Sighting the finishing line in measles-rubella elimination

News: The COVID-19 pandemic stole two years from the MR Elimination programme. The MR elimination target has been re-set to 2023.

About measles-rubella (MR) Program

It is a program for providing immunisation to children from 5 to 15 years. It is being implemented as a school-based vaccination programme and is being conducted in all States.

Furthermore, it will lead to vaccination-induced immunity against both Measles and Rubella diseases.

To cover immunity gaps after one dose of measles vaccine, a second dose was necessary.

Why is MR Elimination important?

MR elimination is defined as zero transmission of measles and rubella viruses. It should have evidence of zero clinical disease, sustained over three years.

It can be achieved through two methods: (a) surveillance: identify places where either virus is still in transmission, and (b) vaccination: two doses of the MR vaccine — the first dose between nine and 11 months and second dose ideally in the second year of life

The MR vaccine is a combined product which targets two diseases in one shot. This is because fever and rash surveillance cover both diseases

How was the program implemented?

The district was chosen as the ideal population-cum-administrative unit for efficiently implementing all activities.

For epidemiological reasons, rubella vaccination had to cover children up to 15 years. School registration and attendance are high in all States and as a programme, therefore children were to be vaccinated in schools. 

(A) Why should measles be eliminated?

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 may range from 10%- to 15%.

It leads to loss of weight as well as cognitive development and scholastic performance.

Measles affects the immune system rendering the child vulnerable to other infectious diseases.

(B) Why should rubella be eliminated?

The rubella virus is a slower transmitter. The risk of rubella extends from childhood through adolescence into the reproductive age range.

It can show no symptoms, or with a short fever and a skin rash that is less pronounced than that of measles.

In case of an infected pregnant woman, the virus has a tendency to cross the placenta. Affected babies are born with severe birth defects such as cataracts, deafness, heart defects and developmental delay which is called as ‘congenital rubella syndrome’ (CRS). This is preventable with vaccination if given prior to pregnancy.

What are the issues in the implementation of the MR Elimination program?

The stakeholders such as school managements, teachers, children themselves and parents were not properly informed about the basis and features of the new programme.

Due to a lack of information, there was antipathy towards about the programme, in the minds of parents and school authorities.

Lack of information has led to shifting of goal posts. For example, the Government first missed target of 2015, and second missed target of 2020

Way Forward

In order to achieve the MR Elimination in all 773 districts, the Immunisation Division of the Union Ministry of Health and Family Welfare should support the state governments, and all the states should galvanise the district administration to carry out activities.

The District Magistrate should activate the Task Force mechanism overseeing the Universal Immunisation Program (UIP) that is managed by the District Immunisation Officer.

Clinical and laboratory surveillance and vaccination have to be sustained. Measles virus, could be imported from outside.

There are 19 months available to achieve the target before the finishing line b of y July-August 2023.

The cooperation of parents, health-care personnel at all levels, opinion leaders, influencers, the media, non-governmental organisations such as the Rotary and Lions, can play a role in making this district-by-district programme a story of success.

Source: The post is based on an article “Sighting the finishing line in measles-rubella elimination” published in the “The Hindu” on 27^th May 2022.