Measles and Rubella

• The COVID-19 epidemic snatched two years from the programs therefore the government opted to shift the Measles-Rubella eradication target to 2023.
• India set the goal of eradicating measles and rubella by 2023 in anticipation that the 2020 target would not be feasible.

Why is it important to eradicate diseases?

Elimination of measles:

• Prior to vaccination, measles killed 1% of all children under the age of five, whereas polio paralyzed around 1% of all children under the age of five.
• Measles case fatality rates ranged from 10% to 15%.
• Children who made a full recovery would have lost weight as well as consistent progress made in their scholastic and cognitive development.
• The immune system is weakened by measles, making children more susceptible to other infectious diseases and increased mortality during the following two to three years.
• Rubella must be eradicated since it has the propensity to cross the placenta of infected pregnant women and harm the growing fetus's eyes, brain, heart, and other tissues.
• Congenital rubella syndrome, in which affected infants are born with serious birth abnormalities including cataracts, deafness, heart issues, and developmental delay.

What is the Measles and Rubella Scenario in India and the World?

• According to the World Health Organization, measles is one of the most contagious human viruses in the world and kills more than a million children annually, while rubella is a prominent vaccine-preventable cause of birth abnormalities.
• According to figures from the WHO, the measles vaccine is thought to have prevented more than 30 million deaths worldwide over the past 20 years.
• In 14 States between 2010 and 2013, India carried out a staged measles catch-up immunization program for children aged 9 months to 10 years, immunising over 119 million kids.
• In 2014, Mission Indradhanush was established to increase vaccination rates among the unvaccinated.
• India developed a national strategic plan for the eradication of measles and rubella from 2017 to 2021.
• The government added the rubella-containing vaccine (RCV) to the regular immunisation schedule during this time.
• As of December 2021, Bhutan, DPR Korea, the Maldives, Sri Lanka, and Timor-Leste have all been confirmed as having eliminated the measles. Maldives and Sri Lanka have also maintained their status as countries that have eradicated rubella in 2021.

About measles:

• Measles is a highly contagious viral illness.
• It is transmitted by the mouth, throat, or nose droplets of an infected individual.
• Before the measles vaccine was launched in 1963, the disease was responsible for more than 2 million fatalities annually.
• A safe and effective vaccination is currently available, but measles still claims the lives of thousands of youngsters each year throughout the world.
• Young children make up the majority of the fatalities.
• The paramyxovirus family includes the measles virus, which is often spread through direct contact with the air.
• Measles mortality decreased by almost 73% between 2000 and 2018 thanks to intensive vaccination campaigns conducted worldwide.
• Measles symptoms often start 10 to 12 days after the infection. The typical signs include:
• extreme fever
• clogged nose
• eyes that are red
• Little white dots on the mouth's interior
• Rashes that extend downward from the face and upper neck (this appears after several days)

Vaccine for measles:

• This vaccination, known as the MMR, protects against measles, mumps, and rubella.
• MMR is administered twice, once at 12 to 15 months and once around 4 to 6 years of age.
• Teenagers and adults can receive the MMR vaccine as needed.

About Rubella:

• Young adults can contract the typically mild viral infection known as rubella, much like children.
• It is contagious and has no known cure, while vaccinations are available to prevent it.
• If a pregnant woman contracts rubella, the unborn child is in grave danger.
• It may result in permanent birth abnormalities or blindness (congenital rubella syndrome).
• It is also known as German measles or three-day measles and has a red rash as its distinguishing characteristic.
• The measles virus is distinct from the rubella virus.
• Rubella is not as severe or contagious as measles, despite the fact that they both have some symptoms.

Difference between measles and rubella:

What steps has the government made to eradicate measles and rubella?

