The introduction of the measles vaccine in the 1960s led to large reductions in measles deaths in many countries. Yet, measles remains a major killer of children younger than age five worldwide, particularly among children living in Africa and Asia, where fewer children are immunized. India has been particularly hard hit, with annual child measles deaths exceeding 60,000 in 2005.

In the 1990s, India’s national vaccination program made one dose of the measles vaccine part of routine vaccinations through much of the country to help reduce the numbers of measles deaths. However, it was one of the last countries to add a second dose of measles vaccine as recommended by the World Health Organization, which has been shown to prevent infection and death in 90-95% of vaccinated children.

In 2008, the Indian government announced it would introduce a second dose of measles vaccine to its routine vaccine schedule for children from 2010 onwards. Prior to the introduction of a second-dose measles vaccine, campaigns were launched to increase immunization rates in regions where few children were being vaccinated. But how many young children’s lives were saved by these campaigns was unknown.

Now, Wong et al. show that India’s measles immunization campaigns saved the lives of 41,000 to 56,000 children between 2010 and 2013. This averted between 39-57% of the expected measles deaths nationally during that time period. Wong et al. used data from the Million Death Study, which used household surveys to capture information on the cause of 27,000 child deaths in India between 2005 and 2013, to assess the affects of the state vaccination campaigns on measles deaths. Changes in measles deaths were compared to changes in unrelated child deaths to make sure any differences were related to the vaccination campaigns and not other improvements in children’s health care.

Indian states with measles immunization campaigns saw larger decreases in measles deaths among children younger than five than states without such a campaign (27% vs 11%). Similar decreases were not seen in child deaths from other causes. Girls, who are disproportionately affected by measles in India, benefited from larger reductions in deaths than boys in states with immunization campaigns. The success of two-dose measles vaccination campaigns at reducing young children’s deaths in India may help to boost vaccination rates and help combat parents’ hesitance to immunize their children.

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). Direct estimation of cause-specific mortality documented a 90% decline in 1–59 month measles mortality rates in India from 2000 to 2015 (Fadel et al., 2017).

The role of national intervention strategies in explaining the decline in measles deaths in India is unknown. 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). District-level mass immunization campaigns (termed supplementary immunization activities) for second-dose measles vaccine were launched in 2010 in 14 target states where first-dose measles vaccination coverage was below 80% (hereafter referred to as campaign states). 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 immunization. The remaining 21 states with higher coverage added only second-dose measles vaccine through routine immunization (Gupta et al., 2011).

The ideal method of evaluation, a randomized trial, was not practical in the rollout of the national campaign. Mathematical models estimate an 84% decline in measles deaths globally during 2000–2016, but are unable to evaluate the effectiveness of interventions (Dabbagh et al., 2017; Jha, 2014). In these scenarios, interrupted time series is considered a robust quasi-experimental evaluation method (Cochrane Effective Practice and Organisation of Care, 2017). Here, we apply interrupted time series supplemented with multilevel regression analysis to provide the first direct quantification of the impact of the national mass measles immunization campaign on childhood measles mortality in India. These analyses have the additional advantage of using the Million Death Study (MDS), a nationally representative sample of all deaths in India, including 27,000 child deaths from 1.3 million households surveyed from 2005 to 2013 (Fadel et al., 2017; Gomes et al., 2017).

The measles vaccine has high efficacy, preventing infection and death in 90–95% of children who receive two doses (Guerra et al., 2017; Moss, 2017). However, evidence for vaccine effectiveness in low- and middle-income countries is more limited. Evidence of effectiveness at the population level is particularly required to counter scientific skepticism and waning public confidence in government immunization programs in India (Francis et al., 2018; Larson et al., 2011; Larson et al., 2010). Our first ever quantification of the impact of national mass measles immunization campaign in a high-burden country using direct cause-specific data finds high effectiveness of measles vaccination programs in reducing child measles deaths in India.

