Vaccination net grows: two new, another widens

ABANTIKA GHOSH explains how measles-rubella, pneumococcal conjugate and rotavirus vaccines will boost the Universal Immunisation Programme

THE BASKET of vaccines in India’s Universal Immunisation Programme (UIP) was static for many years — until the entry of the Pentavalent [which protects against 5 infections — diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae Type B (Hib) in one shot], and Japanese Encephalitis vaccines during the UPA regime.

There have been regular additions to the basket since, and both this month and the next will be busy on the vaccination front. Two new vaccines — measles-rubella and pneumococcal conjugate — are lined up for launch in January and February respectively, and a third, rotavirus vaccine, will become part of the UIP in another 5 states — also from February.

What is rubella, and why is vaccination for it important?

More commonly known as German Measles, Congenital Rubella Syndrome, or CRS, is believed to affect about 25,000 children born in India every year. Symptoms can include cataracts and deafness, and the disease can also affect the heart and the brain.

According to a study by University College of Medical Sciences, Delhi, “1-15% of all infants suspected to have intra-uterine infection were found to have laboratory evidence of CRS. About 3-10% of suspected CRS cases are ultimately proven to have confirmed CRS... CRS accounts for 10-15% of paediatric cataract. 1050% of children with congenital anomalies have laboratory evidence of CRS. 10-30% of adolescent females and 12-30% of women in the reproductive age-group are susceptible to rubella infection in India.”

As an aside, German measles was central to the plot of Agatha Christie’s The Mirror Crack’d from Side to Side, a Miss Marple mystery published in 1962, in which one woman murders another responsible for her contracting German measles while pregnant, which led to the death of her child. The book inspired Rituparno Ghosh’s Bengali thriller Shubho Mahurat, starring Sharmila Tagore, Rakhee and Nandita Das, which was released in 2003.

In which states will the measles-rubella (MR) vaccine be introduced?

After its formal launch on January 17, the vaccine will be introduced in Goa, Karnataka, Lakshadweep, Puducherry and Tamil Nadu around February 3-4. The Health Ministry will run a campaign among children aged 9 months to 15 years before making the vaccine a part of routine immunisation. Two shots will be given — one between the ages of 9-12 months, the other at age one-and-ahalf. The monovalent measles vaccine is already part of the UIP basket of 10 vaccines; it will be discontinued once MR is introduced.

And what is pneumococcal conjugate vaccine (PCV)?

PCV is a mix of several bacteria of the pneumococci family, which are known to cause pneumonia — hence ‘conjugate’ in the name. Pneumonia caused by the pneumococcus bacteria is supposed to be the most common.

Pneumonia and diarrhoea have long been responsible for the most child deaths in India — ballpark estimates say pneumonia is responsible for about 20% of under-5 child mortality in India, of which half are of pneumococcal origin. In 2008, the World Health Organisation’s Child Health Epidemiology Reference Group reported that 5 countries in which 44% of the world’s children aged less than 5 years live (India, China, Pakistan, Bangladesh, Indonesia and Nigeria) contribute more than half of all new pneumonia cases annually. It estimated around 43 million pneumonia cases (23% of the global total) and an incidence of 0.37 episodes per child-year for clinical pneumonia in India.

Which states will PCV be introduced?

In Himachal Pradesh and parts of Uttar Pradesh and Bihar from March 17. Three doses will be administered at one-and-a-half months, three-and-a-half months and 9 months. A study by the Public Health Foundation of India and a consortium of UK universities published in the peer-reviewed, open-access online scientific journal PLOS ONE estimated: “In year 2010, 0.56 million severe pneumococcal pneumonia episodes and 105 thousand pneumococcal pneumonia deaths had occurred in children younger than 5 years of age in India. The annual incidence of severe pneumococcal pneumonia in India was estimated to be 4.8 episodes per 1,000 children younger than 5 years. The top five contributors to India’s pneumococcal pneumonia burden in terms of number of cases and deaths were Uttar Pradesh (1,33,167 cases; 27,785 deaths), Bihar (91,578 cases; 23,202 deaths) Madhya Pradesh (52,250 cases; 13,043 deaths), Rajasthan (43,911 cases; 11,889 deaths) and Jharkhand (28,969 cases; 6,296 deaths).”

And where will the rotavirus vaccine be introduced?

The rotavirus vaccine first became a part of UIP in April 2016. Rotavirus infections are the most common cause of diarrhoea in children. An estimated 1 lakh children die every year of the disease. According to a study by researchers from AIIMS, Christian Medical College, Vellore and Tufts University School of Medicine, Boston, rotavirus infections could be costing India between Rs 135 crore and Rs 261 crore annually. The vaccine is currently being administered in HP, Haryana, Odisha and AP. From February, it will be a part of UIP also in Assam, Tripura, Rajasthan, Madhya Pradesh and Tamil Nadu.

Portrait, Reuters