Measles occurrence, vaccination coverages and malnutrition in India: correlations, trends, and projections by time series analysis

Abstract

Background: Measles is a highly infectious viral disease responsible for a considerable morbidity and mortality in childhood. India has committed to achieve measles elimination by 2020. Currently, Sustainable Development Goals (SDG) have placed a lot of emphasis on measles elimination. Methods: Data on reported measles cases, immunization coverages and malnutrition status of children specific to India for a period from 1980 to 2017 were collected from WHO, UNICEF and related official online web sources. Also, various official measles elimination strategy documents, available literature and experiences from various countries were reviewed. The data were analysed for correlations, trends. Time series model projections were made till 2020 using two different software tools. Results: The occurrence of measles cases showed a significant downward trend especially since 2000, but continues to exhibit mild cyclical trend of 3-4 years with strong seasonality. Measles vaccine coverages are steadily and significantly increasing more so since 2014. Reduction in measles cases is strongly and significantly correlated with the vaccination coverages; moderate correlation with wasting and mild correlation with stunting was observed. Current progress in India to achieve elimination appears to be well on track with remarkable strides made in strengthening case based surveillance, immunization with 2 doses of measles containing vaccine (MCV) and establishment of high quality laboratory network. MCV1 and MCV 2 coverage forecasts look promising to reach about 95% by 2020 at current rates. Also, the projections of measles case occurrence indicate the reduction in incidence to about 20 per million, which may even be augmented further with concurrent enhancements in nutritional status and socio-economic growth. Conclusions: India is well on track to achieve measles elimination goal as per the commitment made in 2014, using the established strategies.