the total Measles cases, he said.
"Since this dose of MRCV is being given to this cohort in "Outbreak Response Immunization" (ORI) mode, therefore, these children should also be covered by first and second dose of MRCV as per the primary (routine) Measles and Rubella vaccination schedule," he said.
As the disease is known to witness a surge in cases of numbers from November to March, annually, the health ministry said an active fever and rash surveillance mechanism needs to be strengthened for early case identification.
"Headcount survey of all children aged 6 months to 5 years must be undertaken in the vulnerable outbreak areas to facilitate full MRCV coverage in an accelerated manner.
The institutionalized mechanism of the District Task Force on Immunization under the chairmanship of the District Collector must be activated to review the Measles situation on a daily and weekly basis and plan the response activities accordingly," he said.
The disease is known to be fatal among children with moderate and severe malnourishment, he said, underlining that as part of the case identification and management, house-to-house search activities to identify such vulnerable children and provide pre-emptive care with nutritional and Vitamin A supplementation is also necessary.
"Correct and factual information about Measles symptoms and treatment must be disseminated among the public, in general for early identification and prompt management of measles cases," he said.
Any suspected cases with the development of fever and maculopapular rash must be reported and investigated, he added.
The health ministry said immediate isolation of laboratory-confirmed cases must be done for at least seven days from the date of identification.
"Guidance for home-based care of such cases must be issued with reference to age-appropriate two doses of vitamin A supplementation with adequate nutritional support," he said.
Caregivers must be made aware regarding the identification of danger signs for immediate hospitalisation of children with persistent diarrhoea, rapid breathing with chest indrawing (pneumonia), and ear discharge, he said.
The Centre also asked Maharashtra to earmark wards and beds for effective caseload management of measles in dedicated health facilities for timely transfer and treatment of such children.
The "Roadmap to Measles and Rubella Elimination by 2023" must be disseminated among District Collectors for necessary compliance and extensive community participation and participation of religious leaders must be ensured through appropriate IEC and mobilization activities to address vaccine hesitancy were other directions.
"It is requested to kindly direct the concerned officials to initiate prompt action on preparedness and Measles outbreak response activities.
Adequate availability of vaccines across all Blocks/Districts may be ensured for the vaccination campaign," the ministry said.
The Centre has also deployed high-level teams to Ranchi (Jharkhand), Ahmedabad (Gujarat) and Malappuram (Kerala) to assess and manage the increase in the number of measles cases among children there.
In an official statement, the health ministry said the teams will probe the rising trend of measles cases.
They will assist the state health authorities in investigating the outbreak and facilitate operationalization of requisite control and containment, it said.
A record 40 million kids miss measles vaccine dose
According to The Associated Press, the WHO and CDC said that measles immunisation has dropped significantly since the coronavirus pandemic began, resulting in a record high of nearly 40 million children missing a vaccine dose last year.
In a report issued Wednesday, the WHO and the CDC said millions of children were now susceptible to measles, among the world's most contagious diseases.
In 2021, officials said there were about 9 million measles infections and 128,000 deaths worldwide.
The WHO and CDC said continued drops in vaccination, weak disease surveillance and delayed response plans due to COVID-19, in addition to ongoing outbreaks in more than 20 countries, mean that "measles is an imminent threat in every region of the world."
Scientists estimate that at least 95% of a population needs to be immunised to protect against epidemics; the WHO and the CDC reported that only about 81% of children receive their first dose of measles vaccine while 71% get their second dose, marking the lowest global coverage rates of the first measles dose since 2008.
"The record number of children under-immunised and susceptible to measles shows the profound damage immunisation systems have sustained during the COVID-19 pandemic," CDC director Dr Rochelle Walensky said in a statement.
Measles is mostly spread through direct contact or in the air and causes symptoms including fever, muscle pain and a skin rash on the face and upper neck.
Most measles-related deaths are caused by complications including swelling of the brain and dehydration. The WHO says serious complications are most serious in children under five and adults over 30.
More than 95% of measles deaths occur in developing countries, mostly in Africa and Asia. There is no specific treatment for measles, but the two-dose vaccine against it is about 97% effective in preventing severe illness and death.
In July, the UN said 25 million children have missed out on routine immunisations against diseases including diphtheria, largely because the coronavirus disrupted routine health services or triggered vaccine misinformation.
(With inputs from Associated Press)