European Journal of Cardiovascular Medicine

Manuscript

While whole world being stunned by COVID 19 pandemic since almost 3 years, routine health care services were compromised(1). The level of preventive measures which has been achieved with efforts of decades were compromised and new challenges have emerged in form of threat to the goal to eliminate measles by 2020(2)The goal was revised to eliminate measles by 2023. But looking at the recent outbreaks and NFHS-5 data on vaccination coverage(1), it has become near too impossible. But it’s not totally worth to just blame on decreased immunization coverage, being reasonable with the conditions, other factors need to be reassessed and revisited to revise policy that can make “elimination of measles” dreams comes true in meaning.

This cross-sectional study was being done retrogradely on patients notified for fever with rash from OPD from January to May 2023 at Pediatric department at Dr.N. D. Desai faculty of medical science and research, Nadiad. Out of 44 notified patients, 30 patients were traced as seropositive for measles. Indoor files of these 30 patients were traced from MRD with permission of superintendent and proformas were filled to obtain data regarding their immunization status, nutrition status and other clinical parameters. To assess growth, WHO charts for weight, height, BMI for age and weight for length/height charts were used. To classify, anemia, WHO cut off levels of hemoglobin as per age used. Outcome in form of discharge/DAMA/EXIRED also noted

30 cases were found seropositive for measles from 44 reported cases of fever with maculopapular rash from total of 11021 visiting patients with male to female ratio 0f 1:1. 4 patients were under the age of 1 years and above 10 years of age. Youngest child was 2 months of age. 18(60%) positive patients were unimmunized completely, while 3 patients had not received any dose of MR vaccine being under vaccine prescribed age of 9 February (8) and March(13) month had highest number of seropositive cases in this 5 month duration of study. From 14, under 5 patients, 5(35.7%) patients were suffering from severe acute malnutrition and multiple nutritional deficiencies and 3(21.4%) were suffering from Moderate malnutrition. From 16 patients above 5 year, 8(50%) patients were under nourished. Total 24(80%) patients were found to be anemic among which 5(16.6%) were severely anemic as per WHO classification of anemia. Most common cause of not being immunization was refusal by parents as in 38.8%. 90% patients developed rash within 5 days of fever. Cough , coryza and conjunctivitis were most common clinical features among patients followed by diarrhoea. 70% patients had Upper respiratory tract infection. 8 patients also manifested lower respiratory tract infection. All patients were discharged successfully with average duration of stay of 6 days.

.Table 1 Age wise nutrition status of Mealses Seropositive cases

_{*WHO charts used for diagnosis of SAM(Severe acute malnutrition)&MAM(Moderate acute malnutrition)}

_{**WHO BMI charts used to define undernourished}

Table 2 Level of anemia of measles seropositive cases

Table 3 Immunization status of seropositive cases of measles

Table 4 Causes of unimmunization un seropositive cases of measles

Table 5 Clinical features in seropositive cases of measles

Table 6 Lab investigation results used in seropositive cases of measles

Table 7 Clinical diagnosis of seropositive cases of measles

Along with hampered immunization, impaired nutritional status is also associated with high cases of measles during the season which inversely affected goal to eliminate measles. Further comparative studies required to find out strong relation hence providing solutions to achieve goal soon though immunization remains strong pillar of the campaign. Immunization age should be reconsidered early based on further studies including large numbers of positive patients to determine minimum susceptible age to  get infection of mealses.

1. NFHS-5_Phase-II_0.pdf. 
2. Vaidyanathan G. Massive measles outbreak threatens India’s goal to eliminate disease by 2023. Nature. 2022 Dec 22; 
3. https://www.who.int/tools/elena/overview
4. https://www.cdc.gov/globalhealth/measles/data/global-measles-outbreaks.html
5. https://www.who.int/india/news/feature-stories/detail/india-vaccinates-30-million-children-againstmeasles-and-rubella-in-7-
months#:~:text=India%20has%20vaccinated%20over%20348,1.2%20cases%20per%20million%20
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6. 6.Kirti Premabhai Mehta et al., Study of the Clinical Profile and Outcomes of Measles in Children 
Journal of Clinical and Diagnostic Research. 2023 Jan, Vol-17(1): SC30-SC33
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https://www.who.int/data/nutrition/nlis/info/anaemia#:~:text=WHO%20defines%20anaemia%20in
%20children,concentration%20%3C120%20g%2FL.
8. Participant Manual - Facility Based Care of Severe Acute Malnutrition, Ministry of Health and 
Family Welfare Government of India, 2013
9. https://www.who.int/tools/child-growth-standards/standard