Implications and Learnings of Measles Outbreak Through a Clinician’s Lens; Mumbai, India 2022–2023

Background: The COVID-19 pandemic has disrupted preventive healthcare, including routine vaccination coverage and surveillance systems. According to the WHO, approximately 40 million children missed measles-containing vaccine (MCV) doses between 2020 and 2021, posing a global threat of measles outbreaks. Objective: This study aimed to investigate the clinical and demographic profiles of suspected Measles children visiting tertiary care hospitals during the measles outbreak in Mumbai, India, during 2022–2023. Methods: A prospective, descriptive study was conducted at a tertiary care hospital in Mumbai from October 2022 to March 2023. The study included 100 consecutive patients aged 1 month to 14 years admitted to the pediatric ward with fever and maculopapular rash. Data collection involved clinical and demographic information, with analysis using Microsoft Excel 2010 and SPSS V23. Chi-square tests and Fisher’s Exact test were applied to evaluate associations between various factors and outcomes. Results: Among the 100 patients, 32 (32%) were under 9 months, 43 (43%) were between 9.1 to 60 months, and 25 (25%) were over 60 months. Male preponderance was seen with a total of 57 (57%) male patients. The study found 62 (62%) of patients were unvaccinated. Clinical presentations included prodromal symptoms 89 (89%), breathing difficulties 34 (34%), GI symptoms 30 (30%), and complications like pneumonia (32%), acute gastroenteritis (17%), and otitis media (8%). Out of 100 patients, 96 were cured and discharged while 4 patients died. All 4 fatalities were among unvaccinated patients, emphasizing the importance of vaccination. Conclusion: The study highlights mortality and morbidity following the resurgence of measles due to decreased vaccination rates during the pandemic. It underscores the need for improved routine and supplementary immunization activities to achieve measles elimination targets. Additionally, the study raises the question of whether the age for the first measles dose should be reduced to 6 months due to the observed waning immunity from maternally transferred antibodies. The real threat of this outbreak will be the long-term sequalae- Subacute Sclerosing Pan Encephalitis (SSPE) which is anticipated to rise in the coming years.