LAHORE: Measles, a vaccine-preventable disease, continues to take a heavy toll on the children, while the Punjab Expanded Programme on Immunization (EPI) has warned that the annual measles incidence per million has been increasing for the last three years, leading to the outbreaks across the province since start of 2024.

Recent alarming reports suggest that babies aged under nine months, who don’t even qualify for the measles vaccine, are also falling a prey to the disease in large numbers.

Similarly, the partially-immunised children are also contracting measles in the current outbreaks in Punjab, causing serious concern among the public health experts, who declare the trend unusual.

According to the EPI officials, the first dose of measles vaccine is given to a child at the age of nine months, while second one is administered at 15 months, besides a booster dose, to improve immunity.

Children below nine months of age also contracting the disease

An official report sent by the EPI Punjab to Federal Directorate of Immunization, Islamabad, states that the Vaccine Preventable Disease (VPD) surveillance system has continuously been registering measles outbreaks in Punjab, particularly, over the last one year or so.

“However, despite strict vigilance, the measles cases are on the rise, necessitating an increased outbreak response at a much larger scale”, reads the EPI director’s report.

According to the sources, measles has claimed lives of over 30 children across Punjab since January 2024, though the officially-confirmed number is 25.

“The annual measles incidence per million increased by 8.04 per cent in 2021, 16.65pc in 2022 and 30.38pc in 2023 despite the largest ever MR campaign carried out in Nov 2021 across Punjab”, reads the EPI report.

In 2023, it says, more than 98pc of the suspected patients were tested, and lab results found 29 percent of them positive for measles, which was a cause of serious concern.

It says that in 2023 all the 36 districts of Punjab reported suspected measles cases, and 33 of these showed lab-confirmed measles outbreak, with a total 37 deaths caused by the disease.

The EPI Punjab further reports that the programme conducted Measles Risk Assessment on the World Health Organization’s direction, but the findings remained inconclusive due to various reasons.

Although VPD surveillance improved, but still there were gaps in field investigations at the community level, it says, adding that the outbreak response and mop-up remained weak due to non-availability of dedicated vaccine operational support.

“As a susceptible cohort was accumulating, the threat of the large-scale outbreak of the measles and damage increased, the EPI Punjab intimated the federal government.

Following the situation, the EPI sought vaccine and operational support from the federal government for effective case response, mop-up and outbreak response to combat the measels outbreaks in Punjab.

“We are reporting every third under nine [months of age] kid out of 10, who tests positive in the lab reports for measles”, Punjab EPI Director Mukhtar Awan told Dawn.

He says that a total 3,400 confirmed and 11,000 suspected measles cases have been reported during the first five months of 2024.

Though the number is unexpectedly high, the situation is much better in Punjab as compared to Sindh, Khyber Pakhtunkhwa, Islamabad and even in Gilgit Baltistan, where the incidence rate per million is many times higher, he claims.

However, the reporting of under nine-month age children visiting hospitals with measles has become a matter of serious concern for the Punjab EPI, Awan says.

So far, he says, 35pc of the total children, including those with measles-related deaths and confirmed cases reported in Punjab during the ongoing outbreaks, are found to be below nine months of age..

He says that partially-immunised children, mostly one-time vaccinated, are also being brought to the hospitals across the province.

He adds that on receiving every suspected or confirmed case of measles, or report of a related death, the EPI dispatches teams to the affected area (town village or locality) for the case response to test at least 160 children living there.

Most deaths have been reported of the children who developed complications due to being malnourished and, or having compromised immunity, he says.

“We have received 800,000 doses of measles vaccine from the federal government, in addition to procurement at the province level of 900,000 others,” the EPI director says, claiming that the programme vaccinated all the targeted children across Punjab during the recent campaigns.

Published in Dawn, June 6th, 2024