Department of Community Medicine

Learning Objectives

By the end of this lecture you will know:-

Difference between Control, Elimination & Eradication

Why we need to eliminate Measles !

Factors favouring the elimination & Challenges

Current strategies

Basic concepts

Control : Reduction of incidence & prevalence to a locally

acceptable level.

Elimination : Eradication from a large Geographic region or

political jurisdiction.

Eradication : Termination of all transmission by extermination

of agent through Surveillance & containment.

Measles (Rubeola)

An acute highly infectious viral disease of childhood

Caused by RNA virus of family Paramyxovirus

Fever with Cough, coryza or conjunctivitis (3Cs) followed by a

typical RASH

Koplik’s spots

Transmission by person‐to‐person via aerosolised droplets.

Complications

Clinical Presentation

PRODROMAL STAGE

ERUPTIVE STAGE

POST MEASLES STAGE

COMPLICATIONS

Why Measles ?

Global: 122000 Deaths in 2012 (330/day).

Disproportionate burden in developing countries.

India: 56000 Deaths 2011 or 156/day.

MDG 4, one indicator is (%) infants received primary dose.

Very severe in malnourished children (400 times).

Epidemic during winter & early spring.

Factors favoring Elimination

1) Virus: Only one antigenic type & cannot survive outside body

2) Reservoir : Human case

3) Source of infection: Aerosolised droplets

4) Transmission: Person to person

5) Communicability: 4 days before to 4 days after rash

6) Isolation: 1 week from rash

7) Secondary Attack Rate : Rare

8) Vaccine: Gives lifelong immunity but with TWO doses

Challenges for Elimination

Weak Immunization system

Highly infectious nature

Inaccessible population

Refusal by some population

Changing Epidemiology of Measles

Catch–up to > 130 Million children

Gaps in Human & Financial resources at multiple levels

Rationale for 2nd Dose

Effectiveness 85% at 9 months & 95% at >12 months

DLHS-3 (2007-08) Measles 1st dose 69.6%.

Actual protection at 9 months to only 60%

(70% Coverage × 85% Efficacy = 60%).

40% remained susceptible to measles.

2nd opportunity ≥ 1 year will give double benefits.

Measles control - Strategies

Mortality Reduction

Elimination

1st dose coverage >90% >95%

2nd Opportunity >90% >95%

Surveillance Aggregate or case-

basedCase-based

Case ManagementVitamin A Supportive

RxVitamin A Supportive

Rx

Targets for 2015 Routine MCV1 >90% National, >80% every district Incidence < 5 case / million Mortality reduction by >95 % (from 2000 level)

What has been done....

2nd dose Measles introduced in India 2010 under UIP

21 states MCV 1 coverage > 80% by RIA

14 states MCV1 < 80% coverage targeted all children 9mt-10yr

by SIA then introduced in RIA after 6 months

Phase I: 2010-11, Phase II:2011-12 & Phase III:2012-13

Mission Indradhanush (All under 5 by 2020 for 7 VPD)

Global Activities

1980 WHO & UNICEF: Accelerated measles mortality reductionstrategy

2 dose of MCV to all through RI & SIA and improve surveillance

63rd WHA 2010 set targets for 2015

1. Achieve at least 90% measles vaccination coverage nationallyand 80% coverage in all districts.

2. Reduce measles cases to <5 per million.

3. Reduce measles mortality by 95% compared to 2000 levels.

Global Measles & Rubella strategic plan 2012 – 2020

Close the Immunization Gap, 6 targets for 2015