Changing Epidemiology of Viral Exanthems in India: Measles, Rubella, and Parvovirus B19 After COVID-19 Vaccination Era
1. Aiganysh Abzhaparova
2. Ariz Ahmed
Ubaid Ali
Kashish Rangari
Tanay Kamble
Sowmiya Kanimozhi Senthilkumar
(1. Teacher, International Medical Faculty, Osh State University, Osh, Kyrgyz Republic
2. Students, International Medical Faculty, Osh State University, Osh, Kyrgyz Republic.)
Abstract
Background: Viral exanthems like measles, rubella, and parvovirus B19 infection have always been important contributors to morbidity-related health concerns not only amongst children but also amongst the public as a whole in the Indian context. These diseases have comparatively been under control due to widespread immunization efforts before the onset of the COVID-19 pandemic. However, the COVID-19 pandemic may have affected the epidemic trends of such diseases.
Objective: The objective is to review and examine the evolving patterns and implications of measles, rubella, and parvovirus B19 in India during the new era after vaccination against COVID-19.
Methods: A narrative review was carried out using published literature from PubMed, Google Scholar, WHO, and government-run health websites from India. The sources published from 2014-2024 were used. National surveillance data, immunization recommendations, and the epidemiology studies done specifically for India were accessed.
Results: There has been a rise of measles cases reported in various Indian states as a result of the gaps created during the pandemic. There has been a decline in the cases of rubella infections; however, reporting is still weak, especially among the adult population as well as pregnant women. There has been rising awareness of parvovirus B19 infections.
Conclusion: The epidemiology of viral exanthems in India has had many changes post the COVID-19 pandemic. It is important to strengthen the immunization program, improve surveillance, and raise awareness of healthcare providers to avoid outbreaks of viral exanthems.
Keywords: Viral exanthems, Measles, Rubella, Parvovirus B19.
Introduction
Overall, viral exanthems are a leading cause of fever associated with rash worldwide, especially among children in low- and middle-income countries. Among these viruses, measles, rubella, and parvovirus B19 play a significant role as they may have grave complications, outbreaks, and sequelae, including congenital rubella syndrome (CRS) and aplastic anemia.
Even with the availability of effective vaccines, measles remains one of the leading causes of preventable childhood mortality in many parts of the world. In addition, rubella poses a serious threat to pregnant women, while parvovirus B19 is associated with blood-related complications and unfavorable pregnancy outcomes. Prior to 2020, India was forging ahead in measles and rubella control through the UIP and the MR elimination initiative. The COVID-19 pandemic brought about unprecedented disruptions to routine healthcare, resulting from lockdowns, the reallocation of health resources, reduced outpatient visits, and vaccine hesitancy. At the same period, large COVID-19 vaccination campaigns may alter viral transmission patterns due to changes in behavior, immunity, and/or the quality of surveillance systems. Even with such developments, information about how the epidemiology of classic viral exanthems has evolved in the post-COVID era remains scattered. There is a clear need to synthesize the existing evidence in order to understand emerging trends and identify surveillance gaps to guide public health actions.
Aims of the study:
1. Describe the changed epidemiology, if any, of measles, rubella, and parvovirus B19 infection in India after the COVID-19 pandemic.
2. Examine the change in clinical presentation, age distribution, and outbreak patterns.
3. Discuss the implications for public health and future prevention strategies.
Methods
Study Design
The research study is a narrative review of the published literature and health statistics for the nation.
Sources of Data
Data were gathered from:
•PubMed and Google Scholar databases
•Reports by World Health Organization (WHO)
• Ministry of Health and Family Welfare (MoHFW), Government of India
•Surveillance data from National Centre for Disease Control (NCDC)
• National Family Health Survey data
Inclusion Criteria
•Articles from January 2014 to March 2024
•Research regarding measles, rubella, and parvovirus B19
•Indian or South East Asia regional data
•English language
•WHO & national guideline documents.
•Case reports that lack epidemiological significance
•Opinion pieces that
•Studies not related to viral exanthems
Data Extraction and Analysis
Data on incidence, age-specific prevalence, symptoms, vaccine coverage, and outbreak trend were retrieved. The results were interpreted thematically. Ethical Considerations As it is based on publicly available secondary data, it does not require any ethical approval.
Results
1. Measles
•Several states in India reported rising incidents of measles.
•Measles first and second dose immunization coverage decreased during the years of the pandemic.
•There was an observed shift towards infections in older children and adolescents.
•Frequently reported complications include pneumonia and the severity of malnutrition.
2. Rubella
•There was a decline in the number of reported rubella cases overall, though under
•There were sporadic outbreaks in adolescents and young adults.
•Persistent cases were revealed by CRS surveillance.
• Seroprevalence studies indicate gaps in immunity in women of reproductive age.
3. Parvovirus B19
•Higher detection rates because of increased IgM and PCR testing.
•Clinical overlap with dengue, chikungunya, and
•Symptoms in the presentations included fever, rash, arthralgia
•Limited surveillance data; likely underestimation of actual burden
Discussion
Findings of the current review suggest that the COVID-19 pandemic has had an indirect effect on the epidemiology of viral exanthems in the sense that the immune gaps caused by reduced routine immunization practices, especially for measles and rubella, resulted in outbreaks when restrictions were eased.
The rise in measles cases reflects the global trends as reported by WHO, highlighting the vulnerability of measles elimination. The distribution by age cohort indicates a possible buildup of susceptible cases over the years. Rubella infection quietly persists because of asymptomatic cases and lack of surveillance for Congenital Rubella Syndrome. Parvovirus B19 has also gained importance in recent years due to the overlapping clinical manifestations with other viral infections that are common in the Indian population. Greater awareness and advancements in diagnostic tools have resulted in an increase in reported cases rather than the actual incidence. The strengths of this literature review include its broad integration of domestic as well as worldwide literature, as well as its timeliness. The limitations include using secondary data, and underreporting, as in a passive surveillance system.
Recommendations
•Routine immunization and catch-up immunization campaigns
•Improve laboratory-based surveillance for viral exanthems
•Add parvovirus B19 testing to fever and rash illness algorithms
• Enhance CRS surveillance and antenatal screening
Conclusion
The present era after COVID-19 vaccination has uncovered major epidemiologic trends that have altered patterns for contagious diseases like measles, rubella, and parvirus B-19 in India. The disruption in immunization, diagnostic issues, and immune status in communities have led to outbreaks and clinical trends. Strong health efforts and awareness among health professionals form a critical aspect for averting any outbreak in the coming times.
References
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11.Seroepidemiology of human parvovirus B19 worldwide (reference review) — useful for background and comparison.
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18.Fever with rash in India — clinical epidemiology article (differential diagnosis in exanthems).
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