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Background and Objectives: Subacute sclerosing panencephalitis (SSPE) is a progressive disorder caused due to the persistence of mutant measles virus in the brain. Treatment strategies for SSPE remain largely undefined, and there exists no information on how neurologists are currently managing SSPE. Methods: A survey-based study was conducted among Indian neurologists managing pediatric and adult patients with SSPE. A questionnaire-based survey was circulated by email regarding respondent demographics, preference for disease-modifying strategies, and symptomatic therapy. Results: Survey response was obtained from 298 neurologists (responder rate 9.5%) and eventually analyzed from 266 respondents who managed SSPE in routine practice. This included 222 (83.5%) adult and 44 (16.5%) pediatric neurologists from 21 states of India. Ninety-five respondents (35.7%) indicated that they always advised Isoprinosine (inosine pranobex) to their patients. Regarding interferon therapy, 121 (45.5%) reported never advising it, whereas 56 (21.1%) always advised it. For myoclonus, the most frequently used first-line drug was valproate (181, 68%), followed by levetiracetam (58, 21.8%). Most (150, 56.4%) of the respondents favored personalized therapy for the individual patient in terms of the duration of disease-modifying treatment. The patient follow-up was reported to be poor, with most (171, 64.3%) of the patients following up only occasionally and 24 (9%) respondents indicating that patients are lost to follow-up promptly after the initial visit. Conclusions: While SSPE remains a vaccine-preventable illness and the focus should be on prevention through vaccination, there is an unmet urgent need among Indian neurologists for better-defined treatment strategies for patients with SSPE. [ABSTRACT FROM AUTHOR]

Introduction: Measles, a highly transmissible disease marked by fever and a maculopapular rash, posed a substantial threat to life in the 1960s. Nevertheless, the advent of the measles vaccine had a profound impact, significantly diminishing its toll on mortality. Similarly, through effective influenza surveillance and early epidemic warning systems, public health officials can timely identify influenza trends and provide crucial scientific support for prevention and control measures. This proactive approach holds great public health significance. Aim: To analyse the long-term trend of measles cases in Rajasthan, India, and the impact of Coronavirus Disease-2019 (COVID-19) on it, with future predictions using Auto-Regressive Integrated Moving Average (ARIMA) modelling. Materials and Methods: The present study was a retrospective, descriptive observational study in which monthly diagnosed measles cases were collected from the Measles Rubella Laboratory, Department of Microbiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India, for the period of April 2010 to April 2023. An ARIMA model was developed using data from 2010 to 2020 to predict the monthly number of measles cases in 2021. The predicted values were then compared to the actual cases in 2021 to assess the model’s accuracy. Results: Out of the total positive cases, males were slightly more prone to acquire infection than females (1734 males, 54%; 1477 females, 46%). The monthly index for new measles cases ranged from 0.11 to 2.6. It reached its lowest point in July (0.106) and August (0.25) and peaked in March (2.594) and April (1.84). The overall trend was fluctuating; however, the incidence of measles cases clearly increased after the year 2021. The difference between observed cases and predicted cases for the period of April 2020 to December 2021 was not statistically significant (t-value=0.261 and p-value=0.797). Conclusion: The fluctuating trend of measles was observed during the last decade; however, the observed cases of measles showed an upward trajectory during and after the COVID-19 outbreak. This study also highlighted the monthly index of the measles cases, which peaked in March to April and was lowest in July to August. [ABSTRACT FROM AUTHOR]

Measles remains a critical public health concern causing significant morbidity and mortality globally. Despite the success of measles vaccination programs, challenges persist, particularly in India. This study investigates dose-wise measles vaccination coverage and explores gaps in immunization focusing on zero-dose, one-dose, and two-dose coverage among children aged 24–35 months. The National Family Health Survey 2019–21 (NFHS-5) served as the data source and the study analyzed information from 43,864 children aged 24–35 months. Sociodemographic variables such as birth order, wealth quintile, gender, social group, religion, residence, mother education, delivery-related factors, and media exposure were considered. Statistical analysis involved weighted estimates, chi-square tests, and multivariate multinomial logistic regression. The study revealed that challenges persist in achieving optimal measles vaccination coverage. Analysis by sociodemographic factors highlighted disparities in coverage, with variations in zero dose prevalence across states and districts. The percentage of zero-dose children was significantly higher, with 11.5% of children in India remaining to receive any measles vaccination. Factors influencing vaccine coverage include birth order, age, wealth quintile, social group, religion, residence, maternal education, place of delivery, media exposure, and mode of delivery. The findings from the spatial analysis show the clustering of zero-dose children is high in the northeastern states of India. Measles zero-dose children pose a significant obstacle to achieving elimination goals. Spatial analysis identifies clusters of unvaccinated populations guiding targeted interventions. The study aligns with global initiatives such as the Immunization Agenda 2030 emphasizing equitable vaccine access and discusses how India can tailor its strategies to achieve the goal. Lessons from polio eradication efforts inform strategies for measles elimination, stressing the importance of high-quality data and surveillance. The study underscores the urgency of addressing last-mile measles vaccination gaps in India. Spatially targeted interventions informed by sociodemographic factors can enhance immunization coverage. Achieving measles elimination requires sustained efforts and leveraging lessons from successful vaccination campaigns. The study findings have the potential to contribute to informed decision-making, supporting India's roadmap for the measles and rubella elimination goal. [ABSTRACT FROM AUTHOR]

Rash and fever are some of the most common chief complaints present in paediatric dermatology emergencies. The spectrum of differential diagnosis is broad, including many different infectious and some non-infectious agents. A systematic approach involving detailed history taking, careful clinical examination along with particular attention to epidemiological features are the most important factors to make a diagnosis. This article reviews the morphological patterns of various causes of fever with rash in children, including infectious as well as non-infectious causes, with special emphasis on the Indian scenario. We intend to highlight the clinical characteristics of each cause, which will not only help make a clinical diagnosis but also distinguish benign versus life-threatening causes of skin rash in febrile paediatric patients and provide early medical intervention. [ABSTRACT FROM AUTHOR]

Background: In alignment with the Measles and Rubella (MR) Strategic Elimination plan, India conducted a mass measles and rubella vaccination campaign across the country between 2017 and 2020 to provide a dose of MR containing vaccine to all children aged 9 months to 15 years. We estimated campaign vaccination coverage in five districts in India and assessed campaign awareness and factors associated with vaccination during the campaign to better understand reasons for not receiving the dose. Methods and findings: Community-based cross-sectional serosurveys were conducted in five districts of India among children aged 9 months to 15 years after the vaccination campaign. Campaign coverage was estimated based on home-based immunization record or caregiver recall. Campaign coverage was stratified by child- and household-level risk factors and descriptive analyses were performed to assess reasons for not receiving the campaign dose. Three thousand three hundred and fifty-seven children aged 9 months to 15 years at the time of the campaign were enrolled. Campaign coverage among children aged 9 months to 5 years documented or by recall ranged from 74.2% in Kanpur Nagar District to 90.4% in Dibrugarh District, Assam. Similar coverage was observed for older children. Caregiver awareness of the campaign varied from 88.3% in Hoshiarpur District, Punjab to 97.6% in Dibrugarh District, Assam, although 8% of children whose caregivers were aware of the campaign were not vaccinated during the campaign. Failure to receive the campaign dose was associated with urban settings, low maternal education, and lack of school attendance although the associations varied by district. Conclusion: Awareness of the MR vaccination campaign was high; however, campaign coverage varied by district and did not reach the elimination target of 95% coverage in any of the districts studied. Areas with lower coverage among younger children must be prioritized by strengthening the routine immunization programme and implementing strategies to identify and reach under-vaccinated children. [ABSTRACT FROM AUTHOR]

