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Open Access Research article

Age-appropriate vaccination against measles and DPT-3 in India – closing the gaps

Niyi Awofeso12*, Anu Rammohan3 and Kazi Iqbal3

Author Affiliations

1 School of Population Health, University of Western Australia, Nedlands, Australia

2 e-School of Health and Environmental Studies, Hamdan Bin Mohammed e-University, Dubai, United Arab Emirates

3 School of Business, Discipline of Economics, University of Western Australia, Nedlands, Australia

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BMC Public Health 2013, 13:358  doi:10.1186/1471-2458-13-358

Published: 17 April 2013



In 2010, India accounted for 65,500 (47%) of the 139,300 measles-related deaths that occurred globally. Data on the quality of age-appropriate measles vaccination in rural India is sparse. We explored the following issues: (i) What proportion of Indian children were appropriately vaccinated against measles at 9 months of age, and DPT-3 at 4 months? (ii) Which health facilities administered measles vaccine to children prior to 9 months of age and DPT-3 prior to 14 weeks?


We analyzed data from the 2008 Indian District Level Health Survey (DLHS-3) to determine the extent of age-appropriate measles and DPT-3 vaccinations. Among 192,969 households in the dataset, vaccination cards with detailed records were available for 18,670 children aged between 12 and 23 months.


Among this cohort, 72.4% (13,511 infants) had received the first dose of measles vaccine. Only 30% of vaccinated infants received the measles vaccine at the recommended age of 9 months. Similarly, only 31% of infants in the cohort received DPT-3 vaccine at the recommended age of 14 weeks. About 82% of all prematurely vaccinated children were vaccinated at health sub-centres, ICDS and Pulse Polio centres.


Age-inappropriate vaccination impacts adversely on the effectiveness of India’s measles immunisation program due to sub-optimal seroconversion, if premature, and increased vulnerability to vaccine preventable diseases, if delayed. Capacity building approaches to improve age-appropriate vaccination are discussed.

Measles; Vaccination schedule; India; Age-appropriate vaccination