Sunday, July 14, 2019

Sri Lanka is measles-free: Will India achieve its target of eliminating measles by 2020?

Last week, Sri Lanka was declared free of measles by the World Health Organization (WHO). The country reported its last case of measles caused by an indigenous virus in May 2016. Sporadic cases, reported in the last three years have all been importations that were quickly detected, investigated and rapidly responded to, said the WHO.

Measles is a notifiable disease in Sri Lanka, which has a strong surveillance system in place and all vaccine-preventable diseases are an integral part of the communicable disease surveillance system. 

In contrast, there has been a resurgence of measles in the United States. This year 1,109 individual cases of measles have been confirmed in the US from January 1 to July 3, as per CDC. This is the greatest number of cases reported in the US since 1992 and since measles was declared eliminated in 2000. Two factors have been identified as contributing to the outbreaks of measles; firstly, measles is being imported into the US via travelers with measles who bring the disease from other countries such as Israel, Ukraine, and the Philippines, where large measles outbreaks (defined as 3 or more cases) are occurring and secondly, the low vaccination rates because of vaccine refusal facilitates spread in unvaccinated people.

Europe too has witnessed a resurgence of measles, with Ukraine experiencing the worst outbreak in the region, totaling more than 25,000 cases recorded in the first two months of 2019.

Measles is a highly infectious disease that is potentially fatal. It spreads via airborne transmission through sneezing or coughing. 

Measles is still common in many parts of the world including in India.

India has set itself a target of eliminating measles from the country by 2020. Towards this end, the Health Ministry launched a single “Measles-Rubella vaccine” for dual protection against the two diseases as part of Universal Immunization Program (UIP) in 2017. A total of 13.04 crore children have been vaccinated till 29th October 2018. Following the campaign, Measles-Rubella vaccine will be introduced in routine immunization, replacing the currently given two doses of measles vaccine, at 9-12 months and 16-24 months of age. 

What India can do?

India accounts for one-third of all measles-related deaths worldwide. To achieve its target of eliminating measles from India, the first step should be to strengthen the surveillance system.

At least 95% of population must have immunity to spread of measles i.e. not less than 95% of the population must be vaccinated against measles to ensure community protection for everyone “herd immunity”. This happens when unvaccinated people are protected because so many of those around them are. About 15% of vaccinated children fail to develop immunity from the first dose, meaning that if only 80% are fully immunized, an outbreak is likely.

This calls for intensification of efforts to ensure maximum coverage of the population with the MR vaccine.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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