The neutralizing antibody (Nt-Ab) response to vaccine and wild-type measles viruses (MeV) was studied in suspected measles cases reported during the years 2012–2016. The neutralization activity against MeV A, D4 and D8 genotypes was studied on sera (Panel A; n = 68 (measles-immunized) and Panel B; n = 50 (unvaccinated)) that were either laboratory confirmed or not confirmed by the presence of IgM antibodies. Additionally, the Nt-Ab response in Panel A was measured against the MeV vaccine and four wild-type viruses. Neutralization results were compared using homology modeling and molecular dynamics simulation (MDS) of MeV-hemagglutinin (H) and fusion (F) proteins. Overall, the Nt-Ab titres for MeV-A were found to be significantly lower than MeV-D4 and MeV-D8 viruses for Panel A. No major difference was noted in Nt-Ab titres between MeV-D8 viruses (Jamnagar and New Delhi), whereas MeV-D4 (Sindhudurg and Bagalkot (BGK) viruses) showed significant differences between Nt-Ab titres for Panel B. Interestingly, the substitutions observed in epitopes of H-protein, L249P and G316A are observed to be unique to MeV-BGK. MDS of H-protein revealed significant fluctuations in neutralizing epitopes due to L249P substitution. The majority of the clinically suspected cases showed Nt-Abs to MeV wild-types. Higher IgG antibody avidity and Nt-Ab titres were noted in IgM-negatives than in IgM-positives cases, indicating reinfection or breakthrough. MDS revealed reduced neutralization due to decreased conformational flexibility in the H-epitope. [ABSTRACT FROM AUTHOR]

Dystonia has been described in a few cases with SSPE, but there are only very few reports with status dystonicus and none from South India. Here, we report a six-year-old child presenting with severe dystonic posturing of all four limbs and trunk for 10 days duration following a febrile illness and initially treated elsewhere as viral encephalitis. Scalp EEG showed periodic high-amplitude slow wave discharges. MRI brain showed T2/FLAIR hyperintensity in bilateral frontal, left parietal, and deep white matter, extending across the corpus collosum with diffuse cerebral atrophy. The titer for IgG antibodies to measles virus by ELISA was 1:625, suggestive of SSPE. With medications, dystonia used to subside transiently; however, the patient had worsening of symptoms and showed gradual deterioration. [ABSTRACT FROM AUTHOR]

Subacute sclerosing panencephalitis (SSPE) is a progressive neurodegenerative disease of children and young adults that may occur as an uncommon complication 7-10 years after a measles infection. In measles - endemic countries like India, the incidence of this fatal disease is high and more number of new cases are detected in recent times. In this case series, we have presented three cases of SSPE between the 4 and 5 years age group, presented with abnormal movement and neuroregression and diagnosed by characteristic clinical features, raised anti-measles antibody titer in CSF, and typical Electroencephalography findings. All of them had a history of measles infection before the vaccination and very short latency period between measles infection and the development of SSPE. They were discharged in stable condition after the treatment with oral Isoprinosine and intrathecal Interferon alfa 2b. Early age of presentation, short latency period, and apparently good response to treatment for the time being prompted us to present these cases. [ABSTRACT FROM AUTHOR]

Background: Infectious diseases such as measles and rubella (MR) spread quickly to infect vulnerable populations, especially children below 5 years. Mass vaccination had been implemented to prevent it and its success has been observed through decreasing numbers of cases. The Government of India started MR campaign in February 2017, and Maharashtra was one of the selected states for it. The study was planned to find out the trend of measles cases before and after MR campaign and also to find out the effect of lockdown due to pandemic on vaccine usage. Aim: The aim of this study is to find out the trend of MR cases before and after MR campaign. Materials and Methods: A Descriptive observational study was done in tertiary care center for 2 years. Measles cases from the past 5 years were taken, and the impact of MR campaign was seen. Lockdown due to COVID-19 pandemic had an impact on the vaccination drive. To find out the impact, data for different vaccines were collected from different health centers, and analysis was done in Epi-info. Results: Post MR campaign, there was a sharp decrease in measles cases. Measles mostly targeted children below 6 years, and infants were seen having the longest stay in hospital due to the infection. At the onset of lockdown due to pandemic, vaccine consumption has gone down everywhere in the study. Conclusion: Vaccination is a proven weapon to prevent vaccine-preventable diseases, and measles is no different from other infectious diseases. Lockdown hindered the process of mass vaccination of vaccine-preventable diseases and which has gone down everywhere. [ABSTRACT FROM AUTHOR]

Supplementary immunization activities (SIAs) aim to interrupt measles transmission by reaching susceptible children, including children who have not received the recommended two routine doses of MCV before the SIA. However, both strategies may miss the same children if vaccine doses are highly correlated. How well SIAs reach children missed by routine immunization is a key metric in assessing the added value of SIAs. Children aged 9 months to younger than 5 years were enrolled in cross-sectional household serosurveys conducted in five districts in India following the 2017–2019 measles-rubella (MR) SIA. History of measles containing vaccine (MCV) through routine services or SIA was obtained from documents and verbal recall. Receipt of a first or second MCV dose during the SIA was categorized as "added value" of the SIA in reaching un- and under-vaccinated children. A total of 1,675 children were enrolled in these post-SIA surveys. The percentage of children receiving a 1st or 2nd dose through the SIA ranged from 12.8% in Thiruvananthapuram District to 48.6% in Dibrugarh District. Although the number of zero-dose children prior to the SIA was small in most sites, the proportion reached by the SIA ranged from 45.8% in Thiruvananthapuram District to 94.9% in Dibrugarh District. Fewer than 7% of children remained measles zero-dose after the MR SIA (range: 1.1–6.4%) compared to up to 28% before the SIA (range: 7.3–28.1%). We demonstrated the MR SIA provided considerable added value in terms of measles vaccination coverage, although there was variability across districts due to differences in routine and SIA coverage, and which children were reached by the SIA. Metrics evaluating the added value of an SIA can help to inform the design of vaccination strategies to better reach zero-dose or undervaccinated children. [ABSTRACT FROM AUTHOR]

Introduction: Measles is a highly infectious acute viral disease that can lead to serious complications and death. Effective immunisation coverage for measles will play a pivotal role in its elimination strategy. So, the global commitment, strengthening of health infrastructure and effective vaccine coverage are essential to achieve a world that will be free of measles. Aim: To assess the factors associated with the occurrence of measles and to determine the factors responsible for non compliance to measles vaccination. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics at Niloufer Hospital, Hyderabad, India, during the period from October 2019 to March 2020 among the children clinical diagnosed with measles. The patients were evaluated for fever, rash, respiratory and other clinical symptoms associated with measles. History of measles vaccination and vitamin A administration were taken. Blood samples of patients were collected and measles specific IgM antibody detection test was done by Enzyme-linked Immunosorbent Assay (ELISA). Data was statistically analysed and presented as numbers and percentages were calculated. Results: Among 129 children, clinically diagnosed of measles, the predominant age group children effected was 1-6 years 68 (52.71%). Overall, 38 (29.5%) were vaccinated and 85 (65.9%) were unvaccinated during routine immunisation schedule. Measles-Containing Vaccine (MCV) coverage during Supplementary Immunisation Activities (SIAs) was also very limited (19.3%). Out of 129 cases, 121 (93.7%) were confirmed positive by measles IgM ELISA, 5 (3.8%) samples gave equivocal results and 3 (2.3%) were negative for the test. Conclusion: Inspite of the availability of effective and inexpensive measles vaccine for decades, vaccination coverage remains inadequate across the globe. So, effective implementation of vaccine services and monitoring of its surveillance system are needed for eradication of measles. [ABSTRACT FROM AUTHOR]

