KERALA

Measles surveillance network to be launched

C. Maya

To reduce mortality and morbidity

Routine immunisation to be strengthenedCentre plans to reduce measles mortality by two-thirds by 2010

Thiruvananthapuram: The World Health Organisation (WHO), India, and the Union Ministry of Health and Family Welfare are joining hands to undertake a State-wide measles surveillance project to reduce the mortality and morbidity associated with the disease.

The key strategy to reduce measles mortality and morbidity is to ensure high immunisation coverage of children aged 0-12 months through routine immunisation programme. As per the plan drawn up by the Ministry, the well-structured polio surveillance system in the State (supported by the WHO) will be used for measles surveillance and strengthening routine immunisation service activities.

The WHO-supported National Polio Surveillance Project unit in the State, with its network of surveillance officers across districts, will monitor routine immunisation programmes and identify the populations where the programme does not reach. It will monitor pockets where measles outbreaks occur and capture information on the trend, adverse reaction of vaccination, coverage problems and vaccine efficacy.

Despite the availability of a vaccine, measles is an important cause of morbidity and mortality in the country. However, it is not considered to be a serious disease by many or even by health personnel, and often, the patients reach the hospital only when serious complications such as pneumonia, severe diarrhoea or meningo-encephalitis sets in.

As per the figures released by the Health Department, Kerala reported 2,386 cases in 2002 and 4,937 cases in 2003. No deaths were reported. However, experts point out that many deaths due to measles could be `missed' as people fail to associate later complications such as pneumonia with measles.

However, the high burden of measles cases is indicative of the poor immunisation coverage. The immunisation coverage in the State has been coming down in recent years and the percentage of fully vaccinated children is between 75 per cent (NFHS 3) and 82 per cent (UNICEF Coverage Evaluation Survey).

NPSP Surveillance Medical Officer Asha Raghavan points out that when compared to the coverage of other vaccines in the routine immunisation schedule, measles vaccine cover has always been low. This is because, unlike other mandatory vaccines which are administered within days of birth, measles vaccine is given to the infant only at the age of 9-12 months. Unless very motivated, many parents tend to forget about this vaccine, Dr. Raghavan says.

More than 50 per cent cases of measles are reported in children less than five years of age, indicating that poor routine immunisation cover is the primary reason for the disease burden.

Persistent low vaccine coverage in certain areas and an accumulation of children, who are either not immunised or do not develop immunity from one dose of vaccine in successive birth cohorts can result in large measles outbreaks. The Centre plans to reduce measles mortality by two-thirds by 2010. The plan emphasises achieving at least 90 per cent coverage in 80 per cent of the districts by 2009. The current strategy for measles surveillance is being implemented in 11 States, including Kerala.

The WHO-NPSP network in the State will be expanded so that an active surveillance system for measles can be set up by reporting all cases of fevers with rashes, cough or conjunctivitis.

District-level training of health officials has already started. The surveillance network will be activated by April this year, according to officials.

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