1. Epidemiology and Global Health
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The impact of measles immunization campaigns in India using a nationally representative sample of 27,000 child deaths

  1. Benjamin KC Wong  Is a corresponding author
  2. Shaza A Fadel
  3. Shally Awasthi
  4. Ajay Khera
  5. Rajesh Kumar
  6. Geetha Menon
  7. Prabhat Jha  Is a corresponding author
  1. St Michael's Hospital, Canada
  2. King George's Medical University, India
  3. Government of India, India
  4. Postgraduate Institute of Medical Education and Research, India
  5. National Institute of Medical Statistics, Indian Council of Medical Research, India
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Cite this article as: eLife 2019;8:e43290 doi: 10.7554/eLife.43290

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 2005–2013). 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.

Article and author information

Author details

  1. Benjamin KC Wong

    Centre for Global Health Research, St Michael's Hospital, Toronto, Canada
    For correspondence
    wongbenja@smh.ca
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-7745-6271
  2. Shaza A Fadel

    Centre for Global Health Research, St Michael's Hospital, Toronto, Canada
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-2336-6254
  3. Shally Awasthi

    Department of Pediatrics, King George's Medical University, Lucknow, India
    Competing interests
    No competing interests declared.
  4. Ajay Khera

    Ministry of Health and Family Welfare, Government of India, Delhi, India
    Competing interests
    No competing interests declared.
  5. Rajesh Kumar

    School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
    Competing interests
    No competing interests declared.
  6. Geetha Menon

    Department of Health Research, National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
    Competing interests
    No competing interests declared.
  7. Prabhat Jha

    Center for Global Health Research, St Michael's Hospital, Toronto, Canada
    For correspondence
    jhap@smh.ca
    Competing interests
    Prabhat Jha, Senior editor, eLife.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-7067-8341

Funding

Canadian Institutes of Health Research (FDN154277)

  • Prabhat Jha

Bill and Melinda Gates Foundation

  • Prabhat Jha

National Institutes of Health (R01TW05991-01)

  • Prabhat Jha

External funding is from the Canadian Institutes of Health Research (http://www.cihr-irsc.gc.ca, Grant FDN154277), the US National Institutes of Health (https://www.nih.gov, Grant R01TW05991-01), and the Bill and Melinda Gates Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Ethics

Human subjects: Ethics approval for the MDS was obtained from the Post Graduate Institute of Medical Research, St. John's Research Institute and St. Michael's Hospital, Toronto, Ontario, Canada. Consent procedures have been published earlier (Gomes et al., 2017; Jha et al., 2006a; Registrar General of India, 2016).

Reviewing Editor

  1. Mark Jit, London School of Hygiene & Tropical Medicine, and Public Health England, United Kingdom

Publication history

  1. Received: November 3, 2018
  2. Accepted: February 15, 2019
  3. Accepted Manuscript published: March 5, 2019 (version 1)

Copyright

© 2019, Wong et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

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