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Need for 2nd dose of measles vaccine

Nearly 65 per cent of the children in the country are unprotected or inadequately protected against measles, said Dr M A Phadke, Director, ARCON, Advisor MSACS, Government of Maharashtra and Adviser, UNICEF, in Chennai recently.

Measles, Mumps and Rubella are highly contagious childhood illnesses, which are important causes of significant morbidity and mortality, especially in the developing world. Measles is a leading cause of childhood deaths in the world and in India. It kills nearly 800,000 infants and young children annually, the majority being in developing countries. India is one of the countries, which significantly contributes to Measles cases in the world, she said. In India, about 500 chidlren die every day due to measles.

According to Health authorities, for effective control of measles, the vaccine coverage should be over 95 per cent year after year, in all municipalities. The vaccine coverage is below 50 per cent in many states.

Measles also causes flaring up of incidence of Tuberculosis. Mumps is an important childhood disease responsible for long absenteeism from school In India, it is estimated that mumps causes loss of 50 - 60 lakh school days. Rubella Intrauterine infection in the first trimester produces congenital anomalies like Cataract, Deafness, Heart defects and Mental retardation.

MMR VACCINE - INDIAN STUDY

A study was carried out to determine the status of Mumps vaccination and disease incidence in both the vaccinated and unvaccinated groups. A total of 3,832 parents and children participated in the study. The study revealed the following:

1. Only 53.7% of the children had received MMR vaccine. 2. The city-wise coverege of MMR was as follows: Mumbai -- 50.8%, Delhi-­52.4%, Vijayawada- 46.3%, Hyderabad-70.1 %, Kolkatta- 53% and Karnataka (Bangalore and Mangalore) -63.1 % 3. The incidence of mumps was only 7.7% in those babies who were vaccinated with MMR (giving 92.3 % protection) 4. The incidence of Mumps in the unimmunised group was 16.9%. 5. The mean age by which Mumps occurred was 5.7 years.

Thus it can be seen that even today the coverage of MMR vaccine leaves much to be desired. There is a definite need to include this vaccine in the National EFl program. Further, the study revealed that to ensure complete protection against mumps, a second dose of MMR vaccine could be given to protect the children who remain unprotected in spite of vaccination. The ideal age of vaccination for these children will be 5 years that is "age of school entry."

The WHO has recommended a two-dose strategy as the only reliable way to reduce measles deaths. For e.g., one measles vaccine at an early age usually at nine months and the second dose of MMR vaccine at a later date either at 12-15 months or later.

As per the recommendation of the lndian Academy of Paediatrics (IAP), the first dose should be given at 9 months and the second dose should be given as MMR vaccine at 12-15 months.

The measles vaccine has been included in the National Immunization Programme from the 1980s and this had led to a drop in the incidence of measles in India. According to leading health organisations like the WHO, vaccination coverage should be above 90 per cent for effective control of the disease, Dr Phadke pointed out. For eradication, the vaccination percentage should be at least 95 per cent every year. However, in recent times there has been a drop in the all-India measles coverage to 66.5 per cent from 88 per cent at one time, and it had gone below 50 per cent in states like Bihar and Rajasthan. The combined coverage for populous states like UP, Bihar, Rajasthan and MP is just 60 per cent. Moreover, there are reports of gross over-reporting of the vaccine coverage by certain states.

This poor coverage leads to formation of a large pool of susceptible children who are unprotected against measles. There have been many instances of measles outbreaks in India in the recent past leading to deaths of children and several complications.

Further, it has been observed that a single dose of measles vaccine is not enough for effective eradication of this disease. After measles vaccination, in about 10 to 15 per cent of the cases, the protection is inadequate due to various reasons like the presence of maternal antibodies, nutritional status of the child, immune system developmen of the child and so on. Therefore, in India 59 to 65 per cent of the children are unprotected or inadequately protected against measles, she added.

Ths situation was alarming, said Masud Ahmed, managing director of the Serum Institute of India Limited. In India, states like Delhi and Tamil Nadu had taken the lead and have already included the two-dose schedule of measles vaccine in the immunization programme. Serum Institute is the only manufacturer of the measles vaccine and the MMR vaccine in India.

It also exports its vaccines to over 135 countries, Ahmed added.

RR

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