Furthermore, it would also be plausible that travellers experienced the nationwide COVID-19 vaccination campaign and, thus, raised their awareness of travel vaccination.[9] This study has several limitations. Of all the participants, 138 (62.2%) were eligible for measles vaccination as they had no or unknown history of routine measles vaccination and no or unknown history of measles disease, and a total of 50 (22.5%) had visited a clinic for travel vaccination. Keywords: COVID-19; India; travel; vaccination; Measles EN COVID-19 India travel vaccination Measles 1 3 3 09/13/23 20230701 NES 230701 The disruption of vaccination activities during the Coronavirus Disease of 2019 (COVID-19) pandemic posed a significant threat of measles, which is a highly contagious pathogen resurging globally.[1] After the COVID-19-related restrictions were lifted, a sharp increase in tourism, therefore, seems to raise the global risk of measles outbreaks. [Extracted from the article]

A growing number of organisations, including medical associations, recommend that research subjects should be given the option of being informed about the general outcome and results of the study. We recently completed a study involving nine serosurveys from 2018 to 2020 in five districts of India among three age groups (children 9 months to < 5 years; 5 to < 15 years of age, and women 15 to < 50 years of age before and after the measles and rubella (MR) vaccination campaigns). In Palghar district of Maharashtra all individuals in 30 selected clusters were enumerated, and 13 individuals per age group were randomly sampled. We established the procedures to return the results to the respondents for each stage of the survey. Of the 1,166 individuals selected for the measles and rubella serosurvey, 971 (83%) agreed to participate and were enrolled. Participants were informed that they will only be contacted if they test seronegative for measles and/or rubella antibodies. Overall, 140 individuals enrolled in the survey tested seronegative for IgG antibodies to measles and/or rubella viruses; were provided the reports and informed to seek medical advice. Upon follow up by phone, 10% (14) of the 140 participants reported to have been vaccinated. In this paper we discuss the procedures, experiences and considerations in returning results to participants in a community-based measles and rubella serosurvey. Although the lessons learned are specific to post measles-rubella vaccine campaign serosurvey in India, they might be helpful to those contemplating sharing results to participants of large scale survey settings. [ABSTRACT FROM AUTHOR]

Introduction  Subacute sclerosing panencephalitis (SSPE) is a devastating neurodegenerative disease occurring as a complication of measles infection that is still prevalent in low-resource countries. Clinical and electrographical variability in SSPE can lead to diagnostic delays. Methods  Children diagnosed with SSPE in a tertiary care pediatric hospital in India in a period of 8 years were included in the study. The diagnosis was established on the basis of Dyken's criteria. The demographic data, clinical presentations, investigations, treatment approaches, and outcomes were reviewed and recorded. Results  Thirty-four patients were included in the analysis. Average age at symptom onset was 7 years, 5 months. Majority of the children were not vaccinated for measles. Most patients (80%) presented with stage 2 of illness. Nearly 25% presented with atypical clinical features. Myoclonus was the most predominant feature seen after diagnosis. Electroencephalography (EEG) was the most useful investigation for suspecting the diagnosis. All patients showed deterioration in neurological status with time and 20% died during follow-up. Conclusion  Atypical presentations of SSPE must be recognized in areas with high incidence to institute timely treatment and establish prognosis. EEG findings were found to be the most important indicator for diagnosis. Measles eradication will pave the way for elimination of this dreaded disease. [ABSTRACT FROM AUTHOR]

Objective To expand the measles and rubella laboratory network of India by integrating new laboratories. Methods In collaboration with the World Health Organization (WHO), the Indian government developed a 10-step scheme to systematically expand the number of laboratories performing serological and molecular testing for measles and rubella. The Indian Council of Medical Research and WHO identified suitable laboratories based on their geographical location, willingness, preparedness, past performance and adherence to national quality control and quality assurance mechanisms. The 10-step scheme was initiated with training on measles and rubella diagnostic assays followed by testing of both measles and rubella serology and molecular unknown panels, cross-verification with reference laboratories and ended with WHO on-site accreditation. Findings After extensive training, technical support, funding and monitoring, all six selected laboratories attained passing scores of 90.0% or more in serological and molecular proficiency testing of measles and rubella. Since 2018, the laboratories are a part of the measles and rubella network of India. Within 12 months of initiation of independent reporting, the six laboratories have tested 2287 serum samples and 701 throat or nasopharyngeal swabs or urine samples. Conclusion The process led to strengthening and expansion of the network. This proficient laboratory network has helped India in scaling up serological and molecular testing of measles and rubella while ensuring high quality testing. The collaborative model developed by the Indian government with WHO can be implemented by other countries for expanding laboratory networks for surveillance of measles and rubella as well as other infectious diseases. [ABSTRACT FROM AUTHOR]

Background: Despite high immunization coverage, outbreaks of measles do occur, but occurrence of measles outbreak among adolescents in a health care institution setting in India, is rather unusual or unreported. Methods: On the 21st November 2013, cases of suspected measles among the students were reported at St. John’s Medical College, Bangalore. The preliminary investigation using the epidemiological case sheet identified seven suspected cases of measles. This led to a detailed investigation for a suspected outbreak at the campus. The outbreak was notified to the government authority. A measles outbreak investigation case sheet was distributed among the students and a door to door survey was carried out. The laboratory confirmation of suspected measles cases was done at the National Institute of Virology, Bangalore by IgM test for measles specific antibodies, viral culture and RT PCR. Results: The outbreak occurred during the months of November and December 2013. A total of 13 confirmed cases of measles were identified with an overall attack rate of 2%. Five cases were confirmed by IgM test for measles antibodies, besides virus isolation and RT PCR was positive for two cases. More than half (54%) of the suspected cases were vaccinated for measles and the rest were unvaccinated (23%) or had an unknown vaccination status (23%). There were no complications or deaths due to measles. Conclusion: An outbreak of measles among a group of adolescents in a health care institutional setting who were mostly vaccinated raises a concern about the vaccine effectiveness and the duration of vaccine efficacy after immunization. Along with improving the immunization coverage of two doses of measles vaccine, research is needed to determine the most-effective timing of delivering the second routine dose to bring down the susceptible population. [ABSTRACT FROM AUTHOR]

Background: Measles is the leading cause of child mortality in India. MR vaccine provides immunity against measles & rubella and was offered in 2 doses – 9 completed months and 16-24 months of age. This study aims to assess the awareness among the parents of children (aged 9 months – 2 years) in Mangalore about the presence and the risks associated with measles and rubella and to determine how the parents perceive the MR vaccination drive launched by the Government of India in terms of its necessity and safety of their children. Methodology: This cross-sectional study was conducted among 188 parents of children between the age of 9 months – 2 years from health centers in Mangalore. The data was collected using a semi-structured questionnaire- consisting of 3 sections: 1) Socio-demographic information of study participants 2) Knowledge-based questions on measles and rubella 3) Perception of MR vaccination drive. Data was analyzed using SPSS version 21. Appropriate statistical tests were applied, and results were interpreted. Results: The study population mainly comprised individuals aged 23-30 years (37.8%), predominantly females (65.3%), they prefer government hospitals for child vaccination (71.5%), resulting in 73.1% of children being meeting national immunization targets by age 2 years. Only 33,4% of the parents have understanding of Measles and Rubella diseases and associated risks. Parents exhibit awareness of the MR vaccine drive (Overall 86.7%) through newspapers (46.0%) and schools (39.0%), supporting its mandatory status (76.0%). Doctors play a crucial role in addressing parental queries (59.5%) regarding the MR vaccination drive. Conclusions: Parents show awareness of the MR Vaccination Drive but lack understanding of Measles and Rubella diseases and associated risks. Despite limited knowledge, parent's express receptiveness to the MR Vaccination, drive for their children's safety, with some showing interest in learning more about the vaccine and diseases. [ABSTRACT FROM AUTHOR]

