Measles outbreak in Mumbai: alarm bells ring before 2023 target of elimination

Vaccination of a child during a campaign led by the World Health Organization (WHO). (Photo by nik wheeler/Sygma via Getty Images)

An outbreak of measles, a highly contagious viral disease, in Mumbai — a year before the December 2023 target of eliminating the disease from the country — has sent alarm bells ringing across the health administration order.

In Mumbai’s Govandi locality, civic authorities have confirmed that three kids, aged 1-5 years, have died due to measles, which is characterized by high fever and red rashes, while some other suspected cases too have been identified.

As per the available information, the deceased children were either unvaccinated or only partially vaccinated even though MR (Measles Rubella) vaccine against it is offered free of cost as part of the government’s universal immunisation programme and is also privately available.

The detection of cases in the area prompted the Centre to rush a three-member team of specialists to the city on November 9.

The state has also sent collected samples from some suspected cases to the National Institute of Virology in Pune to assess whether there is a new strain of the pathogen triggering the outbreak.

Specialists based in Mumbai, too, stressed the need for stepped-up disease surveillance.

“It may be too early to comment if we are dealing with a new strain but close vigilance is needed,” insisted infectious disease expert Dr Umang Agrawal, who is associated with P D Hinduja Hospital.

National plan

The incidence of the disease, which can kill up to 5-10 percent of the infected children during an outbreak, comes just months after the Centre adopted a National Strategic Plan in May to eliminate measles by the end of next year.

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The government, as part of the World Health Organization (WHO) South-East Asia Region (SEAR) adopted the goal of measles elimination and rubella and congenital rubella syndrome control† by 2020 but revised it for 2023 in 2019.

As part of the plan adopted this year, a task force under the chairmanship of district magistrates has been set up in every district, which has been asked to come up with a local plan to reach 95 percent plus coverage of MR vaccination of the eligible kids.

Disease and vaccine

Measles is a highly infectious disease caused by the measles virus and lasts 7-10 days post-infection during which infected kids can develop diarrhoea, ear infection and pneumonia, apart from fever and rashes.

Dr Jacob John, a senior virologist who is co-chairman of the National Technical Advisory Group on measles, pointed out that vaccines against the disease are highly effective and no kid, who receives two doses of MR vaccine, offered at 9-12 months and 16-24 months, is likely to get the disease.

Also once infected, those under 1 year of age have a higher chance of mortality as compared to kids who are at least 3-4 years of age or older.

Dr Trupti Gilada, an infectious disease expert from Masina hospital in Mumbai, pointed out that slippage in routine immunisation coverage mainly due to the Covid-19 pandemic may have led to a situation like the present one.

“The Covid-19 vaccination programme occupied the government’s immunisation division during the pandemic as a result of which the routine vaccination programme may have been badly hit by up to 20 percent of kids missing their routine doses,” she said.

The lack of immunisation coverage, Gilada said, has made a large number of kids susceptible to vaccine-preventable diseases such as measles.

Measles vaccine coverage in India

There is no recent data available in the public domain on what percentage of kids aged under 2 years of age received the vaccine over the last few years but a paper published last year said that as of 2014, about 90 percent of the eligible kids received the first dose of MR vaccine while it was just 66 percent for the second dose.

“Measles cannot be eliminated unless at least 95 percent of the kids are immunised against it in every village, every district and every community,” said John.

Huge concerns

John calls measles mini AIDS (Acquired Immunodeficiency Syndrome) for the effect it has on immunity systems in kids.

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“It wreaks havoc on a child’s immunity system-especially if they are under 1 year of age,” he said.

He pointed out that only those who die within three months of infection are counted as measles death while the fatality due to any other infection caught because of measles-induced immunosuppression can stay till after 3 years of catching the virus.

The way forward, as of now, may be to launch an intensive MR vaccination campaign in high-priority districts on an urgent basis.

“India may fail in eliminating measles by 2023 but it would be highly disappointing if it does, given that even our tiny island neighbour Sri Lanka managed to eliminate the disease two years back,” John said.