Status of coverage of MR vaccination, after supplementary immunization activities in a rural area of south India: A rapid immunization coverage survey

Introduction: After a commendable achievement on polio-free status for the South-East Asian Region (SEAR), WHO is now focusing towards measles elimination, which is still a major contributor of under-five mortality in SEAR. India has introduced measles and rubella (MR) vaccination throughout the country through supplementary immunization activity, followed by introducing the same in the routine vaccination. Health indicators and public health system functioning in the southern states of India are good, so India introduced the MR campaign in the southern high-performing states as phase 1 on 5 April 2017. The aim of the campaign was to vaccinate more than 95% of eligible children (aged 9 months to 15 years). At the same time, rumors and negative campaigning about this initiative started in social media. This study aimed to measure the coverage of MR vaccination among the target population in South India. Methods: Data was collected immediately after phase 1 of the MR vaccine campaign in April 2017. Data was collected based on the WHO-recommended 30/7 rapid monitoring method. Thirty villages around the Rural Health Training Centre of Pondicherry Institute of Medical Sciences were selected and seven children aged 9 months to 5 years and seven children aged 6 to 15 years from each village were included. Children were classified as 'vaccinated' or 'not vaccinated' based on the WHO 'card or history' method. Results: Among the total sample of 420 children, 380 children (90.5% (range 87.4-93.0%)) were found to be vaccinated and 40 children (9.5% (range 7.0-12.6%)) were found to be unvaccinated. Most of the people came to know about the MR vaccination through auxiliary nurses and midwives, followed by school teachers. The main reasons for not getting vaccinated was fear of an adverse event following vaccination or fear of injection. Reasons for not getting vaccinated were significantly associated with usage of smartphone by at least one of the parents (adjusted odds ratio (OR) 2.1 (1.1-4.2)), better literacy level among mothers (adjusted OR 5.2 (1.1-24.8)) and poor literacy level among fathers (adjusted OR 3.6 (1.1-11.5)). Conclusion: Despite the negative propaganda by social media, the coverage of vaccination by the public healthcare providers was near optimal in phase 1, which shows the strength of the public health system in this rural area of southern India. In accordance with the modern technology, public health policymakers should think about and plan informat