Background: Measles is a communicable and potentially fatal, but vaccine- preventable disease. India has set a target of 95% vaccination coverage for Measles-Rubella elimination by the end of 2023 with the help of Intensified Mission Indradhanush (IMI 5.0). The National Immunization Schedule of India recommends two doses of Measles-Rubella (MR) vaccine at 9 months and 16-24 months. The immunization coverage dropped across the globe during the COVID-19 pandemic during the year 2020-2021. Consequently, there was a recent surge in measles cases in some Indian states. The state of Maharashtra reported over 3000 cases; and its capital city Mumbai reported with over 400 cases in December 2022. Various factors such as fear of side effects, lack of information and ignorance have been found to influence vaccine uptake. Objective: To determine the factors associated with the uptake of measles vaccine in the community. Methodology: The study data collection was conducted during November- December 2023, in the M-east municipal ward of Mumbai, using Qualitative research methods until data saturation, i.e., In-depth Interviews and Focus- Group Discussions. 1. On a one-to-one basis, In-depth Interviews (IDI) were conducted among health authorities and healthcare workers involved in the immunization program, from the Public Health Department of Mumbai. 2. Focus-Group Discussions were conducted with a homogenous group of participants comprising mothers of under-five children, and healthcare workers. Results: The most common barriers in measles vaccination that emerged was fear of side effects and overworked healthcare workers, while the motivating factors were good rapport between the community and healthcare workers and communicating health-related information. One of the core themes that emerged was the need for strengthening routine immunization services. Conclusion: Tremendous efforts are taken by the public health systems and healthcare workers in the community for ensuring good quality healthcare, including routine immunization. However, establishing a good rapport and building trust among the community members is the need of the hour for ensuring a robust immunization coverage uniformly across the nation. [ABSTRACT FROM AUTHOR]

The cross-sectional observational study evaluated the prevalence and predictors of needle-fear among school-going children during mass Measles-Rubella (MR) immunization campaign (year 2017) in the north Indian city of Chandigarh. Fear of needle was assessed using a single-item self-report global question, anxiety was assessed using the Likert scale (score 1–5) and the standardized "Children Faces Scale" where facial responses were graded from 0 to 4. Out of a total sample of 2568 school children, 1225 (47.7%) reported needle fear (95% CI: 45.8%–49.6%) on a global single item assessment. On an anxiety related Likert scale, 52.3% did not respond (mainly younger children) and among those who responded, 42.6% (523/1226) showed significant anxiety (score of ≥3 on Likert scale of 1 to 5). Finally, 17.4% children (95% CI: 15.9%–18.9%) (n = 446/2568) scored 2 or above (indicating significant needle fear) on the 'Children Faces Scale' during the actual vaccination procedure. The needle fear were significantly increased among girl students as compared to boys (adjusted OR 2.58; 95% CI: 2.05–3.24, p < 0.001) as well as children accompanied by their parents (adjusted OR 2.05; 95% CI:1.57–2.69, p < 0.001). On the other hand, needle fear was significantly lowered in children studying in private schools as compared to public school children (adjusted OR 0.45; 95% CI: 0.28–0.74, p = 0.002). The needle fear, which was an overriding concern in the minds of girls, children accompanied by their parents, and public-school students, must be proactively addressed for successful mass vaccination campaigns. These findings assume further importance with recent international roll out of COVID 19 vaccine. [ABSTRACT FROM AUTHOR]

Subacute sclerosing panencephalitis (SSPE) is typically observed in school-going children, adolescents, and young adults. Herein, we report a 3-year-old boy of SSPE and systematically review all such reported cases (age ≤3 years). We searched PubMed database on June 16, 2020 with "English language & Human only" restrictions. Eligible publications were screened and retrieved by three authors (NK, SP, and RU). Variables like author, year of publication, country, age of onset, sex, duration of illness, immunization, history of measles, clinical presentation, neuroimaging, treatment, and outcome were extracted. Neurological outcome was assessed in terms of improvement, static course or death. The defined search criteria resulted in 791 manuscripts (1951 to June 16, 2020). Only 47 manuscripts were eligible for data extraction. Seventy cases were retrieved. The mean age of onset was 26.34 months. The M:F ratio was 3.2:1. Turkey (19 cases), India (10 cases), and Japan (10 cases) collectively comprised more than half cases of SSPE. Only six children were immunized, 17 have no measles immunization, and the rest 47 had insufficient immunization records. Preceding history of measles was present in 27 cases. Most patients presented in stage II/III with altered sensorium, myoclonic jerks, and seizures. The most common reported outcome was death (18/70) followed by vegetative state (10/70). The absence of measles vaccination is frequently associated with childhood SSPE. Early measles vaccination may prevent SSPE in toddlers. Perinatal measles infection results in short onset latency and fulminant course. Outcome was not good in reviewed age group of ≤3 years. [ABSTRACT FROM AUTHOR]

Background: The nutritional and immunization status of children can play an important role in determining their future health status of a particular country. The aim of the present study is to investigate the nutritional and immunization status of under-five children in India and Bangladesh, and to find the difference in the status between these two countries. Methods: We have used the National Family Health Survey data, 2015–2016 of India and Bangladesh Demographic Health Survey, 2017–2018 datasets. The sample sizes are 222,418, among them 8759 and 8759 children for India and Bangladesh respectively. The nutritional status of under-five children is measured by standard anthropometric indicators of height-for-age (HAZ) and weight-for-age (WAZ). Regarding child immunization status, only BCG, DPT, polio and measles vaccinations are considered for the present study. Multiple binary logistic model has been used for analysing the data. Results: This study reveals that the prevalence of stunting and underweight of under-five children in India are higher than Bangladeshi children. Secondary and higher educated mothers are more likely of having normal HAZ and WAZ children than up to primary educated mothers for both countries. Chances of having normal HAZ and WAZ are higher among non-poor category for both countries. The present study also shows that immunization status of Bangladeshi children is better than Indian children except measles. Religion of mother also shows influence on immunization status of children in India whereas Bangladesh shows no significant results regarding religion. Mother's educational attainment and wealth index show influence on immunization status among children for both countries. Conclusions: The study concludes that a remarkable number of under-five children are suffering from under nutrition for both countries, however Bangladeshi children have better nutritional and immunization status compared to Indian children. Higher wealth index, better educational attainment and lower unemployment of Bangladeshi mothers may be the causes for better nutritional and immunization status of children. Mother's socio-economic factors have significant impact on determining the child's health status. Our findings can help to government of Indian and Bangladesh for taking health policy to improve under-five children nutritional and immunization status. [ABSTRACT FROM AUTHOR]

