MR Vaccine Drive Is the Only Way to Protect Babies From Fatal CRS

This World Immunization Week, we put the focus on Congenital Rubella Syndrome which this drive was aimed at.

A recent incident in the country has perfectly exemplified the importance of driving awareness about vaccination and the value of immunisation for the public.

Early this February, India launched an ambitious campaign to vaccinate children across the country against two life threatening diseases – measles and rubella – as part its Universal Immunization Programme.

The first phase of the campaign was rolled out in 5 states of Karnataka, Tamil Nadu, Puducherry, Goa and Lakshadweep, targeting nearly 3.6 crore children. The measles-rubella (MR) vaccine was provided free-of-cost across schools as well as health facilities and outreach session sites.

However, the campaign was met with resistance, especially in the bigger states of Karnataka and Tamil Nadu, from unexpected quarters. It was rocked by a number of rumours propagated on social media platforms such as WhatsApp and Facebook.

Faced with a challenge that threatened the success of the campaign itself, the government quickly launched a series of educational drives and awareness programmes to fight the misinformation campaign.

Why the Rubella Vaccine Is the Need of the Hour

This World Immunization Week, we put the focus on a lesser known disease which this vaccination drive was aimed at. It causes birth defects in babies, such as congenital blindness or deafness. Thousands of children in India are getting affected every year. Yet, the average parent is hardly aware.

Rubella is only a mild problem in adults and adolescents. But when it occurs in pregnant women, it causes a ‘syndrome’ of health problems in their babies, including serious birth defects, mental disabilities, premature delivery or even death. It’s almost as if the infection bypasses the adults without any serious complications but in pregnant women latches onto the baby, often with disastrous consequences.

Worse still, there is no cure. The syndrome can cause mild to severe problems but coupled with the lack of awareness and delayed detection, the children who survive the disease end up with lifelong physical or social disabilities.

The hope? You can’t cure the disease but you can prevent it. There’s a vaccine that’s available. In fact, it’s been around for the past 40 years. Why then, are lakhs of Indians living with congenital rubella syndrome (CRS)? Lack of awareness is a key reason.

We invite Dr Jyoti Joshi, for an expert commentary on invisible epidemic of congenital rubella syndrome rand more importantly, what (would-be) parents can do to protect their children. Here is what she had to say.

CRS – An Epidemic in India

At least 30,000 children are born with congenital rubella syndrome (CRS) each year in India, out of a lakh babies born globally with the syndrome. Those are just new cases. The actual disease burden is higher with thousands of new cases each year adding up. Lakhs of people are living with CRS currently, facing lifelong physical and social disabilities.

Congenital rubella is a neglected epidemic in India. In adults and older children, the virus may cause just a fever and rash. The problem arises when it occurs in pregnant women.

Consider this – up to a third of adolescent girls and women of child-bearing age are at risk of the infection according to estimates. This is worrying as pregnant women carry a 90% chance of passing the virus to the unborn baby, which can lead to pre-term deliveries, congenital problems, or even death in babies.

In Indian children, CRS accounts for up to half of all cases of congenital abnormalities and 10-15% of all childhood cataract cases. Deafness is the most common abnormality caused, in addition to blindness, mental disabilities, brain damage and heart defects.

While heart defects can often be corrected, damage to the brain is permanent. Diagnosis is usually delayed and a further lack of support services for the management of the disabilities causes a huge socio-economic burden for families.

No Cure, Prevention the Only Way Forward

Specific symptoms can be treated, but there is no cure for CRS. So, how do we fight the disease?

To put it simply, prevention is the only way out. While most vaccines protect the person directly, vaccination against rubella (German measles) protects the next generation against CRS. Therefore, it is important to vaccinate not just infants but older children, adolescents and women prior to pregnancy.

Otherwise, we will continue to see many cases of CRS in babies born to unvaccinated mothers. Vaccinating both boys and girls also helps to decrease the infection levels in the environment.

As part of the global commitment to eliminate measles and rubella, India has introduced the MR vaccine in its public health programme. The campaign targets 41 crore children across the country, from 9 months to 15 years of age – one of the largest campaigns rolled out in India. CRS is a public health problem which can be solely controlled with vaccination. For example, Cuba was the first country to eliminate CRS during the 1990s and the United States followed suit in 2004. It is time India does the same.

Here’s What the Public Can Do

Meanwhile, demanding vaccination for preventing rubella is an important step you can take to protect your children. Here is what you can do, especially if you are planning a baby:

1. Consult your doctor and get tested for rubella. It is a simple blood test that tests for antibodies to rubella.
2. In case the tests shows up negative, which means you don’t have the immunity against it, get vaccinated.
3. After vaccination, wait for at least one month before planning a pregnancy.
4. In case there is someone in your close vicinity suspected with the infection, consult your doctor.
5. Remember to get tested, even if you are already a parent, but planning to have another pregnancy. Vaccination will still be important, as the infection can affect any pregnancy.
6. If you have an older child, do get him or her vaccinated. Immunising the child and the other family members will help to decrease infection levels in the environment.

CRS may be a hidden epidemic, but remember, there is a very simple solution – a vaccine that works. Don’t forget to spread the word, so children can have a healthy future.

(Dr Jyoti Joshi is an infectious diseases expert with specialisation in public health surveillance and immunisation. She is Head-South Asia at Center For Disease Dynamics, Economics & Policy.)

(Shalini is a former television health journalist from India. She has extensively reported on public health issues and epidemics.)