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). However, direct data are a far more robust form of evidence. We document 24,000 measles deaths in 2013 using a broad case definition that included family reporting of history of measles. WHO estimated 49,000 measles deaths in 2015 using a definition of either clinician-suspected measles infection or a diagnosis of fever with rash and cough, runny nose, or red eyes (World Health Organization, 2018a; World Health Organization, 2016). The addition of possible measles deaths with rash and fever to our original case definition raised the estimate of measles deaths in 2013 from 24,000 to 46,000. At our observed rate of decline, we would expect 35,000 deaths in 2015 using the WHO definition. Further investigation of the reasons for these differences in total deaths from measles, particularly at the subnational level, is required. Fadel et al. (2017) documented 7,000 measles deaths in 2015 using a narrower case definition that excluded a history of measles and where all deaths were so assigned by dual physician coding with final adjudication by a third senior physician if needed. Thus, substantial downward revisions of WHO modeled estimates are likely needed. The relationship between measles cases and deaths in India is also uncertain, given that WHO incidence estimates are inconsistent with documented case fatality rates in India which range from 0.8–1.4% (Sudfeld and Halsey, 2009; Verguet et al., 2017; Wolfson et al., 2009; World Health Organization, 2016; World Health Organization, 2018b; Murhekar et al., 2014). Our direct data should help to redefine current estimates of measles mortality and number of infections in India.

Could measles transmission or, at a minimum, measles deaths be eliminated in India? Drastic declines in child measles mortality suggest that elimination of measles deaths in India is feasible, albeit difficult. Measles elimination is challenging due to its high infectivity – each infected child can infect an additional 4–26 children in South-east Asia (Guerra et al., 2017; Holzmann et al., 2016). The WHO estimated the coverage of first-dose vaccine in South-east Asia (which includes India) to be below the levels that would achieve herd immunity (85% in 2012) and stagnation of coverage in the past decade (Dabbagh et al., 2017; Moss, 2017). Documented measles outbreaks indicate that India remains endemic to measles given suboptimal coverage, with about 3 million infants not receiving first-dose measles vaccination in 2013 (Dabbagh et al., 2017; Jamir et al., 2016; Singh and Garg, 2017; Vaidya et al., 2016). India’s Integrated Disease Surveillance Program reported a decline in annual measles outbreaks during 2011–2013 but gradual increases since (Ministry of Health and Family Welfare, 2018). The Global Vaccine Action Plan for 2012–2020 and the Government of India recommend second-dose measles vaccine to achieve herd immunity at 95% coverage to eliminate measles transmission (Dabbagh et al., 2017). Supplementary immunization activities must be regularly scheduled to reach herd immunity and to combat resurgence (Verguet et al., 2017). Though herd immunity may be difficult to achieve, efforts to improve vaccine coverage will curtail mortality, as evident by our findings. The observed reduction in under-five measles mortality may show herd immunity in cohorts born within nine months of the campaign launch. Since 2013, 11 states in India have implemented laboratory-confirmed measles surveillance. This infrastructure provides sero-epidemiological data to facilitate diagnoses of measles, detect suspected cases, and sequence circulating measles genotypes (Bose et al., 2014; Vaidya, 2015; Vaidya and Chowdhury, 2017). High quality measles surveillance through case-based detection and direct mortality statistics such as the MDS provide valuable data to monitor measles elimination programs (Bose et al., 2014; Vaidya, 2015).

The measles campaign was particularly successful for girls, which saw greater absolute declines in measles mortality than boys. Though the girl-boy gap in measles mortality rates narrowed, mortality remains higher in girls, as is the case for other infectious causes of death at ages 1–59 months (Fadel et al., 2017). Persisting higher mortality rates among girls than boys may be due to lower vaccination coverage, social preference for boys, and lower levels of breastfeeding and health care access (Alkema et al., 2014; Corsi et al., 2009; Fadel et al., 2017; Guilmoto et al., 2018; Jha et al., 2006b; Ram et al., 2013).

The interrupted time series design addresses potential confounding by the effects of different policies occurring at the same time as the measles campaign launch. Given that the majority of child causes of death were declining from 2000 onward, we selected unbiased control deaths comparable with the pre-intervention trends of measles, pneumonia, and diarrhoea deaths. The addition of control deaths allows for evaluation of post-intervention differences rather than single-group mean or slope differences. In stratified analysis, we tested alternate intervention time points and measles case definitions, all of which reported a consistent effect. We did not observe a change in slope when moving the intervention forward to 2010, likely due to fewer time points in the post-intervention trend. The observed decreased in level of measles mortality when using 2010 as the intervention year might reflect greater actual vaccine delivery.

