Abstract
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.
Highlights
Measles remains an important cause of death among under-five children (Moss, 2017)
Of the 1,638 measles deaths using the definition of one or more physician coding or the family reported a measles history for the deceased, 79% occurred in rural areas, 73% in campaign states, 59% at ages 12–59 months, and 57% in girls
Our direct estimates of 41,000–56,000 measles deaths averted are consistent with modeled estimates documenting approximately 66,000 under-five child deaths averted (Verguet et al, 2017)
Summary
Measles remains an important cause of death among under-five children (Moss, 2017). Much of this persisting global burden of measles is located in Africa and Asia, notably in India (Black et al, 2010; Dabbagh et al, 2017). In 2005, the Government of India launched the National Rural Health Mission – a program geared towards improving public health infrastructure and reducing child mortality in priority states (Ministry of Health and Family Welfare, 2005). In 2008, the Government of India announced a policy change to introduce second-dose measles vaccine through the routine immunization (Ministry of Health and Family Welfare, 2010). The campaign prioritized immunization of children aged 9 months to 10 years in the 14 campaign states, after which second-dose measles vaccine was provided through routine
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