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India has slipped behind all of Africa and Asia in combating measles, delaying action to bolster immunisation against the infection that kills an estimated 160,000 children in the country every year, say medical experts
India was among 47 African and Asian countries identified by the World Health Organisation (WHO) more than two years ago as “worst affected” by measles, accounting for 98% of global deaths from the infection. All the countries were advised to introduce a second dose of the measles vaccine through their immunisation programmes that would help protect nearly all children. Among the countries that have taken action to reduce measles mortality are Angola, Burkina Faso, Cambodia, Ethiopia, Kenya, Nigeria, Somalia, Vietnam, Yemen and Pakistan, public health experts said. India remains the only country in the world that has not systematically introduced the second dose of the measles vaccine, experts said in a commentary in Indian Paediatrics, a journal of the Indian Academy of Paediatrics. “This is certainly a shame,” Panna Choudhury, co-author and president of the academy, says. “India has the resources and the infrastructure, and the measles vaccine is widely and easily available.” A single dose of the measles vaccine given to children at about nine months of age protects only 85% of immunised children. The second dose between 15 and 18 months is dubbed a “second opportunity” expected to protect 99% of children. The early public health advisories for a second dose emerged in 2004 and were reiterated by the WHO’s Strategic Advisory Group of Experts on Immunisation in November 2008. But the health ministry still has not introduced the second dose in the public immunisation programme although it is routinely provided by doctors in the private sector. “We expect this (a second dose) will start sometime in 2010,” says T Jacob John, co-chair of the National Technical Advisory Group on Immunisation, which has asked the health ministry to introduce the second dose through two strategies. States where routine immunisation coverage is higher than 80% have been asked to deliver the second measles dose when a child comes to get a booster dose of the diphtheria-pertussis-tetanus vaccine at 18 months. Other states may need to introduce the second dose through mass immunisation campaigns of the type used to deliver the oral polio vaccine. Public health experts believe poor routine immunisation, lack of diagnosis and access to proper treatment, and poor awareness are among the factors that have frustrated efforts to reduce measles mortality in the country. According to a public health expert: “A dose of vitamin A can reduce the risk of complications and mortality in measles infection, but many children do not get this vitamin A as part of routine therapy.” “The immunisation programme also appears understaffed,” John says. The Advisory Group on Immunisation has asked a panel of experts to examine the human resource requirements to improve immunisation coverage. “Measles can cause life-threatening pneumonia in children, but many parents still appear unaware of this,” Choudhury says. “Action against measles could significantly reduce mortality in children below 5 years of age,” he adds. Source: The Telegraph, November 11, 2009
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