The MDS verbal autopsy form is designed to identify all major causes of death in children with low levels of misclassification (Aleksandrowicz et al., 2014; Fadel et al., 2017). The verbal autopsy form contains specific questions relating to measles (e.g. presence of rash, cough, whether the respondent reported history of measles) but cannot ascertain exposure and timing of symptoms. Thus, we tested alternate case definitions, one including family-reporting of a history of measles to capture measles-associated deaths of pneumonia or diarrhoea, and the other using only physician coding of measles deaths. We observed declines specific to the campaign, in each case definition, as opposed to no additional declines in pneumonia or diarrhoea deaths. The lack of effect in pneumonia deaths may be due to measles contributing a smaller etiologic fraction than other viral, bacterial, or fungal agents (Farrar et al., submitted). The success of the measles campaign is the increase in vaccination in campaign states to levels comparable with non-campaign states. Though the effect was smaller in non-campaign states, the introduction of second-dose measles through routine immunization in these non-campaign states also contributed to the declines in measles mortality nationally. Continued diligence in mass immunization and direct mortality monitoring are both needed to achieve elimination of measles deaths in India.

Under legal agreement with the Registrar General of India, the MDS data cannot be redistributed outside of the Centre for Global Health Research. To request MDS data access procedures or to set up a data transfer agreement, please contact the Office of the Registrar General, RK Puram, New Delhi, India (rgoffice.rgi@nic.in). The public census reports can be found at http://www.censusindia.gov.in/vital_statistics/SRS_Statistical_Report.html. Source data files have been provided for Figures 1,2,3,4, Figure 1—figure supplement 1, and Table 2. National survey data (from Figure 5) can be obtained free of charge from the following websites: http://rchiips.org/nfhs/NFHS-4Report.shtml (NFHS-4); http://rchiips.org/nfhs/report.shtml (NFHS-3); http://rchiips.org/DLHS-4.html (DLHS-4); http://rchiips.org/prch-3.html (DLHS-3); and http://rchiips.org/state-report-rch2.html (DLHS-2).

1. 1. Aleksandrowicz L
   2. Malhotra V
   3. Dikshit R
   4. Gupta PC
   5. Kumar R
   6. Sheth J
   7. Rathi SK
   8. Suraweera W
   9. Miasnikof P
   10. Jotkar R
   11. Sinha D
   12. Awasthi S
   13. Bhatia P
   14. Jha P

   (2014) Performance criteria for verbal autopsy-based systems to estimate national causes of death: development and application to the indian million death study

   BMC Medicine 12:21.

   https://doi.org/10.1186/1741-7015-12-21

   • PubMed
   • Google Scholar
2. 1. Alkema L
   2. Chao F
   3. You D
   4. Pedersen J
   5. Sawyer CC

   (2014) National, regional, and global sex ratios of infant, child, and under-5 mortality and identification of countries with outlying ratios: a systematic assessment

   The Lancet Global Health 2:e521–e530.

   https://doi.org/10.1016/S2214-109X(14)70280-3

   • PubMed
   • Google Scholar
3. 1. Bassani DG
   2. Kumar R
   3. Awasthi S
   4. Morris SK
   5. Paul VK
   6. Shet A
   7. Ram U
   8. Gaffey MF
   9. Black RE
   10. Jha P
   11. Million Death Study Collaborators

   (2010) Causes of neonatal and child mortality in India: a nationally representative mortality survey

   The Lancet 376:1853–1860.

   https://doi.org/10.1016/S0140-6736(10)61461-4

   • Google Scholar
4. 1. Black RE
   2. Cousens S
   3. Johnson HL
   4. Lawn JE
   5. Rudan I
   6. Bassani DG
   7. Jha P
   8. Campbell H
   9. Walker CF
   10. Cibulskis R
   11. Eisele T
   12. Liu L
   13. Mathers C

