Measles diseases are endemic. In all countries of the world, in 2013 there are 145,700 deaths caused by measles. It means that every day there are 400 deaths, or 16 deaths per hour in most children under the age of 5 years (toddlers).

Based on the report of the General Directorate of Disease Control and Environmental Health of Indonesian Ministry of Health in 2014, there are 12,222 cases of measles. The outbreak frequency were 173 incidents with 2,104 cases. Most cases of measles occurred to pre-school and elementary-aged children.

Over a four year period, cases of measles were more common in the 5-9 years age group (3591 cases) and in the 1-4 year age group (3383 cases). In Indonesia, Rubella is one of the public health issues that require effective prevention efforts.

Surveillance data over the past five years shows that 70% of rubella cases occur in the <15 years age group. Furthermore, based on the study of estimated burden of CRS disease in Indonesia, in 2013, there are 2,767 CRS cases estimated, and 82 / 100,000 occurred at the age of 15-19 years of age, then decreased to 47 / 100.000 at the age of 40-44 years old.

One out of 10 infants with measles will get middle ear infection (Otitis Media) as complication. The cause of hearing loss or deafness is congenital and persistent. One person out of 20 infants with measles will get complications of pneumonia (pneumonia), as a major cause of death of newborns.

Then one person out of 1000 babies who suffer from measles will get complications of brain infection or encephalitis (seizures, hearing disabilities and mental retardation). Then one or two babies out of 1000 infants in developing countries will die as malnutrition and vitamin A deficiency are common, measles plays a role in causing the death of one in four children with measles.

In addition, measles is also a major cause of permanent blindness in children in developing countries. The economic impact is very large due to the infection of measles and rubella. In the United States, for example, in (only) 12 cases of measles reported in 2008 in the state of California, the health cost to the public has reached 125,000 USD.

In the same year in the state of Arizona, 14 cases had cost 800,000 USD. While in Indonesia, Health Research and Development Agency of Ministry of Health in 2015 estimated a macro-economic loss of 1.09 trillion due to congenital rubella syndrome.

Based on the disability-adjusted life year (DALY) cost review, the estimated potential day-to-day losses due to measles and rubella, between the immunized MR and non-immunization were Rp 26,598,238 / person . Children with congenital rubella syndrome develop cataracts from birth that must be operated on, with the heart (open heart gap / valve), while the cost can be billions.

VACCINE RUBELLA

In 2011, WHO recommended that all countries that have not introduced the rubella vaccine but only used 2 (two) doses of measles vaccine in routine immunization programs to include rubella vaccine in routine immunization programs. The National Immunization Experts Advisory Committee (ITAGI) has issued a recommendation on January 11, 2016 on introduction, integration of the Measles Rubella vaccine into a national immunization program to reduce the incidence of rubella and Congenital Rubella Syndrome.

The government has launched the MR Vaccine Program, the implementation of the MR vaccine campaign in children aged 9 – 15 years is in two phases as follows: The first phase, August-September 2017 in all parts of Java. The second phase, from August to September 2018 throughout Sumatra, Kalimantan, Sulawesi, Bali, Nusa Tenggara, Maluku and Papua with coverage ≥ 95% of 66,859,112 children across Indonesia.

Immunization of MR is given regardless the immunization status or history of measles and rubella before. The rubella vaccine is available in monovalent as well as in combination with other viral vaccines, such as measles (Measles Rubella / MR) or with measles and parotitis ( Measles Mumps Rubella / MMR).

All rubella vaccines can lead to seroconversion of 95% or more after administration of one dose of vaccine and the efficacy of the vaccine is estimated at about 90% – 100%. One medical staff is expected to provide MR immunization injection to maximum of 100-125 targets / day. Dissolved vaccines should only be used within six hours. Therefore, only a vial of vaccine is opened and another vial can be opened again vaccine in the previous vial is used.

The medical staff should also record the hours of vaccine is opened on the vaccine label and take the aseptic procedure into account. Post-vaccination follow-up report is done gradually and graded, with a 24-hour period.

Regarding the matter, GAVI gave a grant of 27 million US dollars for the campaign of MR vaccine. While the cost of immunization operations 3.9 million US dollars with the state budget. The effectiveness of this rubella vaccine is 90%. Side effects of the MR vaccine are red patches and fever, but they are quiet rare.

Based on the report from the General Director of Disease Prevention and Control (P2P) dr. H.M Subuh, MPPM is optimistic to reach 95% of all children in Java Island on the 30th day. Until the end of August in Central Java there were 3,007 million children (about 39.26%) of the total target to be immunized.

Then West Java followed with as 4.38 million (about 35.57%), Yogyakarta 35.67%, and East Java 37.47%. While the lowest coverage is in DKI Jakarta as many as 700,000 children with a percentage of 28.61%. Head of Communication and Public Relations Bureau of the Ministry of Health, Oscar Primadi, explained that the coverage of children vaccinated against MR in Java reached 20 million or 20,503,180 (58.6%) in detail in early September and so far reported there were only 17 sick children after immunization, from 17,133,271 vaccines already given. And it was stated as coincidence, or the sickness was only coincide with the time of immunization, and the original cause of illness has been found.

The result of work meeting with Commission IX of DPR RI, Minister of Health Prof. Nila F. Moeloek is committed to strive for and succeed the MR immunization program. The ministry also tried to halal certify the MR vaccine, so there will be no polemic in the majority Muslim community. Keep the spirit and optimism of MR vaccine fighters for the healthy and quality next generation of the nation. (*)

Editor: Bambang Bes

*) The author, Dr. M. Yusuf Alamudi, S.Si., M.Trop.Med is a researcher at the Institute of Tropical Deseases (ITD) of Universitas Airlangga, and Head of Postgraduate Alumni Master Program of Tropical Medicine Faculty of Medicine, Universitas Airlangga, Surabaya.