Karnataka steps up measures to tackle measles resurgence

While the incidence of measles in the country was 4.16 per 1 million population in 2021, it increased to 22.36 in 2022, according to central government data.

India is also one of the top 10 countries of suspected measles, as per the Centers for Disease Control and Prevention (CDC) global measles report.

According to the government data on measles cases tabled in the Parliament on December 17, 10,416 cases and 40 deaths were reported till December last year across India.

Maharashtra contributed the maximum to the burden, with 3,075 cases and 13 deaths, followed by Jharkhand with 2,683 cases and eight deaths. Six states — Maharashtra, Jharkhand, Bihar, Gujarat, Haryana, and Kerala — contributed the most to the caseload.

In Karnataka, measles cases were reported at 4.18 per 1 million population in 2021. The incidence has doubled in 2022 to 8.52 per 1 million population, according to a health department official.

Meanwhile, according to the World Health Organisation (WHO), India recorded 12,773 cases of measles as of November 2022, making it the largest outbreak in the year. It said that nearly 40 million children across the world have been left susceptible to measles.

With cases of measles on the rise in India since the beginning of 2022, and outbreaks in multiple states, the state health department has increased its efforts to ensure it does not turn into a public health emergency.

Earlier this month, chief secretary Vandita Sharma suggested that all departments should coordinate with the health department to bring measles and rubella cases to zero in the state. At a meeting on the eradication of measles and rubella, Sharma suggested that children under 15 years should be given two doses of the vaccine compulsorily to prevent the outbreak.

According to officials in the health department, cases of measles are on the rise in several districts in the past few months. In Bengaluru, there are two confirmed cases at a government hospital as of March 2023, a person in the know of the matter said.

Dr Bhaskar Shenoy, a paediatrician at Manipal Hospitals, said, “Bengaluru alone has seen 10 to 12 cases in the last two months. Before Covid, it was never there. But we’re seeing a rise in cases in the last year. This is a new trend and reemergence of already controlled infections.”

While measles, a contagious virus, is almost entirely preventable through vaccination, experts said that low vaccine coverage among the eligible beneficiaries due to the Covid-19 pandemic left the unvaccinated kids prone to the virus.

The MR vaccine coverage should be more than 95%, but the vaccine coverage in Karnataka was 82% in 2020-2021 and 86% in 2021-2022, a health department official said.

“Elimination of measles is planned along with Rubella – MR elimination. Of late, measles cases have been rapidly rising in India, including Karnataka. The rise in cases could be attributed to decreased MR vaccine coverage or lesser protection of maternal antibodies in mothers,” Dr Sunil Kumar Dodderi, epidemiologist and public health specialist, said.

Meanwhile, the state government has been conducting active case findings with suspected measles cases by screening fever and rash among children in government and private hospitals, including medical college hospitals.

KV Trilok Chandra, BBMP Special Commissioner (Health), said the Bruhat Bengaluru Mahanagara Palike is carrying out an extensive campaign to cover those who have not taken the measles vaccination.

“The campaign is being done in all the wards to see if there is any missed out child. We are also in touch with the Indian Association of Paediatricians, so that we keep a track of any cases being reported or if any child has been missed out. We are also stocking up vaccines in the BBMP area,” Trilok Chandra said.

The BBMP special commissioner pointed out that a door-to-door campaign has been launched to track the number of cases in the BBMP area.

“We don’t know the exact number of laboratory-confirmed cases. But any case with fever or rash is treated as a suspect case. We are keeping a track of that,” he added.

According to Dr Supraja Chandrasekar, consultant paediatric intensivist at Manipal Hospitals in Bengaluru, measles typically presents with cough, cold, red and watery eyes and fever.

“The typical feature of measles is its rash, which is a kind of blotchy and bumpy rash called the ‘Maculopapular Rash’. It starts with the face and spreads all over the body. The babies become sicker and refuse to eat etc.,” she said.

Dr Chandrasekar pointed out that the rash phase is the most infectious, with a high-grade fever that can go up to 104–105-degree F. “Thereafter, the whole thing subsides, and the baby’s immunity comes down significantly after the infection, making them very prone to bacterial infection.”

According to WHO, a single case of measles can lead to 12-18 infections.

Dr Shenoy said that the rise in cases in the state could be attributed to unimmunised children who are the source of infection or a pocket of partially immunised children.

“The immunisation cover has also reduced during the pandemic. There are three doses of vaccines. One is at 9-10 months. The second is at 15 months, and the third is in the fifth year. This is what the Indian Academy of paediatrics recommends. But the government setups recommend two doses,” Dr Shenoy said.

“Second is, we should make sure that the coverage is more than 90-95%. Then only it can be eliminated. Suppose you have only 80% of the child population, there is still 20% who are very susceptible. They can be the source of infection for others,” Dr Shenoy added.

Meanwhile, doctors pointed out reported cases in which other viruses mimic measles in the state. “In Bengaluru, especially in our hospital, we are seeing a rise in another type of virus called adenovirus infection. Just in the last 10 days, we have seen about 10 cases which have been proven by PCR tests,” Dr Chandrasekar said.

“This infection happens in which the child has similar signs and symptoms of measles with conjunctivitis, upper respiratory tract symptoms like cold and cough, and extremely high-grade fever. This goes on typically for 3-5 days,” she said.

Dr Yogesh Kumar Gupta, consultant-paediatrics, Fortis Hospital in Bengaluru, said that in the last two months, there has been no confirmed case of measles at their settling. “However, we have observed cases that exhibit a rash resembling measles but lack other typical symptoms,” he said.

Experts said that while measles is detected through the serological test, it can go undetected in most cases since the test is not easily available, and is not routinely done. “That is another reason why the confirmed cases may be less,” Dr Shenoy said, adding that the health department should increase surveillance for other diseases as well.

“Alert to parents is to keep an eye on high-grade fever with conjunctivitis, as well as respiratory infections, to consult the doctor, avoid antibiotics, support a treatment with plenty of hydration, keeping the child away from the others, not sending them to school during the viral period, and preventing them from getting a secondary infection,” Dr Chandrasekar said.