Adding interventions to mass measles vaccinations in India.

Mira Johri,Usha Ram,Mark Jit,Shaun K Morris,Cindy Gauvreau,Jitendar K Sharma,Stéphane Verguet,Edward Jones,Prabhat Jha

doi:10.2471/blt.15.160044

Abstract

ObjectiveTo quantify the impact on mortality of offering a hypothetical set of technically feasible, high-impact interventions for maternal and child survival during India’s 2010–2013 measles supplementary immunization activity.MethodsWe developed Lives Saved Tool models for 12 Indian states participating in the supplementary immunization, based on state- and sex-specific data on mortality from India’s Million Deaths Study and on health services coverage from Indian household surveys. Potential add-on interventions were identified through a literature review and expert consultations. We quantified the number of lives saved for a campaign offering measles vaccine alone versus a campaign offering measles vaccine with six add-on interventions (nutritional screening and complementary feeding for children, vitamin A and zinc supplementation for children, multiple micronutrient and calcium supplementation in pregnancy, and free distribution of insecticide-treated bednets).FindingsThe measles vaccination campaign saved an estimated 19 016 lives of children younger than 5 years. A hypothetical campaign including measles vaccine with add-on interventions was projected to save around 73 900 lives (range: 70 200–79 300), preventing 73 700 child deaths (range: 70 000–79 000) and 300 maternal deaths (range: 200–400). The most effective interventions in the whole package were insecticide-treated bednets, measles vaccine and preventive zinc supplementation. Girls accounted for 66% of expected lives saved (12 712/19 346) for the measles vaccine campaign, and 62% of lives saved (45 721/74 367) for the hypothetical campaign including add-on interventions.ConclusionIn India, a measles vaccination campaign including feasible, high-impact interventions could substantially increase the number of lives saved and mitigate gender-related inequities in child mortality.

Highlights

Measles vaccination made an important contribution to the millennium development goal to reduce under-5 mortality (MDG4),[1] accounting for 23% of the estimated worldwide decline in all-cause child mortality from 1990 to 2008.2,3 A cornerstone of the strategy was that all children be offered a second opportunity to receive a dose of measles-containing vaccine, either through routine immunization services or through mass vaccination campaigns.[4]
For states participating in the supplementary immunization activity, we conducted a mathematical modelling study to quantify: (i) the number of lives saved by a supplementary immunization activity delivering measles-containing vaccine alone, and (ii) the number of lives that could be saved by a supplementary immunization activity package delivering measles-containing vaccine plus a set of six hypothetical add-on interventions
We modelled the impact of the interventions on maternal and child mortality over the period 2009–2013 using the freely available Lives Saved Tool (LiST), version 4.7 (Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America)

Summary

Introduction

Measles vaccination made an important contribution to the millennium development goal to reduce under-5 mortality (MDG4),[1] accounting for 23% of the estimated worldwide decline in all-cause child mortality from 1990 to 2008.2,3 A cornerstone of the strategy was that all children be offered a second opportunity to receive a dose of measles-containing vaccine, either through routine immunization services or through mass vaccination campaigns (known as supplementary immunization activities).[4]. India’s first supplementary mass measles vaccination campaign took place from 2010 to 2013 in 14 states[7] containing 59% of India’s 113 million under-5 children (authors’ calculations based on census data).[8] These 14 states have relatively weak health systems compared with the national average[9] and poorer progress towards MDG4.10 The supplementary immunization activity reached 119 million children aged nine months to 10 years, achieving 91% coverage of the target population of 130 743 905.11 India’s first round of supplementary mass measles vaccination delivered only a measles-containing vaccine dose. Planning is underway for a larger measles–rubella vaccine introduction campaign targeting children aged 1–15 years.[12]

Methods

Results

Conclusion