Measles outbreak in Mumbai: Even a 15-year-old must be vaccinated, says Dr Subhash Salunke

The task force will use field functionaries like ASHA workers, anganwadi and local community based organisations and practitioners to spread oral communication in their respective languages. File pic

The sudden outbreak of measles in the city, that started more than a month ago, shows no signs of abating. It is characterised by concentration in slum pockets such as Govandi, and as of Thursday, the city has been recording an average of eight new infections a day, bringing the total cases reported to 440.

Dr Subhash Salunke, former director of state health services, has been appointed to head the state task force for the outbreak. With experience of over 30 years in public healthcare, Dr Salunke has been part of multiple committees to combat different challenges in the past.

The 11-member team has members and representation from the Indian Academy of Paediatrics, Indian Medical Association, WHO, UNICEF and from state health systems. "It is multi-faceted," says Dr Salunke, reassuringly, "focusing on multi-specialty areas and all members are highly efficient, skilled and knowledgeable."

Last Monday, the task force deliberated on a 10-point plan to contain the infectious disease, and Dr Salunke spoke to us about it.

Also Read: Mumbai: Four-year-old dies of measles in Kurla

Excerpts from the interview:

What are the key points of the plan?
Our primary focus is on containing the spread in hotspots. Surveillance needs to be enhanced and intensified. A head count of all the children, without missing a single one, and vaccinating the unvaccinated is another strategy we have recommended. We have also prepared a checklist for all the roles the different functionaries will play over the next month. Another important aspect is inter-sectional coordination, and the crucial involvement of Integrated Child Development Services (ICDS). A campaign will be implemented from December 15 to 25 and another one in January to dispense first and second doses of the vaccines to the children. By January 26, we should be able to confidently say that every unvaccinated child in Maharashtra will be covered. At the same time, the routine immunisation programme should not stop, so that we cover all children between ages nine months and five years. The focus should also be on areas where malnutrition is a problem.

How does malnourishment contribute and how will you tackle it?
Malnutrition predisposes the severity of the disease. A child with Grade 3 or Grade 4 malnourishment is five times at risk of complications and mortality. That's why we are concentrating on Grade 4 malnourished children.

How will you wrestle with the problems caused by the density of population and living quarters in slums?
Different awareness campaigns, tailored to the hotspot, will focus on factors such as minority, migrant population, rural and/or urban groups. The core issue is the same, but the focus will be different; the communication strategy needs to be worked out [accordingly].

The symptoms of measles and common flu are quite similar in the initial stages [and thus the infection spreads]. How can one differentiate between the two?
There has to be joint advocacy and communication through field functionaries such as ASHA and anganwadi workers, community-based organisations and local medical practitioners. There has to be oral communication and printed material in all regional languages.

What are the biggest challenges for the task force?
Our primary task is to provide technical inputs to the government and administration on what needs to be done and how. As experts in the public health and paediatrics field, we hope to provide technical evidence-based guidelines to ministers and commissioners, based on which they need to chalk out an implementation strategy.

You mention that the lapse in routine immunisation is the key reason for this outbreak. How can other such public health risks be curbed?
Yes, the major reason behind the measles outbreak is the lapse in routine immunisation programmes due to two years of the COVID-19 pandemic. Many children have not received 50 per cent of their vaccinations. Also, the government has not focused on public health measures, particularly in slum and urban areas. There is a measure of support but there is no systematic implementation and monitoring. For instance, even a 15-year-old, who has not been inoculated, can be immunised, as can any child from six months of age. If the concentration of vulnerable children in an area grows, the disease becomes more severe and spreads faster.