Should children in Bangladesh receive their first measles vaccine at 6 months of age? Possible 3-dose measles vaccine proposal

Dr. Shamim Ahmed

 

(One)

Public health has been at the heart of Bangladesh’s success over the past few decades. In particular, the Expanded Programme on Immunization (EPI) has been implemented to prevent serious infectious diseases in children and mothers. It is our great misfortune that during the previous interim government, the government canceled the existing ‘Operation Plan’ in the country for the purpose of purchasing vaccines through its own institutions. As a result, most children born in Bangladesh for 18 months remain outside the scope of measles vaccination.

 

(Two)

Nearly 500 children have died of measles in Bangladesh in the last few months, yet this year alone the previous Awami League government was supposed to declare that measles had been eradicated from Bangladesh. During Sheikh Hasina’s rule, we were on the verge of eradicating measles. All that was left was to make the announcement.

 

(Three)

In Bangladesh, children are usually given the first measles vaccine at the age of 9 months. The second vaccine is given at 15 months. We should know why the measles vaccine is given at 9 months and 15 months in Bangladesh and why this vaccine is given at other times in different countries of the world.

 

One of the most important things to consider when giving measles vaccination is:

1) Protect the child as soon as possible, and

2) Ensuring that the vaccine works as effectively as possible.

 

a) The timing of vaccination is determined for that purpose. It is important to know that children receive most of their natural measles immunity from the mother at birth and some later through breast milk. This immunity remains high until the age of 6 months. At the age of 9 months, it loses 85 percent of its effectiveness and between 12 and 15 months, this effectiveness is lost by 90 to 100 percent.

 

b) Scientists recommend that measles vaccination be given only after the mother’s immunity has worn off. Because if the vaccination is given while the mother’s immunity is still present, the child’s body may not be able to understand the effectiveness of the vaccine, and as a result, the vaccine may not work fully. Therefore, measles vaccination should never be given before 6 months of age.

There are several main reasons why children are not vaccinated for the 3 months from 6 months to 9 months. This is because the natural immunity is not completely lost during this period, but remains to some extent. Therefore, if all children in a country are continuously and regularly vaccinated, then the chances of them getting infected from others during this temporary period are very low. This is basically Herd Immunity.

 

c) In developed countries such as America or Canada, the first measles vaccine is given at the age of 12 months and the second vaccine at the age of 4 years, when children go to school. The effectiveness of the first vaccine is highest when given at the age of 12 to 15 months because the immunity received from the mother has already disappeared and the child’s body can retain the effectiveness of the vaccine. Therefore, sometimes the first measles vaccine at 12-15 months is enough, but since children come into contact with a large number of other children at school, in Canada or America they are given the second vaccine at the age of 4 years.

 

d) In Canada or America, 95 percent of children who receive the first dose at 12 months of age develop immunity. 5 percent do not, for various reasons. Since it is expensive to determine who these 5 percent are, all children are given a second dose at the age of 4-6, which is considered a booster dose, and after the second dose, 99 percent of children develop immunity against measles.

 

e) Reasons for waiting until 12 months of age in developed countries:

– Their vaccination program is so good that the little immunity that remains in children’s bodies from 6 to 12 months is due to sufficient herd immunity.

– Since most of the population is measles-free or has achieved herd immunity, there is not much risk of being infected.

– The largest number of children are vaccinated during this time and its effectiveness is highest since the immunity acquired from the mother’s womb is exhausted by then.

 

f) In developed and highly successful countries like Canada or the United States, at 12 months; in countries like Bangladesh, which had high success for a time, the first vaccination is given at 9 months, but in some cases, children can be vaccinated at 6 months:

 

1) If a measles epidemic occurs in a country (outbreak)

2) If a country experiences a sudden influx of refugees

3) During humanitarian disasters

4) If it has spread due to international travel, or

5) If for any reason there is an unexpected disruption to the regular vaccination program.

 

The recent measles epidemic or disaster in Bangladesh occurred for reasons 1 and 5. As a result, it is reasonable to discuss whether children in Bangladesh should be given 3 doses of measles instead of 2 doses in the next few years. The first vaccination should be given at 6 months of age to avoid the initial disaster. But since the immunity received from the mother is effective at this time, the measles vaccine may not work in the long term, but it can prevent ongoing deaths. Subsequent children can be given the 2nd and 3rd doses at 12 months, and 18 months. This exception can be continued by the government for at least two years to prevent child deaths.

 

To prevent the unprecedented disaster of measles in Bangladesh, public health experts must go beyond traditional methods and take measures based on scientific and social considerations. As a public health researcher, I request the government to give three vaccines to Bangladeshi children at 6 months, 12 months and 18 months instead of two vaccines at 9 months and 15 months to get rid of the emergency danger. It is also important to consult with young public health experts on this issue.

Author Profile:
Dr. Shamim Ahmed,
Public Health Specialist,
University of Toronto.