More than one in nine eligible children nationally did not receive any dose of the
measles vaccine
in the 2019-21 period and nearly 30% received just one dose. This worrying fact came to light after frequent outbreaks of measles post-Covid prompted researchers from the health ministry's immunization division, Banaras Hindu University and the Bill and Melinda Gates Foundation to take a closer look at vaccination data from the National Family Health Survey (NFHS-5).
In some districts in Uttar Pradesh, with high number of births, prevalence of
zero-dose children
was as high as 34.2% in Prayagraj and 32.2% in Hapur.
In almost all northeastern states, zero-dose prevalence was roughly 25%.
In a paper published in the journal Vaccine, the researchers investigated dose-wise measles vaccination coverage and explored gaps in immunization focusing on zero-dose, one-dose, and two-dose coverage among children aged 24-35 months. The study analysed information from 43,864 children taking into account socio-demographic variables such as birth order, wealth quintile, gender, social group, religion, residence, mother education, delivery-related factors, and media exposure.
The study noted that a significant percentage of children receiving zero doses signalled a concerning gap in
immunization coverage
. The analysis showed considerable variations between states and districts in zero-dose prevalence. Even within a state, there were significant differences at the district level. For instance, in Arunachal Pradesh, West Siang district had the highest prevalence of children classified as zero-dose cases, 49.6%, while Lower Dibang Valley district had 2.8%. Another major cluster region was in UP where Prayagraj and Banda districts had 34.2% and 32.2% respectively, while in Hapur and Etawah 2.6% and 2.1% were zero-dose children.
The analysis found children with higher birth orders and those from the poorest wealth quintile exhibited a higher percentage of zero doses. Mothers with lower levels of education showed increased odds of having zero-dose measles children. Additionally, mothers with limited media exposure demonstrated a higher probability of their children having a zero-dose status for measles.
"Measles outbreak is considered an early warning sign for immunization programmes and can be effectively used as a signal for tracing missed and dropout children and overall systems strengthening. It is an ideal tracer as measles outbreaks visibly signal clusters with suboptimal immunization service delivery and can drive prioritisation of targeted interventions to improve programme performance and advocacy," stated the paper. Measles outbreaks were reported in 2022 from several districts of Maharashtra, Bihar, Gujarat, Haryana, Jharkhand, Kerala and Delhi, and measles-related deaths were also recorded subsequently.
With humans being the only reservoir for the measles virus and no documented evidence of asymptomatic carriers, it is believed it can be eliminated. In 2017, India adopted the 'National Strategic Plan for Achieving and Sustaining Measles and Rubella Elimination'. In Sept 2022, India adopted a roadmap for eliminating measles and rubella. There is an urgency to reach at least 95% coverage for both doses of measles vaccine as unvaccinated (zero-dose) children "pose an immediate health risk, amplify disease transmission, and act as a barrier to the measles elimination goal".
"With consistent efforts, the country aims to catch up on the immunization gaps and vaccinate dropped-out and left-out children this year through Intensified Mission Indradhanush (IMI) 5.0 campaigns. So far six phases of Intensified Mission Indradhanush (IMI) have been conducted from 2017 to 2022 with a focus on measles rubella (MR) elimination vaccinating approximately 1.9 million children," stated the paper.
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