   (2010) Global, regional, and national causes of child mortality in 2008: a systematic analysis

   The Lancet 375:1969–1987.

   https://doi.org/10.1016/S0140-6736(10)60549-1

   • Google Scholar
5. 1. Bose AS
   2. Jafari H
   3. Sosler S
   4. Narula AP
   5. Kulkarni VM
   6. Ramamurty N
   7. Oommen J
   8. Jadi RS
   9. Banpel RV
   10. Henao-Restrepo AM

   (2014) Case based measles surveillance in pune: evidence to guide current and future measles control and elimination efforts in India

   PLOS ONE 9:e108786.

   https://doi.org/10.1371/journal.pone.0108786

   • PubMed
   • Google Scholar
6. Report

   1. Cochrane Effective Practice and Organisation of Care

   (2017) Interrupted Time Series (ITS) Analyses

   EPOC Resources for Review Authors.

   https://epoc.cochrane.org/sites/epoc.cochrane.org/files/public/uploads/Resources-for-authors2017/interrupted_time_series_analyses.docx

   • Google Scholar
7. 1. Corsi DJ
   2. Bassani DG
   3. Kumar R
   4. Awasthi S
   5. Jotkar R
   6. Kaur N
   7. Jha P

   (2009) Gender inequity and age-appropriate immunization coverage in India from 1992 to 2006

   BMC International Health and Human Rights 9:S3.

   https://doi.org/10.1186/1472-698X-9-S1-S3

   • PubMed
   • Google Scholar
8. 1. Dabbagh A
   2. Patel MK
   3. Dumolard L
   4. Gacic-Dobo M
   5. Mulders MN
   6. Okwo-Bele JM
   7. Kretsinger K
   8. Papania MJ
   9. Rota PA
   10. Goodson JL

   (2017) Progress toward regional measles elimination - Worldwide, 2000-2016

   MMWR. Morbidity and Mortality Weekly Report 66:1148–1153.

   https://doi.org/10.15585/mmwr.mm6642a6

   • PubMed
   • Google Scholar
9. 1. Fadel SA
   2. Rasaily R
   3. Awasthi S
   4. Begum R
   5. Black RE
   6. Gelband H
   7. Gerland P
   8. Kumar R
   9. Liu L
   10. Mathers C
   11. Morris SK
   12. Nair S
   13. Newcombe L
   14. Pandey A
   15. Ram F
   16. Ram U
   17. Rodriguez PS
   18. Sahu D
   19. Sati P
   20. Shah PJ
   21. Shet A
   22. Sheth J
   23. Singh JK
   24. Singh L
   25. Sinha A
   26. Suraweera W
   27. Jha P

   (2017) Changes in cause-specific neonatal and 1–59-month child mortality in India from 2000 to 2015: a nationally representative survey

   The Lancet 390:1972–1980.

   https://doi.org/10.1016/S0140-6736(17)32162-1

   • Google Scholar
10. 1. Francis MR
    2. Nohynek H
    3. Larson H
    4. Balraj V
    5. Mohan VR
    6. Kang G
    7. Nuorti JP

    (2018) Factors associated with routine childhood vaccine uptake and reasons for non-vaccination in India: 1998-2008

    Vaccine 36:6559–6566.

    https://doi.org/10.1016/j.vaccine.2017.08.026

    • PubMed
    • Google Scholar
11. 1. Gomes M
    2. Begum R
    3. Sati P
    4. Dikshit R
    5. Gupta PC
    6. Kumar R
    7. Sheth J
    8. Habib A
    9. Jha P

    (2017) Nationwide mortality studies to quantify causes of death: relevant lessons from India’s Million Death Study

    Health Affairs 36:1887–1895.

    https://doi.org/10.1377/hlthaff.2017.0635

    • Google Scholar
12. 1. Guerra FM
    2. Bolotin S
    3. Lim G
    4. Heffernan J
    5. Deeks SL
    6. Li Y
    7. Crowcroft NS

    (2017) The basic reproduction number (R₀) of measles: a systematic review

    The Lancet Infectious Diseases 17:e420–e428.