The measles virus is an RNA virus belonging to the Paramyxoviridae family. It leads to an acute communicable illness that primarily involves the respiratory tract. Vaccination has significantly reduced the overall incidence and mortality worldwide; however, outbreaks still occur globally each year due to several factors. The SARS-CoV-2 pandemic has been a major hurdle since 2020. Despite the World Health Organization's goal to eradicate measles by 2023, there has been an increase in measles incidence in India, with 61,562 cases in 2022. Vaccination is a crucial preventive measure, and coverage needs to be increased through education, advocacy, and outreach to isolated communities. • Measles is an acute illness, characterized by high-grade fever, coryza, cough, conjunctivitis, and Koplik spots and measles virus is an RNA virus belonging to the Paramyxoviridae family. • Vaccination has significantly reduced the overall incidence and mortality worldwide since 1985, however, outbreaks still occur specially in developing countries each year due to several reasons. • Vaccination is a crucial preventive measure and coverage needs to be increased through education, advocacy, and outreach to isolated communities. [ABSTRACT FROM AUTHOR]

Background/Aim: Mumps is by vaccine preventable infectious disease characterised by parotitis. In India mumps vaccines are not currently used under National Immunisation Programme (NIP). Waning of vaccine-induced immunity is considered to play a central role in the re-emergence of mumps. The comprehensive data on the seroepidemiology of measles, mumps, and rubella (MMR) as well as studies which compare the antibody titre among mumps vaccine naive- and mumps vaccinated children are lacking. The aim of this study was to estimate and compare mumps specific antibody titre in children with and without MMR vaccine. Methods: In 2019/2020, blood samples were collected from 100 healthy children attending immunisation clinic in Government Medical College Kota and associated J K Lon Maternal and Child care hospital Kota. The samples were investigated for MMR IgG antibodies using ELISA. Results: Out of total 100 children included in the study, 32.27 % vaccinated and 4.83 % non-vaccinated children were positive for mumps IgG antibody in the age group of 6 months to 6 years of age. Children aged 6 to 12 years, vaccinated and non-vaccinated, had 31.57 % and 26.57 % positivity, respectively. The seroprevalence of measles, mumps and rubella antibodies among 50 MMR vaccinated children were 94 %, 64 %, and 96 %, respectively. A high measles and rubella seroprevalences were observed among all children age groups, suggesting an effective control program, while the mumps seroprevalence decreased significantly with age. Conclusion: The maximum vaccine effectiveness against mumps for 2 doses of MMR vaccine is ≈ 96 %. The herd immunity threshold to block mumps virus transmission is ≥ 86 %. In this study only 64 % of the vaccinated children were found to have IgG mumps antibodies. In view of morbidity following mumps infection there is a need to incorporate mumps vaccine along with measles and rubella vaccine in the NIP instead of MR. [ABSTRACT FROM AUTHOR]

Background & objectives Immunization is an efficient and cost-effective way of lowering the infectious disease related morbidity and mortality in the community. The current study reviewed the trend of immunization, gaps in doses of vaccine given at the same time and gaps between the doses of same vaccine from National Family Health Survey (NFHS 1-5) rounds. Methods The current study extracted data from all five NFHS rounds conducted from 1992-93 to 2019-21. The study analyzed the State-wise and demography-wise distribution of trends of immunization from NFHS-1 to NFHS-5. State wise distribution of change in vaccination coverage between NFHS-4 and 5 was analyzed. The study also assessed the State-wise trends of fully vaccinated and unvaccinated children from NFHS 1-5. Results The northeastern States had maximum gap between the vaccination given at birth i.e., 47.3 per cent between BCG and Hepatitis B, and 32.8 per cent between BCG and birth dose of OPV in Manipur in NFHS -5. A gradual rise in the percentage of male (40.2%) and female (41.9%) childrens' vaccination was found across the NFHS rounds with reduction in gap between the male and female vaccination from NFHS-1 (2.6%) to NFHS-5 (0.9%). The percentage of vaccination decreased proportionately with birth order. The vaccination coverage has increased in both urban and rural population, but the rise was higher in rural (45.9%) areas than urban (24.8%). An increase in percentage of fully vaccinated children by 41.2 per cent and decrease in percentage of non-vaccinated children by 26.4 per cent was observed from NFHS-1 to NFHS-5. Interpretation & conclusions Our analysis clearly suggests that immunization coverage has improved over a period of time but the variability in vaccine coverage across States and gap in vaccine doses needs attention of the policy makers to cover this for achieving our national immunization goals.

Molluscum contagiosum (MC) is a mucocutaneous viral infection, often self‐limiting but untreated lesions can often last for 2 months to 2 years. Previously intralesional measles, mumps, and rubella (MMR) vaccine has been tried for the treatment of warts but no studies exist of its use in MC. We report our experience with intralesional MMR in 22 patients of MC. The study was carried out to assess the efficacy and safety of intralesional MMR vaccine in patients of MC. We retrospectively analyzed records of patients who received intralesional MMR for MC from September 2018 to September 2019. Demographic characteristics, number, size, and site of molluscum lesions, number of MMR injections given, and response were recorded. Records of 22 patients were analyzed. There were 10 males and 12 females. The age of the patients ranged from 6 to 50 years with a mean of 19.72 ± 10.92. At the end of 12 weeks, 18 patients (81.8%) had complete clearance of lesions, with 4 patients (18.18%) having a partial response of more than 50%. No patient showed less than 50% or no response. In only one patient who had giant molluscum, postinflammatory hyperpigmentation was noted. No other adverse effect was seen in any of the patients. MMR is a safe, effective, easy to administer, time‐saving, and inexpensive therapy for lesions of MC. [ABSTRACT FROM AUTHOR]

Introduction: Several authors have explored the effect of individual risk factors on vaccination inequity in Indian infants. This study explores the combined impact of >1 risk factor on the probability of full vaccination.Methods: The proportion of fully vaccinated infants (aged 1-2 years) was calculated from the National Family Health Survey conducted during 1997-1998 (National Family Health Survey-2, n=10,211), 2005-2006 (National Family Health Survey-3, n=9,582), and 2015-2016 (National Family Health Survey-4, n=48,715). Full vaccination was defined as receiving Bacille Calmette‒Guerin (1 dose); diphtheria, pertussis, tetanus (3 doses); oral polio (3 doses); and measles (1 dose) vaccines. The association between full vaccination status and 6 factors (infant sex, birth order, family wealth status, maternal education level, residence type, and religion) was analyzed individually, followed by the combined impact of ≥1 of the first 4, using logistic regression models.Results: The AORs for full vaccination in the 3 surveys, respectively, were 1.09, 1.13, and 1.00 for male versus female infants; 0.68, 0.71, and 0.88 for birth order >1 versus birth order 1; 1.54, 1.96, and 1.20 for greater wealth versus lowest wealth stratum; 2.21, 2.27, and 1.27 for any maternal education versus none; 1.08, 1.10, and 1.08 for Hindu versus other religion; and 1.51, 1.10, and 0.88 for urban versus rural residence. The respective ORs of full vaccination in the 3 surveys by the number of risk factors were as follows: 1.26, 1.54, and 1.27 for 3 risk factors; 2.41, 3.23, and 1.68 for 2 risk factors; 4.42, 6.45, and 2.18 for 1 risk factor; and 7.32, 9.84, and 2.61 for no risk factor.Conclusions: The presence of multiple risk factors had a cumulative negative impact on infant vaccination in India. Despite an improvement over 2 decades, significant inequities persist.Supplement Information: This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health. [ABSTRACT FROM AUTHOR]

