Context: As the new year dawned, so did a crucial target for India. India had set a target to eliminatemeasles and rubella (MR) by 2023, having missed the earlier deadline of 2015 as well as the extended deadline of 2020, due to a variety of reasons, exacerbated by disruptions due to the COVID-19 pandemic.
MR elimination is defined as zero transmission of measles and rubella viruses, evidenced by zero clinical disease, sustained over three years.
About Measles and Rubella:
Measles: It is a highly contagious viral disease.
Despite the availability of a safe and effective vaccine, measles remains an important cause of death among young children globally.
It can also lead to serious adverse outcomes such as blindness, pneumonia and encephalitis.
Rubella: It is an acute, contagious viral infection.
While rubella virus infection usually causes a mild fever and rash in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, Fetal death, stillbirth, or infants with congenital malformations, known as congenital rubella syndrome (CRS).
Need for the elimination of Measles and Rubella:
Measles:
In the pre-vaccination era, while polio paralysed about 1% of all children before the age of five, measles actually killed 1% of all under-five children.
During measles outbreaks, the case-fatality rate was about 10%-15%.
Children who recovered would have lost weight as well as the steady momentum of cognitive development and scholastic performance.
Measles affects the immune system rendering the child vulnerable to other infectious diseases, leading to high mortality over the next two to three years.
Rubella:
The rubella virus is a slower transmitter and the risk of rubella is extended from childhood through adolescence into the reproductive age range.
Unfortunately, if a pregnant woman gets infected, the virus tends to cross the placenta and damage the developing foetus’s eyes, brain, heart and other tissues.
Therefore ,Measles-Rubella elimination is of very high priority.
The MR vaccine is a combined product, targeting two diseases in one shot.
Challenges associated with the elimination:
School managements, teachers, children themselves and parents were not informed of the basis of school-based campaigns of Measles-Rubella (MR) vaccination.
The set targets were not achieved due to gaps in immunisation.
The COVID-19 pandemic stole two years from the programme.
Government of India Initiatives to eliminate Measles and Rubella:
National Strategic Plan:
Measles and rubella (MR) elimination is a national health priority and the government has adopted the National Strategic Plan for Achieving and Sustaining Measles and Rubella Elimination in India .
Target:
The Government decided to eliminate measles and rubella from India by the year 2020 having missed the earlier set target of 2015 and the MR elimination target was reset to 2023.
Campaigns:
The school-based campaigns of Measles-Rubella (MR) vaccination of children from 5 to 15 years, conducted in all States, in 2017.
Success was good in a few States, but not in others.
The country is moving towards the MR elimination goal of achieving and sustaining vaccination coverage of 95% with two doses of a measles- and rubella-containing vaccine at the national and subnational levels.
Universal Immunisation Programme (UIP):
India’s Universal Immunisation Programme (UIP) provides free vaccines against 12 life threatening diseases.
It provides life-saving vaccines to all children across the country free of cost to protect them against Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, Hepatitis B, Pneumonia and Meningitis due to Haemophilus Influenzae type b (Hib), Measles, Rubella, Japanese Encephalitis (JE) and Rotavirus diarrhoea. (Rubella, JE and Rotavirus vaccine in select states and districts)
Other steps:
The country is also prioritising continued implementation of key strategies for strengthening surveillance, including the sensitisation of front-line workers, increasing active case searches, expansion of the reporting network, rapid response to outbreaks, and establishing synergistic linkages between MR elimination and other public health priorities, such as health systems strengthening and emergency preparedness and response.
WHO Country Office for India is supporting the Government of India and state governments towards reaching key elimination targets.
Way Forward:
It is the high time to further strengthen routine immunisation through intensified efforts to close immunity gaps through Intensified Mission Indradhanush, with a special focus on the first and second dose of measles- and rubella-containing vaccines.
We can reach MR elimination goals in India if we strengthen surveillance by finding, investigating, and collecting and testing a sample for every suspected case, in each district in every state and UT.
It is important to provide full support to the ground level staff who implement the programme — the village health nurses, ASHA (accredited social health activists) workers, Anganwadis and ICDS (Integrated Child Development Services) workers.
While targets will be easier to achieve in States such as Tamil Nadu and Kerala, thanks to the robust immunisation infrastructure, in the other States, additional efforts should be taken to work towards achieving the target.
