Mass measles rubella immunization campaign: Bhutan experience

Abstract

Background:Bhutan has attained universal child immunization since 1991. Since then, immunization coverage is maintained at high level through routine immunization, periodic National Immunization Days, and mop up campaigns. Despite high immunization coverage, every year, significant numbers of clinically suspected measles cases were reported.Objective:To assess the cause of continuing high “suspected measles cases” and take appropriate public health measures.Materials and Methods:Febrile rash outbreaks occurred in several districts in 2003. These episodes were investigated. Simultaneously, a retrospective data search revealed evidence of congenital rubella syndrome (CRS) in the country.Results:Thirty five percent of the tested samples were positive for rubella but none for measles. There were evidences of the presence of CRS. This was discussed in the annual health conference 2004, amongst health policy makers and district heads who recommended that a possibility of inclusion of rubella as an antigen be looked into. A nationwide measles and rubella immunization campaign was conducted in 2006 followed by introduction of rubella vaccine in the immunization schedule.Conclusion:Febrile rash can be caused by a host of viral infections. Following universal measles immunization, it is pertinent that febrile rash be looked in the light of rubella infections. Following the introduction of rubella vaccination in the national immunization schedule, there has been significant reduction of febrile rash episodes, cases of rubella, and congenital rubella syndrome.

Measles rubella campaign: coverage among slum children of Udupi municipality area in Karnataka

“…In a study conducted by Chuang et al at Hong Kong showed a very high coverage (90%) among children in the age group of 6-11 years. 7,13 The study observed not much gender bias the vaccine recepients (boys: 52.3%, girls: 47.7%) had received the vaccine which is analogous to the coverage observed by Sayed El, et al at Egpt. (boys: 50.9%, girls: 49.1%).…”

“…Karnataka was selected in the first phase of the campaign. 3,13,20 In the present study, out of 312 families covered only 275 families (88%) were aware about the MR campaign. These families had received information from the health workers (50%), school authorities (43.3%) and mass media (2.6%).…”

“…Whereas a higher proportion of coverage was seen in Bhutan (98.17%), Albania (99%) and Iran (100%). 7,13,19,21,23,24 It was observed that majority of the children who received vaccine (75%) were in the age group of one to ten years. Whereas in a study conducted by Uddin et al in Bangladesh the coverage was more (74%) in children in the age group of 5-14 years.…”

“…The WHO has estimated incidence of CRS to be between 0.5-2.2/1000 live births during epidemics in developing countries. 13,18 Adolescent women must be safeguarded with rubella vaccine before child bearing to prevent her from contracting the disease during pregnancy thereby protecting the child from getting congenital rubella syndrome. Moreover, the additional vaccine dose offers surplus protection to all children.…”

“…[11][12][13] To attain this, they have embraced a four-pronged strategy consisting of achieving and sustaining at least 95% coverage of measles-rubella vaccine with consolidation of supportive services. 11,13 Measles is a childhood killer which has been challenging to control because of poor vaccine coverage, high vulnerability of infants to wild measles virus and high case fatality rate. This has foiled India's plans of rising the age of first dose of measles vaccine from 9 months to 1 year.…”