India’s target to eliminate measles and rubella by December 2023 appears to be a long shot, as the country reported 9,489 cases between April and September this year, ahead of Somalia (8,435) and Yemen (6,478). Affected states like Maharashtra are now on an overdrive to vaccinate children with additional shots, extend vaccination to the young, and also focus on boosting nutrition levels among them.

Experts point out that the outbreaks are precipitated by missing routine immunisation. Outbreaks have been reported in several states including Maharashtra, Kerala, Bihar, Jharkhand, Gujarat and Haryana.

Maharashtra is the worst hit, reporting 717 cases this year.

As many as 303 cases have been reported in Mumbai alone.

As of November 28, the city has reported 10 deaths due to measles. Anish T S, associate professor of community medicine at Government Medical College, Manjeri, Kerala, says that Maharashtra has a good surveillance and reporting system.

“More cases are thus being reported from Mumbai.

I suspect there are more outbreaks happening throughout the country,” Anish says, who is working in Malappuram, one of the worst-hit districts in Kerala. He says that while a dip in routine immunisation is to blame, there is also a lot of vaccine hesitancy among some communities.

“Let’s say, if the percentage of active vaccination seekers is around 50 per cent in South Kerala, it would be as low as 25 per cent in North Kerala.

Last week, in our meeting with local health workers, they reported that migrants in North Kerala who come from Bihar and Bengal have better vaccination coverage than the locals,” Anish explains. Malappuram has reported 184 cases so far.

“We touched a vaccination rate of around 94-95 per cent about three years ago.

During Covid-19, this dipped to 87 percent.

Whenever it is less than 95 per cent, incidence of diseases that can be prevented by vaccines is high,” says Renuka R, district medical officer of Malappuram. The Union health ministry had rushed teams to Kerala and Maharashtra.

It has recommended that one additional dose be administered to children aged between 9 months and 5 years in vulnerable areas.

It has also advised that children as young as 6 months old be given a dose in areas where more than 10 per cent measles cases were reported in children aged below 9 months.Maharashtra was quick to act on this directive.

Within 24 hours of getting a final nod from the state government, the Brihanmumbai Municipal Corporation (BMC) readied a list of 138,000 children in Mumbai who would get an additional dose because they live in hotspots (mainly slums), and another 3,496 children aged between 6 and 9 months would be given the measles shot. BMC Executive Health Officer Mangala Gomare says the drive will begin this week. Meanwhile, Kerala is yet to decide whether it would opt for administering an additional shot. “From whatever we have noticed, the measles virus is targeting non-immunised children.

We are creating more awareness and running immunisation campaigns in targeted areas.

Since the nutritional status is better than in other places, we are not reporting any deaths.

Our aim is to prevent deaths and hence two doses of vitamin A is being given to any children having fever with rashes,” Renuka says. A 2014 study in Thane district neighbouring Mumbai had shown that nearly 33 per cent of patients contracted measles despite being vaccinated.

The researcher, Sudhir Sane from Jupiter Hospital in Thane, had done an epidemiological study of a measles outbreak in the area.

The study also showed that nearly 20 per cent of the patients got infected before reaching the age required for vaccination. A government source admits that special attention needs to be given to malnourished children.

Maharashtra has had vaccination coverage of around 60 per cent for measles and rubella this year, lower than last year’s 78 per cent.

“If our target is 100 children, we are still missing 20 children,” the source adds. Anish says that the target for vaccination coverage is 90 per cent to ensure herd immunity and even protect unvaccinated children to an extent.

He adds that since people stayed indoors during the pandemic, the instances of such a disease were less even in areas where it was endemic. Outbreaks of infectious diseases are likely to happen globally now, he feels.

And measles may not be India’s worry alone.

Its vaccination coverage has steadily declined since the beginning of Covid-19.

In 2021, a record high of nearly 40 million children missed a vaccine dose: 25 million children missed their first dose and an additional 14.7 million missed their second dose, a joint publication by the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention said. In 2021, an estimated 9 million cases and 128,000 deaths from measles were reported worldwide; 22 countries experienced large and disruptive outbreaks.

In 2021, nearly 61 million vaccine doses were postponed or missed due to Covid-related delays in immunisation campaigns in 18 countries. Deepa Easow, senior consultant, paediatrics and neonatology, at MGM Healthcare in Chennai stresses that vaccination is the only way to prevent measles infection.

“The reason for this outbreak is a lapse in vaccination due to Covid.

A lot of children have either missed the first or second dose.

WHO said that over 40 million children missed vaccination due to Covid,” she adds. According to Easow, measles patients tend to get infected four days before rashes appear.

“Its symptoms are like any other flu.

Viruses are very difficult to eradicate and stay in place for a very long time, even after the infected person moves out.

Anybody having symptoms should be isolated.

If a person gets exposed and is unvaccinated, he or she can be vaccinated within 72 hours.

Measles tends to affect people who have low immunity,” she says.

“There is no particular drug for it.

We give patients a dose of vitamin A to avoid complications.

Other than that treatment is only symptomatic.”