Measles cases still not showing signs of dipping worldwide

Health Care, Heart Care Foundation of India, Medicine Comments Off

India accounts for one-third of all measles deaths worldwide

New Delhi, 23 April 2019: Measles cases rose 300% worldwide through the first three months of 2019 compared to the same period last year, as per recent statistics by the UN. Measles, which is highly contagious, can be entirely prevented through a two-dose vaccine, but the WHO has in recent months sounded the alarm over slipping global vaccination rates.

Statistics indicate that India accounts for one-third of all measles-related deaths worldwide. Measles is highly infectious and as per the WHO, a country needs to ensure that at least 95% of all children receive two doses of the vaccine. About 15% of vaccinated children fail to develop immunity from the first dose, meaning that if only 80% are fully immunized, an outbreak is likely.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Measles is serious and highly contagious and lead to debilitating or fatal complications. Some of them include encephalitis (an infection that leads to swelling of the brain), severe diarrhea and dehydration, pneumonia, ear infections and permanent vision loss. Babies and young children with malnutrition and weak immune systems are particularly vulnerable to complications and death. Unlike measles, rubella is a mild viral infection that mainly occurs in children. A woman who is infected with the rubella virus during the early stage of pregnancy has a 90% chance of transmitting it to the fetus. Some issues that the virus can cause include hearing impairments, eye and heart defects and brain damage in newborns. It can also lead to spontaneous abortion and fetal deaths.”

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “here is still reluctance, opposition, and slow acceptance of vaccination apart from other operational challenges. The challenges faced in delivering lifesaving vaccines need to be addressed from the existing knowledge and lessons must be learnt from past experiences.”

The Vaccination Schedule under the UIP is as follows.

  • BCG (Bacillus Calmette Guerin) 1 dose at Birth (up to 1 year if not given earlier).
  • DPT (Diphtheria, Pertussis and Tetanus Toxoid) 5 doses; Three primary doses at 6 weeks, 10 weeks, and 14 weeks and two booster doses at 16-24 months and 5 Years of age.
  • OPV (Oral Polio Vaccine) 5 doses; 0 dose at birth, three primary doses at 6,10 and 14 weeks and one booster dose at 16-24 months of age.
  • Hepatitis B vaccine 4 doses; 0 dose within 24 hours of birth and three doses at 6, 10 and 14 weeks of age.
  • Measles 2 doses; first dose at 9-12 months and second dose at 16-24months of age.
  • TT (Tetanus Toxoid) 2 doses at 10 years and 16 years of age
  • TT – for pregnant woman two doses or one dose if previously vaccinated within 3 Year
  • In addition, the Japanese Encephalitis (JE vaccine) vaccine was introduced in 112 endemic districts in campaign mode in phased manner from 2006 to 2010 and has now been incorporated under the Routine Immunization Programme.

Supreme Court to decide about apology: Will the Apex Court’s decision on apology have implications on medical mistakes?

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Yesterday, the Congress president Rahul Gandhi expressed regrets in the Supreme Court over his remarks related to Rafaele.

If the Apex Court decides to accept the apology of Rahul Gandhi, this will provide another tool for councils to decide about medical apology.

The council has powers to accept the mistake. As per Regulation 8.2 of MCI Code of Ethics, “…If the medical practitioner is found to be guilty of committing professional misconduct, the appropriate Medical Council may award such punishment as deemed necessary or may direct the removal altogether or for a specified period, from the register of the name of the delinquent registered practitioner…”.

Apologies are gaining in importance, both nationally and internationally. These started with the example set by Pope John Paul II in his numerous apologies on behalf of the “children of the church” in anticipation of the Jubilee Year, as well as redress through national apologies to various groups-including Japanese Americans interned during World War II; Native Americans, whose land was confiscated and were otherwise mistreated; African Americans, whose ancestors were victims of slavery; and particular African Americans, who were victims of medical tests such as the “Tuskegee Experiment.”

The importance of the apologies of healthcare professionals-particularly physicians and hospital leaders through their risk management personnel-to their patients for medical errors became an important matter in medical education and practice around 2000.

There have been at least five converging forces leading to the current interest in medical error apology.

The physician-patient relationship is more egalitarian than ever before. Patients are now apt to be informed consumers-due in part to the Internet and popular advertising-who feel that they have the right to negotiate their treatment and know when mistakes have been made.
The American medical communitys knowledge about the frequency and seriousness of medical errors has been growing, and many believe that such knowledge and disclosure to patients will ultimately improve medical practice. Such disclosure is now required by the Joint Commission on Accreditation of Healthcare Organizations.
Once doctors disclose a serious medical error to a patient, it is only common wisdom for medical professionals to apologize for psychological and humanitarian reasons. Patients would inevitably perceive withholding an apology in such circumstances as offensive, insensitive, and unprofessional.
Physicians and other medical staff in several medical centers have successfully diminished the costs of malpractice suits by apologizing to patients for medical errors and, when appropriate, making out-of-court settlements.
Several states in USA have passed or are considering legislation that would allow supportive, benevolent comments, as well as apologies, to be inadmissible in malpractice cases, thereby encouraging physicians to offer such comments and apologies.
Lawyers have always advised physicians and other healthcare professionals to refrain from apologizing to patients, because they believed that offering an apology is an admission of guilt, which would increase the frequency and amount of malpractice claims.

This assumption is changing and today many believe that such apologies are not only ethically correct but may even decrease such claims.

“Hushing up’ of errors increases results in an angry patient and creates distrust between the doctor and the patient.

Apologize to the patient in such situations…While it does not undo the damage caused, an apology may soothe the emotions of the patient and/or the family and lessen the anger and distrust.

Let us see what the apex court decides…

(Source: De Paul University)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA