2]. As the vaccine efficacy is only 85% for first dose of measles at nine completed months, there selleck chem is progressive accumulation of a small number of susceptible children in the community over the years. Such accumulations are typically caused by the combination of the measles vaccine efficacy that does not reach 100% and children left un-immunized each year. As the coverage increases, inter-epidemic interval increases as well as a shift towards older age groups may be observed as in Thailand and Sri Lanka.[18] Although awareness and practice regarding measles were satisfactory among healthcare providers in both settings yet in the Shahpur block workers, there were observable gaps not only in the knowledge part but also in the scientific usage of the vaccine carriers, while conducting the immunization sessions in the fields which might lead towards the mechanism of cold chain failure.

Yeung et al. recorded the findings of the cold chain failure despite 95% vaccination as one of the factors for the measles outbreak.[19] With respect to beneficiaries related issues, results in two areas suggest difference with respect to knowledge regarding cause of measles, treatment and follow-up practices. Measles is locally known as Dharrssali. Illiteracy and knowledge are complimentary. Added with beliefs and barriers, many statistically significant factors like geographically difficult hilly areas, poor socio-economic status, poverty with over-crowding in the muddy thatched houses and illiterate mothers were found to be more inclined towards traditional unscientific lines in terms of cause and effect.

Earlier studies had also shown that cases hypothesize the genesis of measles as curse of goddess.[20�C23] Despite high immunization coverage in the areas, majorities of respondents opted for traditional faith healing treatment and with diet rich in Seul�Ca medicinal plant employed to facilitate eruption of measles during illness. For the vaccination of the children, they had to travel a distance of6�C10 kms on hilly terrain on foot consuming 3/4th hour to 2 and ? hour for nearest available health care facility [Table 4]. The attack rates even among highly vaccinated children aged 11�C17 years in Jathrear and 6�C15 years in Kutharna villages were higher. This suggests waning of immunity with age (secondary vaccine failure), which can be due to the use of poorly stored vaccine.

However, effect of exposure to ultra Batimastat violet radiation to wane immunity as observed by Mary cannot be ruled out.[24] There was no measles cases in the age group of 0�C5 years, and it is possible that there is higher risk of the occurrence of secondary vaccine failure that reduce the immunity to measles over time than the primary vaccine failure that did not develop the immunity. Also, there is the possibility of the failure of the cold chain maintenance in the area with the lower vaccine efficacy at the time when the older children aged 11�C16 years in Jathrear had their measles vaccine.