The impact of measles immunization campaigns in India using a nationally representative sample of 27,000 child deaths

Autor: Shaza A. Fadel, Benjamin Kc Wong, Geetha R Menon, Prabhat Jha, Shally Awasthi, Ajay Khera, Rajesh Kumar
Rok vydání: 2019
Předmět:
Male
0301 basic medicine
0302 clinical medicine
Epidemiology
Global health
030212 general & internal medicine
Biology (General)
child
General Neuroscience
Mortality rate
Vaccination
General Medicine
Multilevel regression
3. Good health
Child
Preschool
Medicine
Female
Insight
Research Article
Human
medicine.medical_specialty
QH301-705.5
Science
Measles Vaccine
India
immunization
Mass Vaccination
Measles
General Biochemistry
Genetics and Molecular Biology
03 medical and health sciences
medicine
Humans
measles
interrupted time series
General Immunology and Microbiology
business.industry
Infant
Interrupted time series
Interrupted Time Series Analysis
medicine.disease
Survival Analysis
mortality
Epidemiology and Global Health
030104 developmental biology
Immunization
business
Measles immunization
Demography
Zdroj: eLife, Vol 8 (2019)
eLife
ISSN: 2050-084X
DOI: 10.7554/elife.43290
Popis: India comprises much of the persisting global childhood measles mortality. India implemented a mass second-dose measles immunization campaign in 2010. We used interrupted time series and multilevel regression to quantify the campaign’s impact on measles mortality using the nationally representative Million Death Study (including 27,000 child deaths in 1.3 million households surveyed from 2005 to 2013). 1–59 month measles mortality rates fell more in the campaign states following launch (27%) versus non-campaign states (11%). Declines were steeper in girls than boys and were specific to measles deaths. Measles mortality risk was lower for children living in a campaign district (OR 0.6, 99% CI 0.4–0.8) or born in 2009 or later (OR 0.8, 99% CI 0.7–0.9). The campaign averted up to 41,000–56,000 deaths during 2010–13, or 39–57% of the expected deaths nationally. Elimination of measles deaths in India is feasible.
eLife digest The introduction of the measles vaccine in the 1960s led to large reductions in measles deaths in many countries. Yet, measles remains a major killer of children younger than age five worldwide, particularly among children living in Africa and Asia, where fewer children are immunized. India has been particularly hard hit, with annual child measles deaths exceeding 60,000 in 2005. In the 1990s, India’s national vaccination program made one dose of the measles vaccine part of routine vaccinations through much of the country to help reduce the numbers of measles deaths. However, it was one of the last countries to add a second dose of measles vaccine as recommended by the World Health Organization, which has been shown to prevent infection and death in 90-95% of vaccinated children. In 2008, the Indian government announced it would introduce a second dose of measles vaccine to its routine vaccine schedule for children from 2010 onwards. Prior to the introduction of a second-dose measles vaccine, campaigns were launched to increase immunization rates in regions where few children were being vaccinated. But how many young children’s lives were saved by these campaigns was unknown. Now, Wong et al. show that India’s measles immunization campaigns saved the lives of 41,000 to 56,000 children between 2010 and 2013. This averted between 39-57% of the expected measles deaths nationally during that time period. Wong et al. used data from the Million Death Study, which used household surveys to capture information on the cause of 27,000 child deaths in India between 2005 and 2013, to assess the affects of the state vaccination campaigns on measles deaths. Changes in measles deaths were compared to changes in unrelated child deaths to make sure any differences were related to the vaccination campaigns and not other improvements in children’s health care. Indian states with measles immunization campaigns saw larger decreases in measles deaths among children younger than five than states without such a campaign (27% vs 11%). Similar decreases were not seen in child deaths from other causes. Girls, who are disproportionately affected by measles in India, benefited from larger reductions in deaths than boys in states with immunization campaigns. The success of two-dose measles vaccination campaigns at reducing young children’s deaths in India may help to boost vaccination rates and help combat parents’ hesitance to immunize their children.
Databáze: OpenAIRE
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