WITH 13 deaths over the last month and a sharp spike in cases, Mumbai and its surrounding areas are staring at a measles outbreak. Until Wednesday, the city had reported 233 confirmed cases, of which over 200 were reported in the last two months.
This is a huge jump from the last few years — 10 cases and 1 death in 2021; 29 cases and no death in 2020; and 37 cases and 3 deaths in 2019 (see chart).
Among the surrounding areas which have reported a spike in cases, 51 cases were reported in Malegaon, 37 in Bhiwandi, 28 in Thane, 17 in Nashik, 15 in Thane Rural, 11 in Akola, 10 each in Nashik and Yavatmal, and nine each in Kalyan-Dombivali and Vasai-Virar (till November 17).
The spike in these areas has seen the state’s case count climb to 553 (until Wednesday), a six-fold jump from last year, when it reported 92 cases and 2 deaths. The state reported 193 cases and 3 deaths in 2020; and 153 cases and 3 deaths in 2019.
Of the 13 deaths so far, nine were from Mumbai while the remaining were from the city’s outskirts – one from Nalasopara and three from Bhiwandi. While three were in the age group of 0-11 months, eight were in the 1-2 years group, and two in 3-5 years group.
The first death was reported between October 26-27, when three children — Fazal Khan (13 months), Noorain (three-and-a-half years), Hasnain (5 years) – died within 48 hours, all in Govandi area. Besides a 14-month-old girl who died in Kalwa district hospital in Thane, all the other deaths were reported in Mumbai hospitals.
Seven pockets of Mumbai – Dharavi, Govandi, Kurla, Mahim, Bandra and Matunga – have emerged as hotspots. While the case count was 25 till September, 60 cases were reported in the city in October, indicating the start of the outbreak.
Officials blamed the spike in cases on a gap in vaccination due to Covid. According to the national immunisation programme, the measles vaccine has to be administered in two doses – at 9 and 15 months of age.
“Amid Covid-19, the vaccination got impacted. We have around 20,000 children who didn’t get the measles vaccine. Now, we are tracking all these children and holding vaccination camps on priority,” said Dr Mangala Gomare, executive health officer, Brihanmumbai Municipal Corporation (BMC).
While the civic body has ramped up vaccination, data showed that till October, when the outbreak started, only 41 per cent of the eligible children had been vaccinated in Mumbai.
According to a presentation by the state’s public health department to Chief Minister Eknath Shinde, in 2022-23, till October, only 73,120 children (42.5 per cent), of the targeted total of 1,71,890 children in the city, had been administered the first dose of the measles vaccine. Similarly, only 70,102 children (41.2 per cent), of the targeted total of 1,69,872 children, had been administered the second dose (see chart).
In contrast, the first dose coverage in the city was 72 per cent in 2021-22, 87 per cent in 2020-21, and 92 per cent in 2019-20. Similarly, the second dose coverage was 82 per cent in 2021-22, 87 per cent in 2020-21, and 90 per cent in 2019-20.
The total vaccination coverage for the state too showed similar patterns – 60 per cent for first dose in 2022-23 (till October) as compared to 97 per cent in the last two years and 99 per in 2019-20; 56 per cent for second dose this year as compared to 97 per cent in 2021-22, 94 per cent in 2020-21, and 98 per cent in 2019-20.
Vaccine hesitancy has turned into the biggest hurdle for ASHA and health volunteers. “After vaccination, some children develop mild fever and pain in the injected area, so parents don’t let them get vaccinated. Instead, they claim that neem kadha is a safer way to fight against measles,” said Shreya Salvi, a health volunteer in Govandi.
Yusuf Sheikh, a relative of Mansoon Ansari whose six-month-old daughter, Ashifa, died of measles in Govandi last week, said they have put neem leaves at their doors to stave off the infection. “Some even make a paste of neem and apply it on the skin of the infected children,” he said.
The civic body has now roped in local politicians and religious leaders to convince parents to get their children vaccinated. The BMC has also roped in doctors with knowledge of Urdu to spread awareness in areas like Govandi, which have a significant Muslim population.
While measles is a highly contagious viral disease that mostly affects younger children, at least two adults (above 20 years) and older children above 10 years have also reported the disease this time.
“Measles infection among older children or adults is extremely rare. This can happen either because of a breakthrough infection when they get exposed to an infected patient or because they didn’t take the vaccine when they were young,” said Dr Bela Verma, head of the pediatric unit at the government-run JJ Hospital. “However, the severity rate among adults is less as they have higher immunity than children,” she added.
“To contain and control the outbreak, it is crucial that cases are quickly identified and isolated, and contacts and other susceptible children are immunised,” said Dr Ajit Gajendragadkar, Consultant, Paediatrics, P D Hinduja Hospital.