Background: Between 2010 and 2018, measles-related mortality had halved in India mainly with effective measles vaccination campaigns and widespread coverage across the states and population subgroups. Despite the commendable vaccination coverage, 2.9 million children in India missed the first dose of measles vaccine (MCV1) in 2017, and many of those vaccinated were not vaccinated at the recommended age (i.e. between 9 and 12 months). This study analyzed pattern and correlates of MCV1 coverage and MCV1 administration at recommended age among children aged 12-23 months in India.Methods: We used the official data from the recent round of National Family Health Survey (NFHS-4), a nationally representative cross-sectional household survey in India conducted in 2015-16. Descriptive statistics and logistic regression analysis were applied to ascertain the influence of specified socio-demographic variables affecting measles vaccination coverage in India.Results: The study revealed the distinct variations in coverage of MCV1 between the districts of India. There were also major challenges with age recommended vaccination, with about 15% of eligible children not vaccinated within the recommended age range, attributable to several socio-demographic factors. Significantly, antenatal care utilization of mothers strongly influenced MCV1 coverage and age recommended MCV1 coverage in India. The study also identified that children who missed MCV1 had one or more adverse health risks such as malnutrition, anemia and diarrhea disease.Conclusions: A socio-economic gradient exists in India's MCV1 coverage, mediated by antenatal visits, education of mothers, and highlighted socio-demographic factors. Infection with measles was significantly correlated with greater anthropometric deficits among the study cohort, indicating a wider range of benefits from preventing measles infection. Eliminating morbidity and mortality from measles in India is feasible, although it will require efficient expanded program on immunization management, enhanced health literacy among mothers, continuing commitment from central state and district political authorities. [ABSTRACT FROM AUTHOR]

Background: Globally, measles deaths were estimated to be over 1,28,000 in the year 2021, despite the easy availability of safe and effective vaccines to prevent the infection. Routine childhood immunization coverage rates dropped during the COVID-19 pandemic and India has been one of the worst affected countries. The most recent measles outbreak was reported last year in Mumbai, Maharashtra. Objectives: 1. To estimate the level of uptake of measles vaccine in children aged 12 months to 5 years 2. To determine the factors associated with the uptake of measles vaccine. Methodology: This cross-sectional study was conducted over 2 months in a municipal ward of Mumbai during Oct-Nov 2023 in mothers with children aged 12 to 60 months, living in the area for at least past 6 months. Five out of fifteen clusters of Municipal Health Post areas were selected randomly & from each, 82 eligible households were chosen randomly for door-to-door interviews with the participants. Results: Among the sample of 428 children, measles vaccine coverage was 96.7%, but only 263 (61.45%) children were vaccinated in timely manner. The facilitator for mothers in vaccine uptake was receiving information from healthcare workers during and after pregnancy (77.57%). The barriers were lack of information about vaccination schedule (18.69%), and child being unwell during vaccination (10.74%). Conclusion: Huge efforts have been taken by the Public Health Department for achieving this level of vaccine coverage, however, measles elimination is still a challenge due to delayed vaccination. [ABSTRACT FROM AUTHOR]

Objective: To map genomic diversity of Measles virus (MeV) isolates collected during 2009-2017 from ten states of India.Methods: Genome sequencing of Indian isolates and comparative genomics with global MeV using phylogeny, population stratification and selection pressure approaches were performed.Results: The first report of complete genome sequences of forty-three Indian MeV isolates belonging to genotypes D4 (eight) and D8 (thirty-five). Three Indian isolates mapped to named strains D4-Enfield, D8-Villupuram and D8-Victoria. Indian D4 isolates deviate from standard genome length due to indels in M-F intergenic region. Estimated nucleotide substitution rates of Indian MeV derived using genome and individual genes are lower than that of global isolates. Phylogeny revealed genotype-based temporal clustering, suggesting existence of two lineages of D4 and three lineages of D8 in India. Absence of spatial clustering suggests role of cross-border travel in MeV transmission.Conclusions: Evolutionary analyses suggest the need for surveillance of MeV in India, particularly in view of diversified trajectories of D4 and D8 isolates. This study contributes to global measles epidemiology and indicates no major impact on antigenicity in Indian isolates, thereby substantiating the use of current vaccines to meet measles elimination target of 2023 set by World Health Organization for South-East Asia Region. [ABSTRACT FROM AUTHOR]

Background: The current recommendation in India to commence first dose of measles immunization is at 9 months of age. The effectiveness of measles vaccination is greatly impacted by the level of maternal measles antibody (MMA) during infancy. Objectives: To find the prevalence of MMA and to study the maternal and infant factors associated with persistence of MMA among the infants in a Indian rural community. Methodology: Dried blood spot sample was collected before vaccination among infants aged 9 months and above when they came for first dose of measles vaccine to assess measles-specific maternal IgG antibody titers by enzyme immunoassay. Maternal and child factors influencing persistence of MMA were collected by interviewing the mothers. Association between various factors affecting seropositivity was tested using univariate logistic regression analysis and strength of association is reported as risk ratio with 95% confidence interval. Results: Based on the qualitative estimation among all the recruited children (250) in the study, 4 (1.6%) infants showed the presence of MMA whereas 25 (10%) of children had MMA on quantitative estimation. The effect of maternal factors, child nutrition, and sociodemographic factors on the presence of MMA was not found to be statistically significant. Conclusion: The prevalence of persistent MMA (IgG titer ≥200 mlU/ml) among the infants aged 9-12 months was 10%. The choice of vaccinating infants at the end of 9 months for the first dose of measles vaccine is justified as the remaining (90%) of infants were susceptible for measles infection at this age. [ABSTRACT FROM AUTHOR]

Introduction: Measles is a major killer disease and Rubella leads to lifelong birth defects. In India, every year nearly 2.7 million children get measles and over 4000 children are born in India with such birth defects (Congenital Rubella Syndrome).The mortality and morbidity of measles and rubella is not declining a significant level in recent years. To bring it down, government of India has planned a massive vaccination campaign on measles and rubella among children (9 months to 15 years). School based immunization was a part of the strategy. Method: This study aimed at assessing the awareness of MR vaccination among principals and teachers in 90 schools in Trichy, using a self-administered questionnaire and the results were compiled and analyzed. Result: The results showed that 94.4%of the study group was aware of the disease with the main source of awareness being media and social workers which accounted for 38.9%. The results showed that 78.9% people were convinced that measles and rubella is a big burden to our country. Respondents strongly felt that health education regarding MR vaccine was necessary in order to eradicate measles and rubella. IEC activities, Training Programs can be aimed at improving the knowledge about MR Vaccination to the school teachers. Teachers can be trained to conduct Counseling sessions to increase the acceptance rate [ABSTRACT FROM AUTHOR]

To estimate the associations between measles vaccination and child anthropometry, cognition, and schooling outcomes in Ethiopia, India, and Vietnam. Longitudinal survey data from Young Lives were used to compare outcomes at ages 7–8 and 11–12 years between children who reported receipt or non-receipt of measles vaccine at 6–18 months-of-life (n = ∼2000/country). Z-scores of height-for-age (HAZ), BMI-for-age (BMIZ), weight-for-age (WAZ), Peabody Picture Vocabulary Test (PPVT), early grade reading assessment (EGRA), language and mathematics tests, and attained schooling grade were examined. Propensity score matching was used to control for systematic differences between measles-vaccinated and measles-unvaccinated children. Using age- and country-matched measles-unvaccinated children as comparisons, measles-vaccinated children had better anthropometrics, cognition, and schooling. Measles-vaccinated children had 0.1 higher HAZ in India and 0.2 higher BMIZ and WAZ in Vietnam at age 7–8 years, and 0.2 higher BMIZ at age 11–12 years in Vietnam. At ages 7–8 years, they scored 4.5 and 2.9 percentage points (pp) more on PPVT and mathematics, and 2.3 points more on EGRA in Ethiopia, 2.5 points more on EGRA in India, and 2.6 pp, 4 pp, and 2.7 points more respectively on PPVT, mathematics, and EGRA in Vietnam. At ages 11–12 years, they scored 3 pp more on English and PPVT in India, and 1.7 pp more on PPVT in Vietnam. They also attained 0.2–0.3 additional schooling grades across all ages and countries. Our findings suggest that measles vaccination may have benefits on cognitive gains and school-grade attainment that can have broad educational and economic consequences which extend beyond early childhood. [ABSTRACT FROM AUTHOR]

