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

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 440Dr 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 11member team has members and representation from the Indian Academy of Paediatrics Indian Medical Association WHO UNICEF and from state health systems ldquoIt is multifacetedrdquo says Dr Salunke reassuringly ldquofocusing on multispecialty areas and all members are highly efficient skilled and knowledgeablerdquoLast Monday the task force deliberated on a 10point plan to contain the infectious disease and Dr Salunke spoke to us about itAlso Read Mumbai Fouryearold dies of measles in KurlaExcerpts from the interviewWhat are the key points of the planOur 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 intersectional 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 problemHow does malnourishment contribute and how will you tackle itMalnutrition predisposes the severity of the disease A child with Grade 3 or Grade 4 malnourishment is five times at risk of complications and mortality Thatrsquos why we are concentrating on Grade 4 malnourished childrenHow will you wrestle with the problems caused by the density of population and living quarters in slumsDifferent awareness campaigns tailored to the hotspot will focus on factors such as minority migrant population rural andor urban groups The core issue is the same but the focus will be different the communication strategy needs to be worked out accordinglyThe symptoms of measles and common flu are quite similar in the initial stages and thus the infection spreads How can one differentiate between the twoThere has to be joint advocacy and communication through field functionaries such as ASHA and anganwadi workers communitybased organisations and local medical practitioners There has to be oral communication and printed material in all regional languagesWhat are the biggest challenges for the task forceOur 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 evidencebased guidelines to ministers and commissioners based on which they need to chalk out an implementation strategyYou mention that the lapse in routine immunisation is the key reason for this outbreak How can other such public health risks be curbedYes the major reason behind the measles outbreak is the lapse in routine immunisation programmes due to two years of the COVID19 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 15yearold 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