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Adding interventions to mass measles vaccinations in India

Wednesday, 7th of December 2016

Bull World Health Organ. 2016 Oct 1;94(10):718-727. Epub 2016 Jul 5.

Adding interventions to mass measles vaccinations in India

Johri M¹, Verguet S², Morris SK³, Sharma JK⁴, Ram U⁵, Gauvreau C⁵, Jones E⁶, Jha P⁵, Jit M⁶.

¹Centre de Recherche du Centre Hospitalier de lUniversité de Montréal, Tour Saint-Antoine, Porte S03-458, 850 Rue St-Denis, Montréal, Québec, H2X 0A9, Canada .
²Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, United States of America .
³Division of Infectious Diseases, Department of Pediatrics, University of Toronto, Toronto, Canada .
⁴National Health Systems Resource Centre, Ministry of Health and Family Welfare, New Delhi, India .
⁵Centre for Global Health Research, Dalla Lana School of Public Health, Toronto, Canada .
⁶Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England .

Abstract below; full text is at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5043198/

OBJECTIVE:

To quantify the impact on mortality of offering a hypothetical set of technically feasible, high-impact interventions for maternal and child survival during the Indian 2010-2013 measles supplementary immunization activity.

METHODS:

We developed Lives Saved Tool models for 12 Indian states participating in the supplementary immunization, based on state- and sex-specific data on mortality from the Indian Million Deaths Study and on health services coverage from Indian household surveys. Potential add-on interventions were identified through a literature review and expert consultations. We quantified the number of lives saved for a campaign offering measles vaccine alone versus a campaign offering measles vaccine with six add-on interventions (nutritional screening and complementary feeding for children, vitamin A and zinc supplementation for children, multiple micronutrient and calcium supplementation in pregnancy, and free distribution of insecticide-treated bednets).

FINDINGS:

The measles vaccination campaign saved an estimated 19 016 lives of children younger than 5 years. A hypothetical campaign including measles vaccine with add-on interventions was projected to save around 73 900 lives (range: 70 200-79 300), preventing 73 700 child deaths (range: 70 000-79 000) and 300 maternal deaths (range: 200-400). The most effective interventions in the whole package were insecticide-treated bednets, measles vaccine and preventive zinc supplementation. Girls accounted for 66% of expected lives saved (12 712/19 346) for the measles vaccine campaign, and 62% of lives saved (45 721/74 367) for the hypothetical campaign including add-on interventions.

CONCLUSION:

In India, a measles vaccination campaign including feasible, high-impact interventions could substantially increase the number of lives saved and mitigate gender-related inequities in child mortality.