Measles Outbreak in Mumbai: Should Infants Be Given the Vaccine Sooner?

Health officials are debating whether the first dose of the measles-rubella vaccine should be administered sooner.

Health officials in the state are debating whether the first dose of the measles-rubella vaccine which is given to infants at the age of nine months, should be administered earlier.

(Photo: Chetan Bhakuni/FIT)

The death toll of the measles outbreak in Mumbai climbed to 13 on Thursday, 24 November.

Considering we already have a vaccine for the disease which is offered free of charge under the Universal Immunisation Programme (UIP), health authorities in Maharashtra are stumped about how to tackle this outbreak.

One suggestion that has popped up is to offer the first dose of the measles-rubella vaccine to babies younger than nine months.

This debate gains significance as children and infants are the most affected group due to the measles outbreak, with at least 8-9 percent of the city's infections reported in 'babies below nine months' of age.

But is administering this vaccine that is meant for kids over nine months to even younger babies such a good idea? FIT asks experts.

Why Isn’t the Vaccine Given to Infants Sooner?

Dr Umang Agrawal, Infectious Disease Consultant at Mumbai’s PD Hinduja Hospital & MRC, explains that when a baby is born, the maternal antibodies they get from their mother protect them from measles. 

If the measles-rubella vaccine is administered during the first six months of the infant’s life, which is when the maternal antibodies are still active, the response of the body’s immune system to it might be blunted.  

So Are No Vaccines Given to Infants Till the Time They Have Maternal Antibodies?

That’s not the case. Maternal antibodies are present in a baby for at least six months till after they’re born, but they do not protect the babies against every disease.

Thus, polio, BCG, hepatitis B, pneumococcal, diphtheria, pertussis,  rotavirus, and tetanus vaccines are all given to infants before six months of age, shares Dr Agrawal.

But, On the Other Hand...

Dr Agrawal says that since the maternal antibodies cease at six months of age, and the vaccine isn’t administered till nine months of age, the risk of infants being affected by it in those three months increases.

Thus, giving the first dose of vaccine at the mark of 6-7 months might be a useful measure. 

He adds that a Lancet study also mentioned that the efficacy of the vaccine is good between 6-9 months of age.

Renouned virologist Dr Gagandeep Kang tells FIT, "switching the age at vaccination to six months has been done experiementally in programs previously, and yes, it is something to consider but it will require a visit that is not currently in the immunisation schedule."

She adds,

"The important thing for any vaccination programme will be not to stop with that first vaccine whether given at six months or at nine months, but also make sure that children get their second dose in the second year of life."

Dr Gagandeep Kang, Virologist, CMC Vellore

The only argument against administering the vaccine between the ages of 6-9 months is that evidence shows that the immune response in babies who got the vaccine at the nine-month mark was higher than the babies who got it before nine months of age, explains Dr Dhanya Dharmapalan, Consultant, Pediatric Infectious Diseases, Apollo Hospitals, Navi Mumbai.

But, she adds, that this can of course be corrected by giving two additional booster doses in the following months.

"In an outbreak situation, the vaccine should be given as early as possible, which is at the age of six months. Our priority should be to save the lives of young infants."

Dr Dhanya Dharmapalan, Consultant, Pediatric Infectious Diseases, Apollo Hospitals, Mumbai

Dr Dharmapalan also adds that this discussion is a much-delayed one. She feels that we should have started administering the first dose of the vaccine as soon as the outbreak was notified because it takes some time for the immune response to develop as well.