    https://doi.org/10.1016/S1473-3099(17)30307-9

    • PubMed
    • Google Scholar
13. 1. Guilmoto CZ
    2. Saikia N
    3. Tamrakar V
    4. Bora JK

    (2018) Excess under-5 female mortality across India: a spatial analysis using 2011 census data

    The Lancet Global Health 6:e650–e658.

    https://doi.org/10.1016/S2214-109X(18)30184-0

    • PubMed
    • Google Scholar
14. 1. Gupta SK
    2. Sosler S
    3. Haldar P
    4. Hombergh H
    5. Bose AS

    (2011) Introduction strategy of a second dose measles containing vaccine in India

    Indian Pediatrics 48:379–382.

    https://doi.org/10.1007/s13312-011-0066-1

    • PubMed
    • Google Scholar
15. 1. Holzmann H
    2. Hengel H
    3. Tenbusch M
    4. Doerr HW

    (2016) Eradication of measles: remaining challenges

    Medical Microbiology and Immunology 205:201–208.

    https://doi.org/10.1007/s00430-016-0451-4

    • PubMed
    • Google Scholar
16. 1. Jamir T
    2. Sodha S
    3. Bhagabati B
    4. Das B
    5. Shrivastava A
    6. Kumar A
    7. Venkatesh S

    (2016) Outbreak of measles in Bhelterghat, Ghanapara and Pekbeki, Goalpara, Assam, India, 2015

    International Journal of Infectious Diseases 45:228.

    https://doi.org/10.1016/j.ijid.2016.02.515

    • Google Scholar
17. 1. Jha P
    2. Gajalakshmi V
    3. Gupta PC
    4. Kumar R
    5. Mony P
    6. Dhingra N
    7. Peto R
    8. RGI-CGHR Prospective Study Collaborators

    (2006a) Prospective study of one million deaths in India: rationale, design, and validation results

    PLOS Medicine 3:e18.

    https://doi.org/10.1371/journal.pmed.0030018

    • PubMed
    • Google Scholar
18. 1. Jha P
    2. Kumar R
    3. Vasa P
    4. Dhingra N
    5. Thiruchelvam D
    6. Moineddin R

    (2006b) Low male-to-female sex ratio of children born in India: national survey of 1·1 million households

    The Lancet 367:211–218.

    https://doi.org/10.1016/S0140-6736(06)67930-0

    • Google Scholar
19. 1. Jha P
    2. Jacob B
    3. Gajalakshmi V
    4. Gupta PC
    5. Dhingra N
    6. Kumar R
    7. Sinha DN
    8. Dikshit RP
    9. Parida DK
    10. Kamadod R
    11. Boreham J
    12. Peto R
    13. RGI-CGHR Investigators

    (2008) A nationally representative case-control study of smoking and death in India

    New England Journal of Medicine 358:1137–1147.

    https://doi.org/10.1056/NEJMsa0707719

    • PubMed
    • Google Scholar
20. 1. Jha P

    (2014) Reliable direct measurement of causes of death in low- and middle-income countries

    BMC Medicine 12:19.

    https://doi.org/10.1186/1741-7015-12-19

    • PubMed
    • Google Scholar
21. 1. Larsen K
    2. Merlo J

    (2005) Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression

    American Journal of Epidemiology 161:81–88.

    https://doi.org/10.1093/aje/kwi017

    • PubMed
    • Google Scholar
22. 1. Larson HJ
    2. Brocard P
    3. Garnett G

    (2010) The India HPV-vaccine suspension

    The Lancet 376:572–573.

    https://doi.org/10.1016/S0140-6736(10)60881-1

    • Google Scholar
23. 1. Larson HJ
    2. Cooper LZ
    3. Eskola J
    4. Katz SL
    5. Ratzan S

    (2011) Addressing the vaccine confidence gap

    The Lancet 378:526–535.

    https://doi.org/10.1016/S0140-6736(11)60678-8

    • Google Scholar
24. 1. Linden A

    (2015) Conducting interrupted Time-series analysis for single- and Multiple-group comparisons

    The Stata Journal: Promoting Communications on Statistics and Stata 15:480–500.

