The Telegraph
Monday , September 16 , 2013
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India sets measles elimination goal

- 11 nations pledge to eradicate disease by 2020 at WHO meet

New Delhi, Sept. 15: India has decided to join a south-east Asian regional initiative to eliminate measles by 2020, but health experts caution that the country will need to significantly improve immunisation and dramatically enhance case detection to achieve that goal.

India and 10 other countries meeting here for the World Health Organisation’s regional committee for the south-east Asian region committed on Friday to eliminate measles and control a milder infection called rubella, which threatens foetuses with congenital abnormalities, by 2020.

The WHO has estimated that over 70,700 children died of measles in the 11 countries of the south-east Asian region during 2011 where an estimated eight million children are not protected from the infection although the measles and rubella vaccines are safe, effective and inexpensive.

Indian health officials claim that the country lost about 40,000 children to measles during 2010. But public health experts have long cautioned that the country’s disease surveillance network and information flow from private doctors to the government is so weak that the actual figure is likely to be larger.

“But we believe elimination by 2020 can be done,” said Arun Thapa, coordinator for immunisation and vaccines development in the regional office of the WHO. “The south-east Asian region will most likely be certified polio-free in five months — measles elimination will be the new goal.”

The 11 countries have defined measles elimination as the absence of any measles transmission in a defined geographic area for at least 12 months in the presence of a well-performing surveillance system.

“We mean zero cases,” Thapa said. The regional committee meeting has also set a goal of reducing rubella — German measles — infections by 95 per cent from 2008 figures.

Health officials said India needs to improve routine immunisation coverage with the first dose of a measles vaccine from the current national average of 72 per cent to a uniform 95 per cent nationwide and expand coverage with a second dose.

“We need to further intensify routine immunisation, the second dose cannot ride on a weak routine immunisation programme,” said Anuradha Gupta, a senior official with the Union health ministry.

A senior public health specialist told The Telegraph that until now the focus of the measles control programme in the country had been reducing mortality.

“Elimination will require a set of different strategies — including very significant improvements in case-detection capabilities,” he said.

A senior health official said a vast network of 39,000 “reporting units” that India has established over the past decade for polio surveillance will now be used to track and analyse every case of measles.

The WHO has said improved immunisation in the south-east Asian region has led to a 48 per cent decrease in measles deaths between 2000 and 2011. While rubella is a milder infection, pregnant women who get rubella are at risk of having babies with congenital rubella syndrome.

“One option is to deliver the rubella vaccine with measles, the other is to immunise adolescent girls,” Gupta said, adding that the government’s National Technical Advisory Group on Immunisation is now examining how these options can be combined to reduce rubella incidence by 95 per cent by 2020.