A closer look at the National Family Health Survey (NFHS-5) by researchers has found that more than one in nine eligible children nationally did not get any dose of the measles vaccine in the 2019-21 period, and that nearly 30 per cent received just a single dose, ToI reported on May 9.
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The researchers involved in the relook were from health ministry's immunisation division, Banaras Hindu University and the Bill and Melinda Gates Foundation.
In some Uttar Pradesh districts, characterised by a high number of births, the proportion of children who did not receive any doses of the measles vaccine was notably elevated, reaching 34.2% in Prayagraj and 32.2% in Hapur. Similarly, in nearly all northeastern states, the prevalence of zero-dose children was approximately 25%.
The study highlighted a significant proportion of children who received zero doses, indicating a troubling gap in immunization coverage. Analysis revealed substantial variations in zero-dose prevalence between states and districts, with significant disparities even within the same state. For example, in Arunachal Pradesh, West Siang district had the highest prevalence of zero-dose children at 49.6%, whereas Lower Dibang Valley district had only 2.8%. Similarly, in Uttar Pradesh, Prayagraj and Banda districts reported 34.2% and 32.2% zero-dose prevalence respectively, while Hapur and Etawah had much lower percentages at 2.6% and 2.1% respectively.
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According to the paper, "Measles outbreak is considered an early warning sign for immunisation programmes and can be effectively used as a signal for tracing missed and dropout children and overall systems strengthening. It is an ideal tracer as measles outbreaks visibly signal clusters with suboptimal immunisation service delivery and can drive prioritisation of targeted interventions to improve programme performance and advocacy."
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Since humans are the sole reservoir for the measles virus and there is no documented evidence of asymptomatic carriers, there is a belief that measles can be eradicated. In 2017, India implemented the 'National Strategic Plan for Achieving and Sustaining Measles and Rubella Elimination'. Subsequently, in September 2022, India adopted a roadmap for eliminating measles and rubella. There is an urgency to reach at least 95 per cent coverage for both doses of measles vaccine as unvaccinated (zero-dose) children "pose an immediate health risk, amplify disease transmission, and act as a barrier to the measles elimination goal", ToI's report observed.
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