Age-appropriate vaccination against measles and DPT-3 in India – closing the gaps

Abstract

BackgroundIn 2010, India accounted for 65,500 (47%) of the 139,300 measles-related deaths that occurred globally. Data on the quality of age-appropriate measles vaccination in rural India is sparse. We explored the following issues: (i) What proportion of Indian children were appropriately vaccinated against measles at 9 months of age, and DPT-3 at 4 months? (ii) Which health facilities administered measles vaccine to children prior to 9 months of age and DPT-3 prior to 14 weeks?MethodsWe analyzed data from the 2008 Indian District Level Health Survey (DLHS-3) to determine the extent of age-appropriate measles and DPT-3 vaccinations. Among 192,969 households in the dataset, vaccination cards with detailed records were available for 18,670 children aged between 12 and 23 months.ResultsAmong this cohort, 72.4% (13,511 infants) had received the first dose of measles vaccine. Only 30% of vaccinated infants received the measles vaccine at the recommended age of 9 months. Similarly, only 31% of infants in the cohort received DPT-3 vaccine at the recommended age of 14 weeks. About 82% of all prematurely vaccinated children were vaccinated at health sub-centres, ICDS and Pulse Polio centres.ConclusionsAge-inappropriate vaccination impacts adversely on the effectiveness of India’s measles immunisation program due to sub-optimal seroconversion, if premature, and increased vulnerability to vaccine preventable diseases, if delayed. Capacity building approaches to improve age-appropriate vaccination are discussed.

Measles in India: Challenges & recent developments

“…first-dose coverage for the measles vaccine must be ≥90% at the national level and ≥80% for each district); intensive surveillance activities supported by adequate laboratory support (outbreak and case-based surveillance assisted by laboratories to ensure serological/virological categorization); appropriate case management (including administration of vitamin A); and implementation of catch-up measles vaccination campaigns for children aged 9 months to 10 years in states with <80% evaluated coverage with the first dose of measles vaccine ( 12 , 13 ). Despite the presence of these effective strategies, the Indian District Level Health Survey–3 reported that only 30% of vaccinated infants received the measles vaccine at the recommended age of 9 months ( 14 ).…”

“…Policy makers and professional bodies have acknowledged the presence of various challenges and hindering factors; they are working in a concerted manner to improve all components of the measles immunization program (infrastructure support, manpower and other resources, laboratory assistance such as virological surveillance, the importance of continued surveillance, etc.) ( 4 , 14 , 17 , 24 ). However, a mechanism should be developed to obtain an accurate estimate of the vaccine coverage across the nation ( 12 ).…”

Infant vaccination timing: Beyond traditional coverage metrics for maximizing impact of vaccine programs, an example from southern Nepal

“…In the same study BCG coverage was 98% at 1 year but only 38% of infants were vaccinated within the first week of life; the median delay for BCG was 1.7 weeks; similar delays were found for one coastal Kenyan district [23] . In an Indian study using vaccination card records only 31% of infants received DTP3 by 14 weeks [24] . A study examining the timing of vaccination in low and middle income countries, based on surveys and imputed data, found at 6 months median coverage was 82% (Interquartile Range [IQR]: 67–89%) for DTP1, 36% (IQR: 23–54) for DTP3, and 85% (IQR: 73–91) for BCG [11] .…”

Fulminant subacute sclerosing panencephalitis in an immunized 20-month-old Indian boy

“…A vaccinated child can acquire subclinical wild virus infection considering suboptimal coverage, and variable rates of seroprotection following measles vaccination in Indian children. 8 To address the second valid concern, the index case, as well as their both parents, had tested negative for HIV. In developing countries like India, HIV is always on the top of clinical differentials for neuroregression in infants and young children.…”