Delayed implementation of periodic immunisation activities major cause: WHO

“Delayed implementation of accelerated disease control in India” has led the country to account for “47 per cent of estimated measles mortality in 2010” stated a paper published today (April 24) in The Lancet. At 36 per cent, even the World Health Organisation (WHO) African region accounted for lesser mortality than India.

The high number recorded in India stands out, as the global measles mortality had decreased by 74 per cent in 2010.

Except for the Southeast Asia WHO region, all the other WHO regions recorded a reduction in mortality by more than three-quarters during 2000-2010. Even in the case of WHO Southeast Asia region, except for India, the other countries in the region had reported a reduction.

Though India achieved 26 per cent reduction in measles mortality between 2000 and 2010, its contribution to the percentage of global measles deaths increased from 16 per cent in 2000 to 26 per cent in 2010.

Africa is a study in contrast. The mortality reduction during the same period, 2000-2010, was 85 per cent. The effect of this decline gets reflected in the continent's contribution to the global measles deaths — 63 per cent in 2000 to 36 per cent in 2010.

“Delayed implementation” of periodic supplemental immunisation activities (SIA) and “restricted improvement” in measles-containing vaccine (MCV1) coverage were responsible for the increased mortality in the case of India, Peter Strebel, the senior author from the Expanded Programme on Immunisation, WHO, Geneva, and his team has found.

The solution is, therefore, to go in for aggressive immunisation. Targeting 134 million children and “introducing a routine second dose in some States in 2011-13” can reduce mortality “substantially” in another three years (2015), they wrote.

Such planned immunisation in other 10 countries in the WHO Southeast Asia regions had produced a reduction in mortality. “Measles eradication is biologically feasible” despite the disease being a highly contagious one, notes a comment piece accompanying the paper.

The authors had to estimate the deaths in the case of India and other 127 countries as they have inadequate vital registration data. They had developed a new model that used surveillance data to objectively estimate both incidence and the age distribution of cases. Unlike most other models, it takes into account the herd immunity.

Keywords: measlesWHOThe Lancet