Over 200 cases of measles have been recorded in Mumbai with 13 deaths. Maharashtra Chief Minister Eknath Shinde has blamed the lack of vaccination behind the ongoing outbreak. In fact, data accessed by The Indian Express showed that in October, when the outbreak started, Mumbai recorded only 41 per cent vaccine coverage against measles. “Yet measles is a preventable disease through vaccination and everybody should get their shots on priority,” says Dr Asmita Mahajan, Consultant Neonatologist and Paediatrician, SL Raheja Hospital, Mahim.
Why has Mumbai seen a surge in measles-related cases?
Mumbai has certainly seen a surge in measles cases over the past few days, with most of the patients from lower socio-economic backgrounds. Poverty, poor hygiene practices, poor quality of nutrition and lack of vaccination in children have all contributed to the spiralling cases. Most cases have been reported from Bhiwandi (Thane) and Malegaon (Nashik) which lack vaccination coverage, especially among children. Some families didn’t immunise their children because of religious and cultural backgrounds. Many lives could have been saved had the children been vaccinated on time and in more significant numbers.
Which age group is most vulnerable to contracting the infection?
Children below the age of five are the most vulnerable, especially those below the age of two. Children who have not been vaccinated are at the greatest risk. More importantly, if children are vaccinated and do contract the disease, the illness will be mild.
How important are the two doses of vaccines to stop the outbreak?
Studies have shown that vaccines are never 100 per cent protection against the disease but once taken, the child will report mild illness even if affected. At least complications or deadly issues like pneumonia, diarrhoea, further sepsis and other problems may be avoided.
Vaccination is considered the key strategy in limiting the spread of measles during outbreaks. At the individual level, administration of measles vaccine within 72 hours of initial exposure may modify the clinical course of the illness and is generally recommended as a preventive tool. Recent studies have confirmed a benefit from this intervention, with effectiveness of post-exposure immunisation ranging between 91–100 per cent, corroborating observations made in the pre-elimination era.
How much time does the vaccine take to produce antibodies to fight against the infection?
Post-vaccination, it takes at least four weeks to develop antibodies. However, the best possible method of dealing with an outbreak is to vaccinate a large number of individuals, in this case children. Antibodies are produced due to vaccination, and if you compare that to unimmunised children, definitely the ones who have received a vaccine will be at an advantage of fighting the infection if affected. We are hoping that by vaccinating a large number of children, the outbreak will be controlled in the near future.
Do you think the national immunisation programme got impacted during the pandemic?
Undoubtedly, there has been a dip in the national immunisation programme because of the pandemic and the lockdown. That has created a big gap. People were quite sceptical or scared about going to hospitals, clinics or healthcare centres to get their children vaccinated as they were afraid of them picking up Covid-19. Irrespective of this hesitancy, the BMC surpassed the vaccination drives and scheduled drives for polio. Its officials have also been keeping a record of vaccinations undertaken at private hospitals. The official BMC figure is that 20,000 children are estimated to have received the MR vaccine.
What are the symptoms to watch out for? What is the line of treatment?
After exposure to the virus, the symptoms take ten days to appear. Some initial common signs include cough, cold, runny nose, sore throat, loss of appetite, high-grade fever and body aches. After five days, rashes appear, which look like blotchy red marks. They usually start at the hairline or behind the ears of the child. These then spread to other body parts, including the throat, limbs and joints. In a few cases, there can also be tiny white dots on the roof of the mouth, which is another sign of measles.
Since measles is a symptomatic disease, some complications can also arise, especially when the child is unvaccinated and has reported low nutrition levels. Some common complications include red eyes, pneumonia, diarrhoea, ear infections and, in some cases, encephalitis, termed as brain inflammation. In rare cases, it can also lead to Subacute Sclerosing Panencephalitis (SSPE), a fatal disease of the central nervous system. Typically, SSPE develops seven to ten years after a child has had measles and recovered. The best way to prevent the above scenarios is to ensure that every child gets vaccinated against measles.
How can we prevent a future surge?
The best way to prevent future surges is by generating awareness among the community about the importance of vaccines. The measles vaccine must be provided to every child and there is a need to overcome any prejudice a community might have against it. It is entirely safe and prevents measles from becoming fatal in children. Some measures that can be implemented immediately include the following:
– Looking out for infected children and treat them as early as possible
– Make sure that all the children who missed the vaccines due to the lockdown and pandemic get vaccinated
– Seek medical attention from specialised doctors and paediatricians if children show any symptoms related to the disease.
In studies in diverse settings, broad and early implementation of vaccination has been associated with shorter outbreak durations, smaller outbreak sizes, alterations in the epidemic curve, reduction in cases, lower than expected morbidity and mortality, and partial or complete avoidance of outbreaks in closed populations.
Wider use of this control measure may also impact disease transmission at the community level by directly reducing the number of secondary measles cases and by increasing immunity to levels that can impede the spread.