    https://doi.org/10.1177/1536867X1501500208

    • Google Scholar
25. 1. Linden A

    (2018) A matching framework to improve causal inference in interrupted time-series analysis

    Journal of Evaluation in Clinical Practice 24:408–415.

    https://doi.org/10.1111/jep.12874

    • Google Scholar
26. Report

    1. Ministry of Health and Family Welfare

    (2005) National Rural Health Mission Framework for Implementation 2005-2012

    Ministry of Health and Family Welfare, Government of India.

    http://nhm.gov.in/images/pdf/about-nrhm/nrhm-framework-implementation/nrhm-framework-latest.pdf

    • Google Scholar
27. Report

    1. Ministry of Health and Family Welfare

    (2010) Measles Catch-Up Immunization Campaign, Guidelines for Planning and Implementation

    Ministry of Health and Family Welfare, Government of India.

    http://www.nihfw.org/pdf/Measles%20SIA%20Guidelines%20India%20_Final_Foreword_ver3.pdf

    • Google Scholar
28. Data

    1. Ministry of Health and Family Welfare

    (authors) (2018) State/disease-wise compiled outbreaks reported under IDSP

    Integrated Disease Surveillance Program. ID 3751.

    http://www.idsp.nic.in/index1.php?lang=1&level=1&sublinkid=5803&lid=3751
29. 1. Moss WJ

    (2017) Measles

    The Lancet 390:2490–2502.

    https://doi.org/10.1016/S0140-6736(17)31463-0

    • Google Scholar
30. 1. Murhekar MV
    2. Ahmad M
    3. Shukla H
    4. Abhishek K
    5. Perry RT
    6. Bose AS
    7. Shimpi R
    8. Kumar A
    9. Kaliaperumal K
    10. Sethi R
    11. Selvaraj V
    12. Kamaraj P
    13. Routray S
    14. Das VN
    15. Menabde N
    16. Bahl S

    (2014) Measles case fatality rate in Bihar, India, 2011-12

    PLoS ONE 9:e96668.

    https://doi.org/10.1371/journal.pone.0096668

    • PubMed
    • Google Scholar
31. 1. Ram U
    2. Jha P
    3. Ram F
    4. Kumar K
    5. Awasthi S
    6. Shet A
    7. Pader J
    8. Nansukusa S
    9. Kumar R

    (2013) Neonatal, 1-59 month, and under-5 mortality in 597 indian districts, 2001 to 2012: estimates from national demographic and mortality surveys

    The Lancet Global Health 1:e219–e226.

    https://doi.org/10.1016/S2214-109X(13)70073-1

    • PubMed
    • Google Scholar
32. Report

    1. Registrar General of India

    (2016)

    Sample Registration System Statistical Report 2015

    New Delhi: Office of the Registrar General of India.

    • Google Scholar
33. 1. Singh K
    2. Garg R

    (2017) Outbreaks of measles in Rajasthan in 2014: a cross sectional epidemiological investigation

    International Journal of Community Medicine and Public Health 4:1751.

    https://doi.org/10.18203/2394-6040.ijcmph20171796

    • Google Scholar
34. 1. Sudfeld CR
    2. Halsey NA

    (2009)

    Measles case fatality ratio in India a review of community based studies

    Indian Pediatrics 46:983–989.

    • PubMed
    • Google Scholar
35. Report

    1. UNICEF

    (2007) Technical Note: How to Calculate Average Annual Rate of Reduction (AARR) of Underweight Prevalence

    UNICEF.

    https://data.unicef.org/wp-content/uploads/2015/12/Technical_Note_AARR_185.pdf

    • Google Scholar
36. 1. Vaidya SR

    (2015) Commitment of measles elimination by 2020: challenges in India

    Indian Pediatrics 52:103–106.

    https://doi.org/10.1007/s13312-015-0580-7

    • PubMed
    • Google Scholar
37. 1. Vaidya SR
    2. Kamble MB
    3. Chowdhury DT
    4. Kumbhar NS

    (2016) Measles & rubella outbreaks in Maharashtra state, India

    Indian Journal of Medical Research 143:227–231.

