When measles vaccine was included in our national
Universal Immunization Program in 1985, the schedule was to give one dose
between 9 and 12 months of age. With the emphasis on immunization coverage
assessment at the end of the first year of life, 9-12 months was
interpreted by health workers as the exclusive age window for the vaccine
and children who missed it within that window were not given it at a later
age. This was recognized and corrected by the National Technical Advisory
Group on Immunization (NTAGI), resulting in a Government Order to ensure
that a dose of measles vaccine should be given to all children up to age 5
(personal communication, John TJ, co-chair, NTAGI). Despite these
guidelines, many health workers still believe that by 12 months the window
for the vaccine is over. We illustrate this with a case report to
highlight the need for wider publicity to ensure that the vaccine is not
denied to any child on the basis of age.
An 18 month old child, not vaccinated against measles
was hospitalized with severe measles in February 2010. The child was
treated appropriately and recovered. Measles IgM antibody was detected
according to standard methodology, confirming the clinical diagnosis.
Colleagues in the Department of Child Health corroborated the occurrence
of an outbreak of measles in at least one periurban village during
January/February. The child’s mother reported that she had taken the child
on completion of 9 months for the measles vaccine on 3 occasions, to the
closest urban health center. Twice the health worker declined to vaccinate
as the child had a mild cough and cold and the third time the mother was
told that the child was too old to receive the measles vaccine, having
passed the first birthday. The child had received all the other UIP
vaccines including 3 doses of Hepatitis B vaccine, currently included in
UIP in Tamil Nadu.
The refusal to offer measles vaccine after 12 months of
age is a matter of serious concern. The Immunization Handbook for Medical
Officers states that while the ideal target age to administer measles
vaccine is 9 to 12 months, it is to be administered up to 5 years of age
under the UIP [1]. We spoke with 2 staff members of 2 urban health posts;
one said that measles vaccine should be given beyond 12 months up to 5
years but the second said she would not give the vaccine beyond 12 months
of age. We reiterate the importance of informing all staff of the current
guidelines to use every opportunity to vaccinate all children aged 10
months to 5 years against measles.
References