Vaccination gaps, drop in mask use, no social distancing: Why India is seeing measles outbreaks
Health

Vaccination gaps, drop in mask use, no social distancing: Why India is seeing measles outbreaks

WHO and US CDC estimate that about 40 million children across the world may have missed out on measles vaccine because of the restrictions imposed during the Covid pandemic.

   
Representational image of a health worker giving vaccine to children

Representational image of a health worker giving vaccine to children | Photo: Commons

New Delhi: The sporadic outbreaks of measles cases across the country may be linked to drop in usage of masks as well as disappearance of social distancing norms, apart from that fact that some children in India missed their measles vaccine due to disruptions caused by the Covid pandemic, an initial analysis by health officials has suggested.

Measles, an airborne infection like Covid, is one of the most contagious human viruses. It has an estimated R0 (an index that measures the average number of people an infected individual is likely to spread the disease to) of 12-18. Cases of localised measles outbreaks have been seen in many parts of Maharashtra, Jharkhand, Kerala and Gujarat over the last few weeks. In some pockets such as Malegaon in Maharashtra and Malappuram in Kerala – where the disease seems to be making a comeback in very young children – officials say, there were also instances of vaccine refusal from families of kids, who eventually succumbed to the disease.

In a statement, issued Thursday, the World Health Organisation said that nearly 40 million children across the world have been left susceptible to measles – which is a part of childhood immunisation in most countries – because of gaps in vaccination during the Covid pandemic.

“In 2021, a record high of nearly 40 million children missed a measles vaccine dose: 25 million children missed their first dose and an additional 14.7 million children missed their second dose, a joint publication by the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC) reports,” said the statement.

Government estimates suggest that India’s immunisation coverage was set back by about 5% over the “two phases of disruption” in the last two years.

“The first was during the lockdown in 2020 and then again around April-May 2021 when the second wave was at its peak. But an interesting trend is that the outbreaks are happening now, often in very young children.

“About measles, because of its infectiousness, it is always said in public health that before the system finds children who missed vaccinations, the disease will find them. But till now the masking and social distancing norms had provided some protection. Now that all of that is gone, we are seeing the results,” said a senior health official associated with routine immunisation.


Also read: Measles now an imminent global threat as Covid affected vaccination coverage, say WHO, US CDC


Masks help prevent respiratory diseases

It is well-documented that while the masking norms were put in place for Covid, they helped reduce the number of other diseases, especially those that spread through the respiratory route. According to the World Health Organisation, measles “is normally passed through direct contact and through the air. The virus infects the respiratory tract, then spreads throughout the body”.

Over the last two years, many publications have reported the collateral advantages of masking on other diseases.

In 2021, seasonal influenza cases in India were very low, thanks to the practice of people keeping their nose and mouth covered, according to doctors.

In a 2021 article in the journal Frontiers in Public Health, Chinese researchers wrote: “Public health measures were very effective in reducing the incidence of respiratory infectious diseases, especially when the respiratory infectious diseases would normally have been at their peak.”

Change in vaccination norms

The incidence of measles in very young children has, meanwhile, triggered a temporary change in India’s vaccination policy. According to existing norms under the Universal Immunisation Programme, a child gets its first dose of measles vaccine at nine months.

“Before that it is believed that the child is protected by the mother’s antibodies and the effect of vaccination is not as pronounced,” explained a senior health ministry official.

However, the fact that some of the cases reported have been in children as young as six months, caused the Centre to step up measures. It wrote to states asking for the administration of an additional dose of the measles vaccine in children aged 6-9 months, in areas where infections in that age group are more than 10% of the total identified cases.

Children between the age group of 9 months-5 years should also get one additional dose of the vaccine, joint secretary P Ashok Babu wrote to states on 23 November.

“The additional dose will give protection. We are not compromising anything by giving it early (reference to concerns about the mother’s antibodies reducing vaccine efficacy) because the doses from nine months onwards will be given as scheduled and one additional dose also will be given,” the official said.

Central teams have also been sent to Jharkhand, Gujarat and Kerala to help investigate measles outbreaks.


Also read: BMC appeals for vaccination amid hike in Measles cases in Mumbai