    https://doi.org/10.4103/0971-5916.180214

    • PubMed
    • Google Scholar
38. 1. Vaidya SR
    2. Chowdhury DT

    (2017) Measles virus genotypes circulating in India, 2011-2015

    Journal of Medical Virology 89:753–758.

    https://doi.org/10.1002/jmv.24702

    • PubMed
    • Google Scholar
39. 1. Verguet S
    2. Jones EO
    3. Johri M
    4. Morris SK
    5. Suraweera W
    6. Gauvreau CL
    7. Jha P
    8. Jit M

    (2017) Characterizing measles transmission in India: a dynamic modeling study using verbal autopsy data

    BMC Medicine 15:151.

    https://doi.org/10.1186/s12916-017-0908-3

    • PubMed
    • Google Scholar
40. 1. Wolfson LJ
    2. Grais RF
    3. Luquero FJ
    4. Birmingham ME
    5. Strebel PM

    (2009) Estimates of measles case fatality ratios: a comprehensive review of community-based studies

    International Journal of Epidemiology 38:192–205.

    https://doi.org/10.1093/ije/dyn224

    • PubMed
    • Google Scholar
41. Book

    1. World Health Organization

    (1992)

    ICD-10: International Statistical Classification of Diseases and Related Health Problems, 2 (10th Revision)

    WHO. ISBN 978-92-4-154834-2.

    • Google Scholar
42. Website

    1. World Health Organization

    (2016) India’s Measles-Rubella Vaccination Campaign a Big Step Towards Reducing Childhood Mortality, Addressing Birth Defects

    Accessed March 5, 2019.

    http://www.searo.who.int/mediacentre/features/2017/india-measles-rubella-vaccination-campaign/en/
43. Report

    1. World Health Organization

    (2018a) Vaccine Preventable Diseases Surveillance Standards - Measles

    World Health Organization.

    https://www.who.int/immunization/monitoring_surveillance/burden/vpd/WHO_SurveillanceVaccinePreventable_11_Measles_R2.pdf

    • Google Scholar
44. Report

    1. World Health Organization

    (2018b) Measles and Rubella Surveillance Data

    World Health Organization.

    http://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/

    • Google Scholar

Author details

1. Benjamin KC Wong

   Centre for Global Health Research, Dalla Lana School of Public Health, St. Michael’s Hospital, University of Toronto, Ontario, Canada

   Contribution

   Conceptualization, Data curation, Formal analysis, Validation, Investigation, Visualization, Methodology, Writing—original draft, Project administration, Writing—review and editing

   Competing interests

   No competing interests declared

   "This ORCID iD identifies the author of this article:" 0000-0002-7745-6271

2. Shaza A Fadel

   Centre for Global Health Research, Dalla Lana School of Public Health, St. Michael’s Hospital, University of Toronto, Ontario, Canada

   Contribution

   Conceptualization, Data curation, Supervision, Validation, Investigation, Methodology, Writing—original draft, Project administration, Writing—review and editing

   Competing interests

   No competing interests declared

   "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

   Contribution

   Writing—review and editing

   Competing interests

   No competing interests declared

4. Ajay Khera

   Ministry of Health and Family Welfare, Government of India, Delhi, India

   Contribution

   Writing—review and editing

   Competing interests

   No competing interests declared

5. Rajesh Kumar

   School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India

   Contribution

   Writing—review and editing

   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

   Contribution

   Writing—review and editing

   Competing interests

   No competing interests declared

7. Prabhat Jha

   Centre for Global Health Research, Dalla Lana School of Public Health, St. Michael’s Hospital, University of Toronto, Ontario, Canada

   Contribution

   Conceptualization, Resources, Software, Supervision, Funding acquisition, Validation, Investigation, Methodology, Writing—original draft, Project administration, Writing—review and editing

   For correspondence

   prabhat.jha@utoronto.ca

   Competing interests

   Prabhat Jha is a Reviewing Editor at eLife

   "This ORCID iD identifies the author of this article:" 0000-0001-7067-8341

• 3,443

  views

• 396

  downloads

• 10

  citations

Views, downloads and citations are aggregated across all versions of this paper published by eLife.