Sounding an alarm over measles outbreak, Centre has rushed teams to Ranchi, Ahmedabad and Malappuram to investigate and assist in management of rising trend of cases and also asked states to consider administering one additional dose of Measles and Rubella vaccines to all children, aged 9 months to 5 years, in vulnerable areas.
The advisory by the government comes amid an increased numbers of measles cases being reported from certain districts of Bihar, Gujarat, Haryana, Jharkhand, Kerala and Maharashtra and an eight-month old child being identified as the latest casualty of the outbreak in Mumbai.
An 8-month-old child was identified as the latest casualty of a measles outbreak in Mumbai, taking the total number of deaths to 12 on Wednesday, as the central government expressed concern at the rising cases and issued an advisory.
Areas under Brihanmumbai Municipal Corporation (BMC) and some other districts in Maharashtra have reported a rapid rise in infections and several mortalities caused by the Measles virus.
In a letter to the Principal Health Secretary of Maharashtra that was also marked to all states and Union Territories (UTs), the Union Health Ministry said this surge is of particular concern from the public health point of view.
“It is also clear that in all such geographies, the effected children were predominantly unvaccinated and the average coverage of Measles and Rubella Containing Vaccine (MRCV) among the eligible beneficiaries is also significantly below the national average,” Health ministry Joint Secretary P Ashok Babu said.
In this context, he said a meeting of Domain Knowledge Technical Experts was held on Wednesday under the Chairpersonship of Member (Health), NITI Aayog to review the situation.
Administer Additional Dose to All Children of 9 Months to 5 Years of Age
Based on inputs received from the meeting, the Centre said states and Union Territories are advised to consider administering one additional dose to all children of 9 months to 5 years in vulnerable areas, referring to the geographies which are showing a recent increase in numbers of Measles cases.
The special dose for Measles and Rubella for Universal Immunization Programme (UIP) reporting purposes is referred to as the one additional dose.
“This dose would be in addition to the primary vaccination schedule of first dose at 9-12 months and second dose at 16-24 months,” P Ashok Babu said.
The vulnerable areas are to be identified by the state government and UT administration in “Outbreak Response Immunization” (ORI) mode.
A dose of MRCV is to be administered to all children aged 6 months and up to less than 9 months in those areas where the Measles cases in the age group of less than 9 months are above 10 per cent of the total Measles cases, Babu said.
“Since this dose of MRCV is being given to this cohort in “Outbreak Response Immunization” (ORI) mode, therefore, these children should also be covered by first and second dose of MRCV as per the primary (routine) Measles and Rubella vaccination schedule,” he said.
Centre Calls for Strengthening Fever and Rash surveillance Mechanism
With the disease known to witness a surge in cases of numbers from November to March, annually, the health ministry said an active fever and rash surveillance mechanism needs to be strengthened for early case identification.
“Head count survey of all children aged 6 months to 5 years must be undertaken in the vulnerable outbreak areas to facilitate full MRCV coverage in an accelerated manner. The institutionalized mechanism of District Task Force on Immunization under the chairmanship of the District Collector must be activated to review the Measles situation on a daily and weekly basis and plan the response activities accordingly,” he said.
Reminding that the disease is known to be fatal among children with moderate and severe malnourishment, he underlined house-to-house search activities to identify such vulnerable children and providing pre-emptive care with nutritional and Vitamin A supplementation is also necessary as part of the case identification and management.
“Correct and factual information about Measles symptoms and treatment must be disseminated among the public, in general for early identification and prompt management of measles cases,” he said.
Any suspected cases with the development of fever and maculopapular rash must be reported and investigated, he added.
The health ministry said immediate isolation of laboratory-confirmed cases must be done for at least seven days from the date of identification. “Guidance for home-based care of such cases must be issued with reference to age-appropriate two doses of vitamin A supplementation with adequate nutritional support,” he said.
Caregivers must be made aware regarding the identification of danger signs for immediate hospitalisation of children with persistent diarrhoea, rapid breathing with chest indrawing (pneumonia), and ear discharge, he said.
The Centre also asked Maharashtra to be prepared with wards and beds for effective caseload management of measles in dedicated health facilities for timely transfer and treatment of such children.
(With PTI inputs)
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