Why Mumbai is witnessing a measles outbreak

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A new outbreak has put Mumbai on tenterhooks. Measles, most commonly seen in children, is fast spreading in the financial capital, putting medical authorities on edge.

On Wednesday, an eight-month-old from Bhiwandi, near Mumbai, suffering from measles, died in a city hospital, taking the toll in the city this year to 12. Furthermore, the city recorded 13 new cases of measles, taking the tally of infections since the beginning of the year to 233.

According to authorities, the infant, who died, had developed a rash all over his body on 20 November and was admitted to a civic-run hospital on Tuesday evening but died within a few hours.

Authorities have said that the measles outbreak in the city has been reported from 22 locations in 11 civic wards. However, the 13 new confirmed cases have emerged from seven different wards, including A ward in South Mumbai.

Graphic: Pranay Bhardwaj

As the situation rapidly worsens, Maharashtra Health Minister Dr Tanaji Sawant held a meeting on the outbreak with state health department officials, municipal officials and experts from the World Health Organization (WHO).

Also, the Centre has asked states to consider administering one additional dose of Measles and Rubella vaccines to all children, aged 9 months to 5 years, in vulnerable areas. In a letter to the Principal Health Secretary of Maharashtra that was also marked to all states and Union Territories (UTs), the Union health ministry said this surge is of particular concern from the public health point of view. “It is also clear that in all such geographies, the effected children were predominantly unvaccinated and the average coverage of Measles and Rubella Containing Vaccine (MRCV) among the eligible beneficiaries is also significantly below the national average,” Health ministry Joint Secretary P Ashok Babu said.

Also read: From symptoms to vaccine, all you need to know about measles

But what exactly is causing a surge in cases in the city? Is Maximum City turning into Measles City?

Drop in vaccination levels

The primary reason for the rise in infections in the city is the dip in vaccination levels. Measles can be prevented with the MMR or MR vaccines, which not only protect children against measles, but also rubella. According to the national immunisation programme, the measles vaccine has to be administered in two doses — at nine and 15 months of age.

The WHO had warned last year that the world was at greater risk of outbreaks after COVID-19 disrupted shots for millions of infants.

Brihanmumbai Municipal Corporation officials have noted a dip in vaccination levels in the city. They say the resurgence in measles can be explained by disruption to local immunisation programmes over the past two years, which has left children across the city unvaccinated against the highly infectious disease.

“We are seeing that most of the affected kids are very young and these are the ones who missed their vaccinations during the COVID-19 pandemic,” Dr Dinesh Raj, senior consultant in the Paediatrics Department in Mumbai’s Holy Family Hospital, was quoted as telling The Telegraph.

“Most of the government resources were diverted to management and man-power, particularly during the intense lockdown.”

Speaking on the same, Dr Mangala Gomare, executive health officer, Brihanmumbai Municipal Corporation (BMC) told Indian Express: “Amid COVID-19, the vaccination got impacted. We have around 20,000 children who didn’t get the measles vaccine. Now, we are tracking all these children and holding vaccination camps on priority.”

Data shows that while the civic body has boosted their vaccination drive, only 41 per cent of the eligible children had been administered their doses until October.

A presentation by the state’s public health department to Chief Minister Eknath Shinde revealed that until October, only 73,120 children — 42.5 per cent — of the total 1,71,890 children had been given their first measles shot. Similarly, only 70,102 children — 41.2 per cent —, of the targeted total of 1,69,872 children, had been administered the second dose.

12 deaths 233 cases and counting Why Mumbai is witnessing a measles outbreak

Graphic: Pranay Bhardwaj

Compare this to previous years and the dip in vaccinations is clear. The first dose coverage in Mumbai in 2021 was 72 per cent, 87 per cent in 2020 and 92 per cent in 2019. Also, the second dose coverage was 82 per cent in 2021, 87 per cent in 2020 and 90 per cent in 2019.

ASHA and health workers in the city, who go from door-to-door, counselling families to vaccinate children, have cited vaccination hesitancy as one of the contributing factors to the dip in levels.

Shabana Shaikh, one of the workers, has been quoted by Scroll as saying, “It is extremely difficult to convince mothers to come for vaccination.

Sabreen Shaikh, who works with the non-profit Apnalaya, said that while mothers are willing to allow their children to be administered the oral polio vaccine, they are afraid of taking them to get injections.

Even Dr Padmaja Keskar, an executive health officer from the BMC said, “There are rumours that the vaccination will cause impotency. We have addressed them, involved religious leaders, but that hasn’t led parents to change their minds in high-refusal wards.”

Some other parents also said they couldn’t afford to take a day off work to visit a community healthcare centre to get their child vaccinated.

12 deaths 233 cases and counting Why Mumbai is witnessing a measles outbreak

A woman cradling her child interacts with municipal staff during a survey inside a slum following a measles outbreak in Mumbai. AFP

Poverty and poor hygiene

Another reason for the rise in measles cases is the poor health infrastructure of the city coupled with acute poverty.

One of the children who died owing to measles had intestinal worms, a result of poor hygiene and sanitation conditions. A white-coloured worm was also extracted from the child’s mouth using medication.

Moreover, some of the children who died were severely undernourished. Dr Pradeep Awate, Maharashtra’s epidemiologist at the state Directorate of Health Services, told Scroll health complications can affect a malnourished child much more than a healthy child. “A malnourished child has a weak immune system,” said Awate. “When an infection sets in, the body is unable to stop the infection from spreading.”

Remigration (act of migrating again) is another reason that is why measles cases in the city are seeing an uptick. Medical experts state that in 2020 when India was first placed under lockdown owing to the COVID pandemic, millions of workers returned to their hometowns and villages and, in the chaos, many did not re-register their families and children with local healthcare services.

Now, having returned to Mumbai again for work, their children remain unvaccinated against measles and other infections.

Dr Subhash Salunke, the former Director of Health for Maharashtra told The Telegraph, “This outbreak of measles is a true reflection that routine public health in India remains far from satisfactory. We have a critical number of non-immunised children here in Mumbai and that is causing the disease to spread.”

With inputs from agencies

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