Delhi has shown an upward trend in enhancing its immunisation coverage and reducing the number of deaths due to vaccine-preventable diseases.
The city’s Health Department, however, has not been able to convince parents to allow their children to get the Measles-Rubella (MR) vaccination, under the extra-dose campaign that is designed to provide ‘herd immunity’.
The campaign is aimed at helping the country achieve the target of eliminating measles and controlling congenital rubella syndrome (CRS), which experts say can only be done by providing immunisation to all children up to 15 years in one go at the earliest.
Through the programme in Delhi, 55 lakh children living here would join several lakh others from across India who have already been vaccinated under the nationwide campaign that started in 2017.
- The MR campaign will protect children and eliminate transmission of measles and rubella by vaccinating 100% target children
- Keep in mind
- What are measles and rubella?
- •Measles and rubella are highly contagious viral diseases that are spread by contact with an infected person through coughing and sneezing
- •Infection with measles is followed by high fever, rash that spreads over the body, cough, running nose and red watery eyes
- •Measles weakens the immune system. It often leads to serious complications, including blindness, encephalitis, severe diarrhoea and respiratory infections such as pneumonia
- •Most measles-related deaths are caused by complications associated with the disease
- •One-third of all measles-related deaths worldwide occur in India
- •Rubella is a mild viral infection that occurs most often in children and young adults
- •Rubella infection is followed by rashes and low fever. It may be associated with swelling of lymph node and joint pain
- •Rubella infection during pregnancy can lead to miscarriage, stillbirth and multiple birth defects in the newborn, like blindness, deafness, heart defects, known as Congenital Rubella Syndrome
- •India accounts for one-third of all children born worldwide with CRS
- How can I protect my child from measles and rubella?
- •Measles-Rubella (MR) vaccine is given for preventing both
- •No specific treatment is available for measles and rubella, but these diseases can easily be prevented through vaccination
- When should I give my child
- MR vaccine?
- •MR vaccine is administered when the child is aged 9-12 months and again at 16-24 months of age
- •The government is providing MR vaccine free of cost through its immunisation programme
- Why is the MR vaccination campaign being conducted?
- •The purpose of the measles-rubella campaign is to protect children and eliminate transmission of measles and rubella by vaccinating 100% target children
- •It is a special campaign to vaccinate all children aged between nine months and 15 years with one additional dose of MR vaccine
- •This extra dose will boost the immunity of the child and protect the community by eliminating transmission of measles and rubella
- •A similar campaign was a major factor in achieving measles elimination in the Western Hemisphere in 2002
- How is the MR vaccine administered during the campaign and routine immunisation sessions?
- •The MR vaccine is diluted and administered by subcutaneous injection on the arm of the child
- •A new auto-disable syringe with needle is used for each child. The syringe and needle are destroyed after single use and a fresh one is used for the next child
- SOURCE: World Health Organization, India
Challenged by plea
The campaign in Delhi, however, hit a roadblock when a petition was filed by six children — through their parents — challenging a direction issued by the Delhi government on December 19, 2018 to all Delhi-NCR schools to conduct the vaccination programme for children aged between nine months and 15 years, starting January 16, 2019.
Parents who moved the court contended that the campaign is a “violation of fundamental rights” as consent was not taken from their wards, even though the Centre had explicitly mentioned that the vaccine would not be administered without informed consent of parents.
Written consent necessary
Taking note of the plea, the HC passed an order in late January stating: “Written consent of a parent is necessary before administering the vaccine during the drive to be held in schools here.”
The court forbid forcible and non-consensual administration of the vaccine on children without their parents’ consent. It also stated that risks of administering the MR vaccine should be indicated in advertisements for the campaign.
Not disheartened by the setback, Delhi’s Health Department is now preparing to “either appeal against the order or make the best of the situation”.
Speaking to The Hindu , State Immunisation Officer Suresh Seth said: “We are of the opinion that we should not work around the order as this would set the road map for further immunisation programmes, which will be difficult to follow.”
“To eliminate measles and control rubella mass [over 95%] immunisation of children is required. The campaign is being carried out in a phased manner across the country. Karnataka, Tamil Nadu, Puducherry, Goa and Lakshadweep are covered in the first phase,” said a senior Health Department official.
“In 2018, Europe saw the highest number of measles cases in over a decade [In the World Health Organization European region, 5,273 measles cases were reported in 2016, which increased to 25,863 in 2017 and 82,596 in 2018]. We can stop this from happening in India by immunising our children,” he said.
Senior Health Department officials said that the campaign in Delhi was based on implied consent.
“In case of public health programmes, consent is said to be implied unless a person wants to opt out. People can refuse the vaccine of course, we will not be forcing anybody,” said the official.
The department has stated: “The vaccine will be administered to only those children whose parents give express permission. But we have to make people understand that unless over 95% coverage is achieved, the target to eliminate measles and rubella in India cannot be achieved.”
Dr. Seth said that the MR extra dose will be given regardless of previous vaccination status or history of measles/rubella-like illness.
In Delhi, the campaign will cover 34 lakh children in recognised schools, 10 lakh in playschools, crèches and shelter homes, and 10 lakh children who are younger or not in school.
Working in partnership
As per information from the Health Department, the departments of health and education are partnering up so that students and teachers of all Delhi schools actively participate in the MR campaign.
The partnership includes orientation for officers/principals, teachers and students by Health Department officials.
Measles is still one of the leading causes of death in young children. It is a highly contagious disease and spreads quickly in communities where children have not been vaccinated.
The virus reduces immunity, children who have had measles, especially those who are undernourished, are at risk of death due to pneumonia, diarrhoea and encephalitis later on.
Due to measles being highly infectious, the WHO stated that 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 immunised, an outbreak is likely.
Explaining the problems being faced by the Health Department regarding immunisation coverage in Delhi, a senior official said: “Lack of option to view birth registration portal for tagging each newborn to Accredited Social Health Activist and their subsequent linkage with Aadhaar number for tracking of each newborn for immunisation, shortage of Auxiliary Nurse Midwives in a few districts and migratory population from neighbouring States making tracking of children difficult by health workers create bottlenecks for the Capital.”
The official added that Delhi also has a problem with multiplicity of agencies implementing the programme, “a challenging job for want of administration”.
To ensure herd immunity
Directions issued by the Delhi government to all schools on December 19, 2018
• Prepare list of students less than 15 years of age
• Assign teachers to help organise and conduct immunisation sessions in schools
• Coordinate with health workers to conduct vaccination sessions during school hours
• Inform about date and time of the sessions to students and their guardians in consultation with district immunisation officers
• Provide space/rooms for carrying out vaccination sessions and for observing the students for 30 minutes after the vaccination
• Ensure that students come to school after breakfast on the date of vaccination. If needed, timings of midday meals may be adjusted
• Ensure that teachers cross-check left-thumb marking of all vaccinated students
• Share list of absentee target students with health workers for vaccination during the outreach campaign session
• Senior students should get involved in motivating and ensuring the vaccination of those under-15, who are out of school
SOURCE: Delhi government