AGE-APPROPRIATE VACCINATION AGAINST MEASLES AND DPT-3 IN INDIA – CLOSING THE GAPS

Monday, 12th of May 2014

[source]BMC Public Health[|source]

The level of immunity that children under nine months possess varies considerably depending on whether the mother acquired measles immunity via vaccination or natural infection, and on antibody variability in the infant. Poor and undernourished children tend to acquire many infections at an early age, and passively acquired maternal antibody is neutralized earlier than among economically advantaged children, particularly in countries where low vaccine coverage does not offer herd immunity. The fact that measles outbreaks continue to occur in Indian districts with high measles vaccination coverage suggest possible adverse impact of low vaccine efficacy on measles control. 

In this report, the authors analyzed the timing of measles vaccination among a sample of Indian children with vaccination cards, using the nationally representative District Level Health Survey dataset.  The authors also examined whether age-appropriateness of measles vaccination apply to DTP vaccinations. Detailed findings and recommendations are accessible at:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3637565/

 

ABSTRACT

 

BACKGROUND: In 2010, India accounted for 65,500 (47%) of the 139,300 measles-related deaths that occurred globally. Data on the quality of age-appropriate measles vaccination in rural India is sparse. We explored the following issues: (i) What proportion of Indian children was appropriately vaccinated against measles at 9 months of age, and DPT-3 at 4 months? (ii) Which health facilities administered measles vaccine to children prior to 9 months of age and DPT-3 prior to 14 weeks?

METHODS: We analyzed data from the 2008 Indian District Level Health Survey (DLHS-3) to determine the extent of age-appropriate measles and DPT-3 vaccinations. Among 192,969 households in the dataset, vaccination cards with detailed records were available for 18,670 children aged between 12 and 23 months.

RESULTS: Among this cohort, 72.4% (13,511 infants) had received the first dose of measles vaccine. Only 30% of vaccinated infants received the measles vaccine at the recommended age of 9 months. Similarly, only 31% of infants in the cohort received DPT-3 vaccine at the recommended age of 14 weeks. About 82% of all prematurely vaccinated children were vaccinated at health sub-centres, ICDS and Pulse Polio centres.

CONCLUSIONS: Age-inappropriate vaccination impacts adversely on the effectiveness of Indias measles immunisation program due to sub-optimal seroconversion, if premature, and increased vulnerability to vaccine preventable diseases, if delayed. Capacity building approaches to improve age-appropriate vaccination are discussed.