Bangladesh is set to lower the age for measles vaccination to six months in a planned nationwide campaign, stepping beyond the standard global schedule as authorities adopt what experts describe as “disaster-time measures” to contain a rapidly spreading outbreak.
The decision, taken at a meeting of the National Immunization Technical Advisory Committee (NITAG) on Monday, comes as infections surge across multiple regions, with rising cases even among infants below the routine vaccination age.
Under the existing immunization schedule, aligned with World Health Organization (WHO) recommendations, children receive the first dose of the measles vaccine at nine months and a second dose at 15 months.
However, health officials say the current outbreak has forced a temporary departure from this framework.
DGHS Director (Disease Control) Prof Dr Md Halimur Rashid said the revised age threshold would apply only to a special campaign expected to begin in early June.
“As measles cases are increasing, we have decided to administer the first dose from six months under special circumstances,” he told Dhaka Tribune.
“Routine immunization will continue as before, with the first dose at nine months,” he added.
The campaign aims to vaccinate around 20 million children aged six months to 10 years.
‘Disaster-time’ approach
Public health experts say such a move is consistent with emergency responses during outbreaks, though it comes with trade-offs.
Dr Tajul Islam A Bari, former EPI program manager and immunologist, described the decision as a necessary but suboptimal intervention.
“In outbreak or disaster situations, vaccination can be given earlier than nine months, but the effectiveness is significantly lower,” he said.
“At nine months, about 85% of children develop immunity. At six months, effectiveness drops to below 50%.”
He noted that WHO allows such early vaccination during emergencies, but it is not part of the routine schedule due to reduced efficacy.
“The current situation resembles a disaster-time trend. In this context, expanding coverage—even with lower effectiveness—becomes necessary to control transmission,” he added.
Health officials say the shift is driven by a changing infection pattern, with a growing number of cases detected among infants under nine months.
DGHS data show measles cases have risen sharply this year, with infections spreading across Dhaka, Rajshahi, Chattogram, Khulna and other regions.
EPI officials said the outbreak is no longer confined to specific areas and is now nationwide.
Deputy Director (EPI) Dr Mohammad Shahriar Sajjad said reported cases have already exceeded 1,500, though the final death toll remains under review.
Delays, gaps and response
The surge has also exposed gaps in immunization coverage and delays in campaign rollout.
Bangladesh had secured vaccines from Gavi, the Vaccine Alliance, in 2024 for a campaign targeting around 20 million children, but those doses were not used.
Amid the current crisis, the government has approved Tk604 crore in emergency funding to procure additional vaccines.
Officials said preparations are underway to launch the campaign and expand treatment capacity, including increasing ICU support and strengthening hospital services in affected areas.
Experts warn that while early vaccination may help slow transmission, it cannot replace routine immunization.
“Lowering the age is a short-term response. The long-term solution remains strengthening routine coverage,” Dr Bari said.
Health authorities say the success of the campaign will depend on rapid implementation and wide coverage, as measles -- one of the most contagious diseases -- continues to spread.
