Improving measles control in India

April 2013

India is building on its polio eradication campaign experience to ensure more children get vaccinated against measles.

It is now more than two years since a child has been infected with polio in India, once considered the global epicentre of the disease.

The country’s polio eradication campaign, led by the Government of India and its partners, including the World Health Organization, has been one of the biggest, most complex, and most meticulously implemented vaccination campaigns in human history.

Building on success of polio campaigns

A baby girl receives her first measles vaccination in Ghaziabad, Uttar Pradesh, India.
WHO/A. Caballero-Reynolds

Intense, six-day polio vaccination campaigns have been run several times a year in India since 1996. During each campaign, 2.3 million vaccinators go door-to-door, visiting 191 million homes to vaccinate 172 million children a year.

Now India is building on the success of the polio eradication strategy to ensure that more children are immunized against other dangerous illnesses.

Measles, for example, is still one of the leading causes of death in young children. A highly contagious disease, it spreads like wildfire in communities where children are unvaccinated. And because the virus reduces immunity, children who have had measles – especially those who are undernourished – may die of pneumonia, diarrhoea and encephalitis later on.

Safe and effective measles vaccine exists

This need not happen. A safe and effective vaccine exists, and has played a major role in reducing the global number of measles deaths from 548 000 to 158 000 a year between 2000 and 2011. But more children need that vaccine: in 2011, 20 million children worldwide remained unimmunized.

“Laboratory-based field surveillance network is providing vital assistance for measles control activities in the country”

Dr Nata Menabde, WHO Representative to India

Because measles is so infectious, a country needs to ensure that at least 95% of all children receive two doses of the vaccine. About 15% of vaccinated children fail to develop immunity from the first dose, meaning that if only 80% are fully immunized, an outbreak is likely.

More than one third of all measles deaths worldwide (around 56 000 in 2011) are among children in India. With support from WHO, in November 2010, India launched a massive polio-style measles vaccination project in 14 high-burden states, in a three-phase campaign.

Increasing child vaccination

Health workers were trained to detect and report measles outbreaks, and they found an unexpectedly high number of infections. The government responded by establishing a system to ensure that every child who receives a first dose of the vaccine routinely gets a second. They also initiated ‘catch-up’ campaigns in areas where first-dose coverage was less than 80%.

An auxiliary nursing and midwifery officer prepares a measles vaccination in Ghaziabad, Uttar Pradesh, India.
WHO/A. Caballero-Reynolds

With two phases of the measles vaccination campaign completed, and the third phase ongoing, more than 102 million children in 344 districts have been vaccinated, achieving between 87% and 90% coverage.

According to Dr Nata Menabde, WHO Representative in India, the lessons learnt through the polio programme are working. “The laboratory-based field surveillance network, which we are supporting, is providing vital assistance for measles control activities in the country,” she says.

While it is not yet possible to assess national impact, as the campaign is in different phases in different states, in some states the impact has been dramatic. Gujarat, for example, has gone from nearly 1000 cases in 2010 to none in 2012.

In Bihar, once the state with the lowest immunization coverage levels in the country, the proportion of children immunized against common childhood diseases tripled as polio eradication activities intensified (from 18.6% in 2005 to 66.8% in 2010), underscoring the synergistic links between polio and measles efforts.

“India is a good example of a large and diverse country with many health systems challenges,” says Dr Hamid Jafari, WHO’s Director of Polio Operations and Research. “This programme demonstrates the impact that can be achieved by linking efforts to eradicate polio with those to improve routine immunization against a disease such as measles.”