India: Vaccines push measles to an older age.

Measles in older kids worries doctors

PUNE: Doctors in the city have noticed a perceptible rise in measles cases reported in the last few days. But what is worrying them is the trend where the contagious viral disease, which is usually seen in toddlers, is being observed among school-going children in the age bracket of four to 10 years.

Though reasons for the surge in cases are not yet known, doctors attribute it to irregular vaccination and declining immunity.

"We see around six to seven cases of measles per week among children, mainly in the four to 10 years age group, which is quite unusual. Apart from irregular vaccination, the rise in cases is an indication of declining immunity level among children," said paediatrician Amruta Walimbe of Bharati Hospital. The hospital's paediatric out-patient-department offers medical check-ups and consultation to over 200 children every day.

"There has definitely been an upsurge in measles cases, which is a cause for worry. The health authorities looking after the universal immunisation programme should intervene. The focus should be to increase awareness and coverage of measles vaccination, including the use of measles-containing vaccines like MMR (measles, mumps and rubella) at the appropriate age," said paediatrician Sanjay Lalwani, medical director of Bharati Hospital.

Paediatrician Shishir Modak says that awareness about giving children a second dose of the measles vaccine is still very low among the Indian population.

"Irregular vaccination and declining immunity are the causes for measles being seen in children above four years of age. I see around three-four cases of measles in school-going children every week. The cases are definitely on the rise. The prevalence must be higher in children living in the city's peripheral areas," said Modak, a former president of the Indian Academy of Paediatrics, Pune chapter.

Paediatrician Rajan Joshi of Deenanath Mangeshkar Hospital, too, sees cases of measles in school-going children.

"It is definitely strange and needs to be looked into urgently. A single dose measles vaccine followed by the MMR vaccine provides adequate protection against the disease. But it is often seen that parents miss the second dose of the vaccine."

Paediatrician Sharad Agarkhedkar says that measles in older children can cause severe illness and complications, including bronchopneumonia, encephalitis, flaring up of hidden tuberculosis and in some cases attacks of severe enteritis (loose motions).

"I see around three to four measles cases in school-going children every week. I have confirmed diagnosis of measles in girls as old as seven to 10 years old, which is quite unusual. Some of them have taken the single dose measles vaccine. All of them have missed out on the second dose," said Agarkhedkar, who is head of the paediatrics department at D Y Patil Medical College and Hospital.

Paediatrician Aarti Kinikar of B J Medical College and Sassoon General Hospital says that measles cases are seen round the year. "It is important to confirm the clinical diagnosis of measles as children tend to have similar symptoms in other viral infections as well," Kinikar said.

"Although children may get rash-like symptoms in other viral infections, the rash in a typical measles case appears on the fourth day of the illness. It shows on the hairline and progresses from head towards the toes. It disappears in the reverse manner by 'brawny desquamation' — a scaly rash. Cough in measles is very typical as well," Agarkhedkar said.

If one child in the group who is not immunised gets the virus, the disease can spread to other children. "This is the season of summer camps and there are possibilities of affected children in their initial stages spreading the infection to others," said a health official from the Pune Municipal Corporation.

State immunisation officer R M Kumbhar, however, said that immunisation coverage of measles has been very good in state. "The measles virus shifts to older age groups when there is optimum immunisation coverage. This is a known phenomenon. The promotion of immunisation in India has resulted in drastic reduction in morbidity and mortality," Kumbhar said.

According to the Indian Academy of Paediatrics, 80,000 Indian children under the age of five die each year due to measles and its complications, amounting to 4% of the under-five deaths.