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Monday, 1st of February 2010 Print

Since India is home to 1/6 of the world's population, it figures importantly in any calculation of progress towards achievement of global objectives for measles mortality reduction. To the extent that Indian children, especially in the northern states, get two doses of measles vaccine in 2010, either by adoption of a two dose regime or through mass measles vaccination campaigns, the world will be closer to reaching its 2010 goals for measles mortality reduction.



Writing in the British Medical Journal, Mudur has given an overview of India's progress in measles control at http://www.bmj.com/cgi/content/full/339/nov03_2/b4542?view=long&pmid=19887530 In this article from Indian Pediatrics, van den Ent and her colleagues make the case for two doses of measles vaccine, with special reference to India. From their discussion:


'Countries with strong health systems deliver 2 doses in the routine system only (41 of the 198 countries) or provide 2 doses during the routine, in addition to having conducted a one- time catch-up campaign (37 countries). Fifty-four countries provide two doses of measles vaccines in the routine, and regularly conduct campaigns. Sixty countries provide one dose of measles vaccination in the routine and conduct regular campaigns. Finally, India has plans to begin introduction of a second dose of measles vaccines in the near future (Fig.4).

Importantly, there are countries in each of the categories that have successfully stopped measles campaigns depends on the coverage of the routine immunization. Generally, major outbreaks can be avoided by conducting follow-up campaigns before one birth cohort of susceptible is reached.'


Abstract is at the foot of this Email. Full text is at http://www.indianpediatrics.net/nov2009/933.pdf


Good reading.



1. Indian Pediatr. 2009 Nov;46(11):933-8.

Two doses of measles vaccine reduce measles deaths.van den Ent M, Gupta SK, Hoekstra E.



Two doses of measles vaccine to children reduce measles related deaths. The first dose is delivered through the routine immunization system to infants and the 2nd dose through campaigns or routine immunization system, whichever strategy reaches the highest coverage in the country. Experience in 46 out of 47 measles priority countries has shown that measles vaccination using mass vaccination campaigns can reduce measles related deaths, even in countries where routine immunization system fails to reach an important proportion of children. The gradual adoption of this strategy by countries has resulted in 74% reduction in measles related deaths between 2000 and 2007. The 2010 goal to reduce measles mortality by 90% compared with 2000 levels is achievable if India fully implements its plans to provide a second dose measles vaccine to all children either through campaigns in low coverage areas or through routine services in high coverage areas. Full implementation of measles mortality reduction strategies in all high burden countries will make an important contribution to achieving Millennium Development Goal 4 to reduce child mortality by two thirds in 2015 as compared to 1990.

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