[Dr D Padung]
The union health & family welfare ministry initiated the Measles-Rubella Vaccination Campaign (MRVC) early last year in a phased manner across the nation. The first phase of the campaign was launched in February 2017, and second phase has also been completed.
This is the largest ever vaccination campaign worldwide, and aims to cover approximately 41 crore children in the age group of nine months to less than 15 years. It is a much-needed step towards reducing child mortality.
The vaccine protects children from measles and rubella – two diseases with a high chance of preventable illness and death. The measles vaccine is already being administered under routine immunization, while rubella is a lesser known disease in India.
This poses two pertinent questions. First, the need for an additional vaccine combination when measles is already been given; and second, administering rubella to boys when the virus affects only the fetus.
Let us answer these questions here:
India’s routine immunization programme is one of the largest public health programmes in the country, targeting 30 million pregnant women and 26 million newborns every year. The aim of the vaccine programme is to ensure that the population at risk is being protected and the burden of disease is no longer a public health concern. India’s under-5 mortality, which was 100 deaths per 1,000 live births, has now come down to 43 per 1,000 live births, as has the infant mortality. This has been achieved through various public health programmes, including vaccines.
Eight vaccines – BCG, DPT, OPV, IPV, Measles, Hepatitis B, Tetanus and Hib – are being provided nationwide and four antigens – Measles-Rubella, Rotavirus, Pneumococcal vaccine and Japanese Encephalitis vaccines – are being administered in select states or districts.
An antigen is a toxin or a foreign substance given through vaccine, which induces an immune response in the body, particularly the antibodies which fight disease-causing pathogens such as bacteria, virus and other microorganisms.
India is the largest manufacturer of vaccines in the world, with a functional national regulatory authority. As many as nine million vaccination sessions are planned every year. But India still has a high burden of maternal, infant and child mortality.
Arunachal Pradesh has shown immense improvement in its child health indicators between 2005-06 and 2015-16. The infant mortality rate declined from 61 per 1,000 live births to 23 per 1,000 live births (NFHS 4) as did the under-5 mortality rate from 88 per 1,000 live births to 33 per 1,000 live births. This was partly possible due to immunization coverage. Measles vaccination, particularly, went up from 38.3% to 54.6% during this decade.
Of all the vaccine-preventable diseases, measles killed an estimated 49,200 infants in India in 2015, contributing nearly 36% of the global figure of approximately 1,34,200 deaths, even though a cost-effective vaccine providing protection against measles has been available for the past 40 years.
In 2010, measles accounted for 2% of infant mortalities in India, which has now come down, albeit marginally -suggesting that the vaccines are effective. There has been a 79% global decline in measles deaths from 2000 to 2015, broadly credited to the measles vaccine.
Measles is a highly contagious disease that spreads through coughing and sneezing. Children who do not have sufficient immunity contract the disease, if exposed. The disease reduces immunity, making the child vulnerable to other life-threatening diseases, such as pneumonia, diarrhoea, blindness, and infection of the brain.
Mortality due to measles may be less compared to other diseases, but it is a major risk factor for other infections and needs to be controlled. Hence, the burden of childhood blindness, diarrhoea and pneumonia can also be reduced by eliminating measles.
Rubella, on the other hand, is a mild viral infection that can have severe consequences for the fetus if infected during early pregnancy. It can result in miscarriage and stillbirth, and set out congenital anomalies in the fetus and newborns – referred to as Congenital Rubella Syndrome (CRS) – which is a growing public health concern.
CRS can cause multiple defects in the fetus, affecting particularly the eyes, ears, brain and heart, many of which defects can become lifelong disabilities, requiring treatment, surgeries and expensive care throughout life.
Vaccinating only girls to protect them from CRS may lead to a decrease in the number of cases, but the infection will still persist in the environment, posing a threat to the people at risk. Therefore, it is important that all children be vaccinated to wipe out the infection.
Arunachal Pradesh has also resolved to eliminate measles and control rubella and CRS by 2020 through the MRVC, which is being held from 1 February to March 2018. The campaign will rapidly build up herd immunity by reaching out to all target children, knocking out the susceptible cohort, and breaking the transmission chain, thereby reducing mortality and morbidity associated with measles and rubella. This drive is a step towards achieving this goal.
Approximately more than six crore children will be vaccinated in 13 states during the first two phases at various states of the country.
The state government is providing continuous support and guidance to achieve 100% coverage among children between 9 months and 15 years of age within a timeline of five weeks from 1 February, 2018. (The contributor is State Immunization Officer, Arunachal Pradesh)