Enzyme linked immunosorbent assay (ELISA) for antibody identification, is important for laboratory confirmation of rubella infection in different settings. The Enzygnost rubella ELISA, widely used in the World Health Organization (WHO) Global Measles and Rubella Laboratory Network, is expensive and often unavailable. Qualitative and quantitative performance of the Euroimmun ELISA was compared with the Enzygnost ELISA, for detection of rubella specific IgM, using 283 sera collected from suspected congenital rubella syndrome (CRS) patients and IgG antibodies using 435 sera from a serosurvey among pregnant women. Good qualitative agreement was observed for detection of both rubella specific IgM (94.7% agreement and κ of 0.86) and IgG (96.3% agreement and κ of 0.84). Bland–Altman analysis for IgG yielded a mean difference of 0.781 IU/ml with 97.1% values within ±2 SD of the mean difference. Our study findings suggest that Euroimmun ELISA may be considered for detection of rubella specific IgM in suspected CRS cases and rubella specific IgG in surveillance studies. [ABSTRACT FROM AUTHOR]

Background: In Tamil Nadu, where health indicators are above the national average and routine immunization coverage is >95%, the tepid response to Measles-Rubella (MR) mass vaccination campaign was unexpected. Several parents refused MR vaccine for their children, due to false news claiming inefficiency and adverse effects due to the vaccine. Aim: This study was conducted to assess the Measles-Rubella (MR) mass vaccination coverage and to know the motivating factors and barriers for vaccination. Methods: A cross-sectional study was conducted in a rural area immediately following the mass vaccination campaign. Using a pre-tested structured questionnaire, data was collected on awareness of MR vaccination campaign, MR vaccination status, motivating factors and reasons for non-acceptance of the vaccine. Results: Vaccine coverage among the 616 children surveyed was 80.2%. Factors that motivated acceptance of vaccine among the immunized participants were easy access to immunization (85%), support and motivation from school teachers (41.1%) and community level health workers (25.5%). Barriers reported among the unimmunized participants were rumours of adverse effects (47.5%), fear of adverse effects (53.3%), and no faith in immunization (18.9%). Risk factors for vaccine refusal included female child (OR = 1.7, 95%CI = 1.1-2.6), Children not attending school (OR = 3.32, 95%CI = 2.1-5.1), Mothers with higher education (OR = 4.3, 95%CI = 1.2-15.2). Conclusion: An effective communication strategy addressing the needs and concerns of the public/parents should be in place and started early on before initiation of the mass vaccination programme. [ABSTRACT FROM AUTHOR]

Accredited Social Health Activists (ASHAs) are female community health workers whose primary role is to promote utilization of primary healthcare services and improve sanitation in rural areas and are financially incentivized for services provided. Prior studies evaluating ASHAs have been largely qualitative, and assess their knowledge, skills, and practice. Globally, there have been very few studies that have quantitatively assessed community health workers. We analyzed the cost effectiveness of ASHAs in facilitating measles vaccination among children under 5 years during 2012–2013. We utilized Markov modeling simulating a cohort of children in villages with and without ASHAs. We extrapolated the health states to a lifetime of 68 years to estimate the effects of ASHA intervention. Measles vaccination rates were obtained from 2013 District Level Household and Facilities Survey 4. Other parameter estimates were obtained from a review of relevant literature. ASHA intervention was highly cost effective at $162 per DALY averted compared to no ASHA and remained cost effective with the ASHA incentive increased from $2 to $15, across the range of probabilities and cost parameters. Analyses were sensitive to probability of death due to childhood pneumonia, susceptibility to measles after one dose measles vaccine, and probability of pneumonia after measles infection. ASHAs were cost-effective under a wide range of scenarios even when a single health outcome such as measles vaccination was considered. The Government of India and individual state governments of India should consider increasing the incentives provided to ASHAs. [ABSTRACT FROM AUTHOR]

Abstract Objective Delayed vaccination increases the susceptibility window for vaccine preventable diseases. Our analysis estimates the proportion of children between 10 and 23 months of age with delayed vaccination in India and the associated socio-demographic, maternal and child related factors. Methods We used individual level data from the National Family and Health Survey 4, conducted in 2015–2016. The primary outcome of the study was delayed vaccination for BCG, DPT- 1st dose and Measles. Delayed vaccination for each vaccine was defined as administration of the vaccine dose after 28 days of the minimum recommended age, as per the national immunization schedule in India. We estimated the proportion of children with delayed vaccination for each vaccine and used multivariable logistic regression to explore associated factors. Findings In the current analysis, 23.1%, 29.3% and 34.8% of children aged 10 to 23 months had delayed vaccination for BCG, DPT-1st dose and Measles respectively. Children from Muslim families (aOR 1.36 for BCG; aOR 1.45 for DPT-1; aOR 1.26 for Measles); birth weight < 2000 g (aOR 2.33 for BCG; aOR 1.53 for DPT-1; aOR 1.36 for Measles) had higher odds of delayed vaccination. Lower maternal education and belonging to a family from lower wealth quintile had higher odds of delayed vaccination. Children of mothers who had tetanus toxoid immunization during pregnancy had lower odds of delayed vaccination (aOR 0.69 for BCG; aOR 0.76 for DPT-1; aOR 0.78 for Measles). Conclusion The proportion of children with delayed vaccination is high in India. Vaccine timeliness should be a core indicator of the immunization program with greater focus on groups with higher chances of delayed vaccination i.e. home birth, low birth weight new-borns, poorer households, children of mothers with lower education and children from Muslim families. [ABSTRACT FROM AUTHOR]

The civic body has set up isolation wards in multiple hospitals, surveillance systems to identify cases and track Measles-Rubella vaccine dropouts, and vaccination sessions across Mumbai to control the spread of the disease. Disruption of the routine immunization programs due to the COVID-19 pandemic has widened the vaccine coverage gap even further, resulting in nearly 3 million children in India not receiving any doses of the measles vaccine [[7]]. Keywords: Measles; COVID-19; India; outbreak EN Measles COVID-19 India outbreak 326 327 2 05/16/23 20230601 NES 230601 As India continues to recover from the COVID-19 pandemic after more than 44 million cumulative cases, an upsurge in cases of measles has been reported in multiple states across the country, particularly in the state of Maharashtra. [Extracted from the article]

In the third week of September 2022, an outbreak of measles was reported from a slum in Eastern Mumbai, India. We sought to investigate whether failure to vaccinate or vaccine failure was the cause. We constructed an epidemic curve, drew a spot map, and calculated the attack rate and case-fatality ratio. We calculated vaccine effectiveness (VE) for one and two doses of measles vaccine in an unmatched case-control study and did stratified analysis by sex, availability of vaccination card, and migrant status. We identified 358 cases and four deaths with a 11.3% attack rate and 1.1% case fatality, both being highest among 0-24-month-old boys. The epidemic curve suggested a propagated mode of spread. The VE for two doses was 64% (95% confidence interval (CI): 23-73%) among under-5-year-old children and 70% (95% CI: 28-88%) among 5-15-year-old children. Failure to vaccinate, consequent to the COVID-19 pandemic, and vaccine hesitancy might have led to the accumulation of susceptible children in the community. Additionally, the occurrence of case-patients among vaccinated suggests reduced VE, which needs further investigation into humoral and cell-mediated immunity as well as contributory factors including nutritional status. Outbreak response immunization to complete immunization of missed and dropout children was carried out to control the outbreak.

