Bangladesh Vaccinates 21.7 Million Children Against Measles but Lacks Accurate Eligibility Data

Bangladesh has vaccinated 21.775 million children against measles in three phases, exceeding official targets, but authorities do not have an accurate count of children eligible for vaccination, raising concerns over whether coverage is sufficient to control the outbreak.

Experts said the number of vaccinated children alone is not enough to assess the success of an immunisation programme. Accurate estimates of the total number of eligible children are also necessary, as a low target can show coverage above 100% on paper while leaving many children unvaccinated.

At least 95% of eligible children must be vaccinated to control measles transmission, experts said. Authorities also need up-to-date data on the number of children currently eligible for vaccines and the number of newborns joining the eligible population each month.

Professor Dr Atiqul Islam of the Department of Paediatric Infectious Diseases and Community Paediatrics at Bangladesh Shishu Hospital and Institute told Ajker Patrika that measles vaccination coverage had not yet reached 95%.

“Measles vaccination coverage has not yet reached 95%. Yet, at least 95% of children must be vaccinated to control transmission,” he said. “This creates herd immunity, which also provides considerable protection to unvaccinated children. But this target has not been achieved in the country. Infection is spreading because there are pockets or clusters of unvaccinated children in different areas.”

Health Services Division Secretary Dr A. N. M. Bazlur Rashid said vaccination efforts were being intensified to control measles despite the lack of a precise count of eligible children.

“Vaccination is being provided continuously. We are close to creating herd immunity, or a strong protective barrier, through vaccination,” he told Ajker Patrika on Thursday. “Measles is almost under control. We are ensuring vaccination by going door to door.”

According to the Directorate General of Health Services, 1,299 people have died while receiving treatment after developing measles symptoms or contracting measles over the past eight months. Since March 15, measles symptoms have been detected in 244,291 people, while 24,880 people have been confirmed with measles.

More than 218,000 people were admitted to hospital, while more than 209,000 were discharged, according to the health directorate.

The measles outbreak began spreading widely from March this year and has shown no sign of coming under control after eight months. The government had expected to contain the outbreak through vaccination.

The national measles-rubella vaccination campaign began on April 5 and ended on May 20. The health authorities have continued vaccinating children missed during the campaign alongside routine immunisation, but measles transmission has not been brought under control.

An Expanded Programme on Immunization report issued by the Health Services Division on November 10 showed that 18,446,122 children were vaccinated during the first phase of the measles-rubella campaign from April 5 to May 20.

The target for that phase was 18,015,064 children, bringing reported coverage to 102.2%.

A further 1,417,727 children were vaccinated between May 21 and September 25. Another 1,911,518 children received vaccines during an intensified campaign from September 26 to November 10.

In total, 21,775,367 children were vaccinated, with cumulative coverage reaching 120.9% from the start of the programme to November 10.

By comparison, the National Vitamin A Plus Campaign on June 28 set a target of 23.5 million children aged between six months and five years. The target included 2.8 million children aged six to 11 months and 20.6 million children aged 12 to 59 months.

Based on those figures, the Vitamin A campaign target was 5.5 million higher than the measles-rubella campaign target.

A review article published this month in the United States Centers for Disease Control and Prevention journal “Emerging Infectious Diseases” raised concerns about the method used to set vaccination targets in Bangladesh.

The article said vaccination coverage exceeding 100% could conceal immunity gaps among parts of the population. It also noted the possibility of over-reporting vaccination figures.

Public health experts in Bangladesh also said vaccination coverage had not met requirements and that discrepancies existed in the figures. Major disruptions to the routine immunisation programme meant that many children did not receive vaccines at the scheduled time, they said.

Professor Dr Md Atiqul Haque, dean of the Faculty of Preventive and Social Medicine at Bangladesh Medical University, said intensified routine vaccination and the identification of missed children were essential alongside special campaigns.

“Measles is highly infectious. There is no alternative to extensive vaccination to prevent its spread,” he told Ajker Patrika. “For some other infectious diseases, vaccinating a large proportion of the population can provide indirect protection to the rest. But it is difficult to create such herd protection for measles. Therefore, at least 95% or more children must be brought under vaccination coverage.”