Amid a drop in the number of children covered by the Measles Rubella (MR) vaccine this year as against 2021 in Vadnagar, at least 91 children below 10 years have been reported as “suspected” cases of measles in just 23 days in the taluka’s Molipur village in Mehsana.
A surveillance conducted by the Mehsana district health officials between November 24 and December 17 identified 91 children as “suspected measles” with symptoms including fever and generalised maculopapular rash, which includes both flat and raised skin lesions.
Meanwhile, a team from the Ministry of Health and Family Welfare (MoHFW), which visited Ahmedabad in November when a spike in measles cases was reported, noted “vaccine hesitancy” and that nearly 60 per cent of those infected were not immunised.
While five samples were sent for testing to the microbiology laboratory at BJ Medical College in Ahmedabad more than three weeks ago, Vadnagar health officials say the results remain pending with the laboratory facing a shortage of testing kits. Three of the samples were sent on November 24 and two on November 30.
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However, Dr Neeta Khandelwal, head of the microbiology department at the Gujarat government’s BJ Medical College, said Saturday, that the laboratory has now received kits. Currently, it is expediting the backlog of samples from Mehsana, along with routine measles testing of samples that are being received daily, she said.
So far from Mehsana, Dr Khandelwal said, the lab has received 11 samples of which nine have been tested and confirmed as negative for measles, while two samples remain to be tested and are expected to be completed by December 19. “There are two kinds of tests—serological and PCR. If a sample is taken within the first four days of illness, PCR is conducted and if the sample is taken from a patient with more than four days of onset of disease, first a serological test is done. If positive, it is then PCR-tested. If PCR comes back positive, we send the sample to NIV Pune for genome-sequencing,” said Dr Khandelwal.
According to CN Karia, taluka health officer at Vadnagar, Molipur has seen a lower rate of MR vaccination “owing to certain beliefs and myths”. “We have managed to get 75 children to take the vaccine through counselling and consistent messaging in the community. There are 185 children who are yet to be vaccinated. We are administering oral solution of Vitamin A as well for those unvaccinated, so as to ensure better management of complications that may arise from measles such as pneumonia, diarrhoea and blindness. Apart from the routine immunisation sessions held every Wednesday, we have also conducted six extra sessions since November 24 and are also accommodating community requests for place and time of their convenience for those coming forward to take the vaccine,” the taluka health official said, adding that there has been no death among the suspected cases so far.
According to data tabled before the Lok Sabha on December 16, as of December 12, Gujarat had reported 1,650 measles cases that were laboratory confirmed cases, epidemiologically linked and clinically compatible and nine deaths—the second highest in the country after Maharashtra.
In 2021 in Vadnagar taluka—the hometown Prime Minister Narendra Modi—93 per cent (2,691) of the target children (nearly 2,900) had received the first dose of the MR vaccine, while 94 per cent (2,388) of the target (2,540) had received the second dose.
The coverage, however, dropped significantly this year in the taluka, with 87 per cent (1,914) of the target 2,200 children receiving the first dose and only 81 per cent (1,666) of 2,058 children receiving the second dose, according to data shared by health officials.
Overall, Gujarat has seen a drop in routine immunisation, including the MR vaccination. According to the Health Management Information System data, 7.16 lakh children were administered the first dose in the financial year 2022-23 as of December 17, compared to over 11.8 lakh covered with the first dose in 2020-21 and 2021-22 each. Only 39,570 second doses—taken after 12 months of age and after a gap of around seven months—were administered. This is nearly half of the number of doses administered in the financial years 2020-21 (71,985) and 2021-2022 (63,135).
“There’s always a pool of population susceptible to measles and this pool has only increased with routine services, including MR vaccination, taking a hit during the Covid-19 pandemic. So now, with measles entering the community, we are seeing these outbreaks,” Dr Deepak Raut, adviser to MoHFW and who was heading the team sent by the Centre to Ahmedabad in November to investigate the measles outbreak, said.
The three-member team constituted by MoHFW by way of a notification on November 23 visited after the Ahmedabad Municipal Corporation (AMC) flagged 20 outbreaks between March and November 26 as against eight outbreaks in 2019 and three in 2020. The team was in Ahmedabad between November 24 and November 30. As of November, the city had reported 420 laboratory confirmed cases and 949 suspected cases. Among the areas to report the maximum cases were Behrampura (48 confirmed, 64 suspected) and Lambha (32 confirmed, 57 suspected).
According to Dr Raut, the team made three-four observations during the visit. “One, nearly 60 per cent of the cases were not vaccinated. Two, our visits to the suspected and confirmed cases’ residences showed they were living in overcrowded conditions. Three, owing to lack of good, verified information, many of the elders in the community were vaccine-hesitant and would not let their daughters or daughters-in-law go ahead with the vaccination for their children. Also, we found that while the AMC health systems were doing their best, the motivation was low among paramedical staff and enough efforts were not being made to check the spread.”
The report submitted by the team to the Ministry, The Indian Express has learnt, observed that a sudden increase in suspected and confirmed cases of measles was noticed from September, with cases doubling each month thereafter; the highest was reported in November. The team has also cautioned against a likely peak in December or January.
The report also stated that nearly 50 per cent of the laboratory confirmed 420 cases were aged between 1-5 years. “Though AMC health department has taken some actions to control measles outbreaks, including active case search, sensitisation of frontline health workers, doctors and Vitamin A supplementations, a lot needs to be done in coordination with other stakeholders,” the report notes. It recorded that community social mobilisation and information, education and communication (IEC) activities were found to be deficient.
The team had recommended AMC to start zero dose MR vaccination among children aged between nine months and five years, irrespective of their vaccination status. Simultaneously, active surveillance, Vitamin A supplementation, training of doctors and frontline health workers, creating awareness through IEC campaigns, community engagement and social mobilisation through involvement of locals should also continue.
Among the short-term interventions, the team recommended AMC to conduct a rapid assessment survey on MR vaccine hesitancy so as to prepare evidence-based social mobilisation strategy and conduct surveillance among malnourished children as they are more vulnerable to measles.