Analysis of measles outbreaks reported to Integrated Disease Surveillance Programme (IDSP), India, 2019–2023

BACKGROUND: In 2022, an estimated 1,36,000 measles deaths were reported worldwide, mostly in children under five. In 2022, thirty-seven countries reported extensive or disruptive measles outbreaks by the WHO, while only 22 countries reported similar outbreaks in 2021. According to NFHS-5, 87.9% of children between 12 and 23 months old had received their initial dose of the measles-containing vaccine (MCV), but only 31.9% of children aged 24-35 months who received MCV2. The study aimed to perform descriptive epidemiology of measles outbreaks reported to IDSP in India from 2019 to 2023. METHODOLOGY: We did a secondary data analysis of weekly outbreak data from the Integrated Disease Surveillance Program (IDSP) for the period 2019-2023. We extracted data from publicly available IDSP weekly outbreak reports and analysed them using MS Excel, focusing on time, place, and person distribution. RESULTS: Out of 259 reported outbreaks, 89% were laboratory-confirmed, and 56.3% of outbreaks were timely, with reporting occurring in the same week. Age distribution was not available in 56% of IDSP outbreak reports. The median (Interquartile range) age was 6.5 (5-9.5). Sex distribution was not available in 96% of IDSP outbreak reports. The 53% (137/259) outbreaks were reported from Bihar (18%), Jharkhand (13%), Uttar Pradesh (11%), and Gujarat (10%). The 25 districts have reported three or more measles outbreaks over five years. These districts account for 117 of the 259 reported outbreaks: Godda (Jharkhand), West Champaran (Bihar), and Nuh (Haryana). The maximum number of outbreaks (116) was recorded in 2023. Vitamin A was given during 56% (114/259) of outbreaks. Twenty deaths were reported. CONCLUSIONS: A substantial proportion of outbreaks (72%) were reported from seven states, predominantly in northern and eastern India. The delayed reporting of outbreaks and the absence of age and sex distribution in most reports highlight areas for improvement. Recommendations include timely reporting, inclusion of age and sex data, and ensuring widespread vitamin A supplementation. CLINICAL TRIAL NUMBER: Not applicable.