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

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.

Data availability

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).

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

Version history

  1. Received: November 3, 2018
  2. Accepted: February 15, 2019
  3. Accepted Manuscript published: March 5, 2019 (version 1)
  4. Version of Record published: April 16, 2019 (version 2)

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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  1. Benjamin KC Wong
  2. Shaza A Fadel
  3. Shally Awasthi
  4. Ajay Khera
  5. Rajesh Kumar
  6. Geetha Menon
  7. Prabhat Jha
(2019)
The impact of measles immunization campaigns in India using a nationally representative sample of 27,000 child deaths
eLife 8:e43290.
https://doi.org/10.7554/eLife.43290

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https://doi.org/10.7554/eLife.43290

Further reading

  1. Measles vaccination campaigns have saved the lives of about 50,000 Indian children in three years.

    1. Epidemiology and Global Health
    Olivera Djuric, Elisabetta Larosa ... The Reggio Emilia Covid-19 Working Group
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    Background:

    The aim of our study was to test the hypothesis that the community contact tracing strategy of testing contacts in households immediately instead of at the end of quarantine had an impact on the transmission of SARS-CoV-2 in schools in Reggio Emilia Province.

    Methods:

    We analysed surveillance data on notification of COVID-19 cases in schools between 1 September 2020 and 4 April 2021. We have applied a mediation analysis that allows for interaction between the intervention (before/after period) and the mediator.

    Results:

    Median tracing delay decreased from 7 to 3.1 days and the percentage of the known infection source increased from 34–54.8% (incident rate ratio-IRR 1.61 1.40–1.86). Implementation of prompt contact tracing was associated with a 10% decrease in the number of secondary cases (excess relative risk –0.1 95% CI –0.35–0.15). Knowing the source of infection of the index case led to a decrease in secondary transmission (IRR 0.75 95% CI 0.63–0.91) while the decrease in tracing delay was associated with decreased risk of secondary cases (1/IRR 0.97 95% CI 0.94–1.01 per one day of delay). The direct effect of the intervention accounted for the 29% decrease in the number of secondary cases (excess relative risk –0.29 95%–0.61 to 0.03).

    Conclusions:

    Prompt contact testing in the community reduces the time of contact tracing and increases the ability to identify the source of infection in school outbreaks. Although there are strong reasons for thinking it is a causal link, observed differences can be also due to differences in the force of infection and to other control measures put in place.

    Funding:

    This project was carried out with the technical and financial support of the Italian Ministry of Health – CCM 2020 and Ricerca Corrente Annual Program 2023.