• Measles and rubella (MR) eradication is defined as three years of no clinical disease and no transmission of the MR viruses.
• Vaccination and surveillance are the two components of the intervention.
• After missing the initial objective of 2015, the government planned to eradicate measles and rubella from India by the year 2020.
• By administering the MR vaccine in 2017, the government sought to induce a very high level of immunity against both diseases.
• All States have high rates of school enrollment and attendance, so the chance to immunize kids in the class was taken.
• However, parents and school administrators had a lot of concern and hostility toward the program because there wasn't enough information provided to the public.
• Additionally, the COVID-19 pandemic robbed the program of two years, moving the MR eradication objective to 2023.
• Despite the pandemic, the UIP has kept its MR second dose coverage below five years at roughly 85% nationwide.
• The district-by-district initiative relies heavily on the support of parents, health care workers at all levels, opinion leaders, influencers, the media, and NGOs to be successful.

Measles and Rubella

GS-Paper-3 Health and Children

Recently, the Maldives and Sri Lanka have become the first two countries in the World Health Organisation’s South-East Asian Region (WHO SEAR) to have eliminated both measles and rubella ahead of the 2023 deadline. In September 2019, member countries of WHO SEAR set 2023 as the target for the elimination of measles and rubella.

The announcement came after the 5^th meeting of the SEAR Verification Commission for Measles and Rubella Elimination. The Commission comprises 11 independent international experts in the fields of epidemiology, virology and public health.

Bhutan, DPR Korea and Timor-Leste are countries in the region which have eliminated measles. Bangladesh, Bhutan, Maldives, Nepal, Sri Lanka and Timor-Leste have controlled Rubella.

Criteria:
A country is verified as having eliminated measles and rubella when there is no evidence of endemic transmission of the respective viruses for over three years in the presence of a well-performing surveillance system.

The Maldives reported its last endemic case of measles in 2009 and of rubella in October 2015. Sri Lanka reported the last endemic case of measles in May 2016 and of rubella in March 2017.

Steps Taken:

• All countries in the region introduced two doses of measles-containing vaccine and at least one dose of rubella-containing vaccine in their routine immunisation programme.
• Since 2017, nearly 500 million additional children have been vaccinated with measles and rubella-containing vaccines.
• Surveillance for measles and rubella has been strengthened further.
• The announcement comes amidst the Covid-19 pandemic and the success demonstrates the importance of joint efforts.
• Globally, more than half of all countries reported moderate-to-severe disruptions or a total suspension of vaccination services in March and April.
• Regionally, both immunisation coverage and surveillance were impacted. However, SEAR countries made coordinated efforts to resume immunisation and surveillance activities.

Measles

• It is a highly contagious viral disease and is a cause of death among young children globally.
• It is particularly dangerous for children from the economically weaker background, as it attacks malnourished children and those with reduced immunity.
• It can cause serious complications, including blindness, encephalitis, severe diarrhoea, ear infection and pneumonia.

Rubella

• It is also called German Measles.
• Rubella is a contagious, generally mild viral infection that occurs most often in children and young adults.
• Rubella infection in pregnant women may cause death or congenital defects known as Congenital Rubella Syndrome (CRS) which causes irreversible birth defects.

Measures and Vaccinations

• The Measles and Rubella Initiative is a global program which aims at eliminating both these diseases.
• The vaccine for the diseases are provided in the form of measles-rubella (MR), measles-mumps-rubella (MMR) or measles-mumps-rubella-varicella (MMRV) combination.

India and Measles

Despite the availability of a safe and effective vaccine since the 1960s, both measles and rubella are major public health concerns in India.

More than 1.3 million children acquire measles infection and around 49000 infected children die each year, contributing nearly 36% to the global figures.

Rubella infection in pregnant women may cause fetal death or congenital defects. It leads to the development of birth defects in almost 40,000 children annually in the country.

Government initiatives:

Measles-Rubella Vaccination

The Ministry of Health and Family Welfare launched the MR Vaccination program in 2017. The MR campaign targets around 41 crore children across the country, the largest ever in any campaign.

All children aged between 9 months and less than 15 years are given a single shot of MR vaccination irrespective of their previous measles/rubella vaccination status or measles/rubella disease status. MR vaccines are provided free-of-cost across the states. Other Initiatives include Universal Immunization Programme (UIP), Mission Indradhanush and Intensified Mission Indradhanush.