Background & objectives: Globally, there is an effort to eliminate the measles and control rubella as these diseases lead to considerable morbidity and mortality especially among under-five children and are important public health problems. This study was aimed to estimate the seroprevalence of measles, mumps and rubella (MMR) antibodies among children of age 5-10 yr in Chandigarh, north India, to provide evidence on prevalent immunity levels. Methods: This cross-sectional study was conducted in Chandigarh, among 196 randomly selected healthy children (5-10 yr), who received either one or two doses of measles or MMR combination vaccine. Socio-economic background and immunization history were recorded. Blood sample (2 ml) was collected to estimate the MMR IgG antibody titres by using ELISA kits. Results: Protective seroprevalence of MMR antibodies was 40.8, 75.5 and 86.2 per cent, respectively. The geometric mean titres of MMR IgG antibodies in the study children were 11.3, 50.6 and 54.3 international units (IU)/ ml, respectively. The proportion of seroprotected children for measles was significantly higher among those who had received two or more doses (46.4%) of measles vaccine compared to those who had received single dose (35.6%) (P <0.001). About 16 per cent of children had received single dose of MMR vaccine. Among these, 71.4 and 100 per cent were seroprotected against mumps and rubella, respectively. Interpretation & conclusions: A large proportion of children aged 5-10 yr lacked protective immunity against measles (60%); about one-fourth (15-25%) were susceptible to infection with mumps and rubella virus. Mumps vaccination may be considered to be included in National Immunization Schedule for children with periodic serosurveillance. [ABSTRACT FROM AUTHOR]

Abstract Background Global elimination of vaccine preventable diseases, such as measles, mumps and rubella is a priority. Many countries have reported diminishing of antibody titres against these diseases among young population as immunization coverage of adolescents and adults in not monitored. The objective of this study was to determine the susceptibility against measles, mumps and rubella among young adults. Methods In this cross-sectional study serological evidence of susceptibility to measles, mumps and rubella was determined by qualitative detection of IgG antibody titres by commercially available enzyme linked florescence assay (VIDAS, bioMerieux) in serum samples young adults. Results A total of 335 young individuals (mean age: 20.54 ± 1.37 years) participated voluntarily between May 2017 to September 2018, of which 183 (54.63%) were males. Seroprotection against measles, mumps and rubella were 87.16%, 82.69% and 79.10% respectively. Conclusion Serological surveillance is important to monitor immune status in population. Susceptibility of young adults to measles, mumps, and rubella indicates need for booster vaccination. With the recent launch of measles-rubella vaccination campaign in India, country specific data will be required to plan periodicity of such campaign, which in turn would be based on accumulation of susceptible individuals in a community. Lastly, inclusion of mumps vaccine in the national universal immunization program needs consideration. [ABSTRACT FROM AUTHOR]

This study was conducted to analyse the clinical characteristics of measles in infants and to compare them with those in older children. Clinical and sociodemographic details of all hospitalised children with suspected measles were recorded and confirmed cases were analysed further. Twenty-four infants and 34 children aged >1 year were included. Most infants were boys and 15 (62.5%) of them were aged <9 months. Early onset of rash (within three days of fever in 62.5% of cases) occurred in infants. The complications of measles in infants included bronchopneumonia (n = 17, 71%), acute diarrhoea (n = 8, 33%), meningitis (n = 1, 4%) and staphylococcal sepsis (n = 2, 8%). The number of infants with complications was significantly high (88% and 65%; P = 0.05). Measles in infants can have atypical presentations, a greater risk for complications and may occur before they are due to receive the conventional first dose of measles vaccine. [ABSTRACT FROM AUTHOR]

Rubella infection during pregnancy can result in miscarriage, fetal death, stillbirth, or a constellation of congenital malformations known as congenital rubella syndrome (CRS). The 11 countries in the World Health Organization (WHO) South-East Asia Region are committed to the elimination of measles and control of rubella and CRS by 2020. Until 2016, when the Government of India's Ministry of Health and Family Welfare and the Indian Council of Medical Research initiated surveillance for CRS in five sentinel sites, India did not conduct systematic surveillance for CRS. During the first 8 months of surveillance, 207 patients with suspected CRS were identified. Based on clinical details and serologic investigations, 72 (34.8%) cases were classified as laboratory-confirmed CRS, four (1.9%) as congenital rubella infection, 11 (5.3%) as clinically compatible cases, and 120 (58.0%) were excluded as noncases. The experience gained during the first phase of surveillance will be useful in expanding the surveillance network, and data from the surveillance network will be used to help monitor progress toward control of rubella and CRS in India. [ABSTRACT FROM AUTHOR]

Background: Like other countries in Asia, measles-rubella (MR) vaccine coverage in India is suboptimal whereas 90-95 % coverage is needed for elimination of these diseases. The Ministry of Health and Family Welfare (MOHFW) of the Government of Tamilnadu implemented MR campaign in February 2017 to increase MR vaccination coverage. Strategically, the MOHFW used both routine immunization centres and educational institutions for providing vaccine to the children aged 9 months to <15 years. This evaluation was carried out to assess the MR vaccination coverage. Objectives: To assess the MR vaccination coverage and barriers of vaccine coverage in the community Methods: A community based cross-sectional study was carried out in March and April 2017. Household visits were made to collect the data from 330 children using a pre-structured questionnaire. The data was analyzed by SPSS 20 using Proportions and Chi square tests. Results: Of the total 330 children surveyed, MR immunization coverage was 77.2% (255). Among the 255 vaccinated children 6.3% of them had mild fever after vaccination. 74.5% and 25.5% of them got the vaccination in their schools and government health centres respectively. Among the 75 non-immunized children, 62.8% and 29.4% were denied vaccination due to inflated information about the adverse events following immunization shared in television and social media respectively Conclusion: The results of our evaluation indicated that the campaign was suboptimal in terms of Measles Rubella immunization coverage. Achieving measles and rubella elimination worldwide will be an important milestone in public health, and every effort toward elimination, including vaccination campaigns should be of high quality and ensure adequate information regarding immunization and its effects to the community. [ABSTRACT FROM AUTHOR]

Background: Measles is the public health problem in India, causing mortality and morbidity in children. Measles vaccination is included in the Immunization program but low coverage is still a major problem. There is a lack of data on measles incidence and coverage in vulnerable population for measles. Methodology: A cross-sectional study was carried out to find out the incidence and vaccination coverage based on parents recall in identified 30 slums of Ahmedabad by using cluster sampling method. 3000 children, less than five years of age were included by selecting 100 children from each cluster. Pre-designed and pre-tested standardized questionnaire of UNICEF was used to assess symptoms of measles and history of the Immunization. Result: The measles incidence was found 20.8% based on symptoms and 3.03% based on confirmed diagnosis by doctors as per parents recall in the past six months. The overall vaccination coverage was found at 64.62%. The most common presenting symptom was found fever with rash in children with measles. Conclusion: No gender difference was found in vaccine coverage, measles incidence and status of treatment received. Vaccine efficacy found to be 42% which is very low and high incidence of measles was reported which shows the need for an effective targeted program for the urban slums. [ABSTRACT FROM AUTHOR]