India has slipped behind all of Africa and Asia in combating measles, delaying action to bolster immunisation against the infection that kills an estimated 160,000 children in the country each year, medical experts have said.

India was among 47 African and Asian countries identified by the World Health Organisation (WHO) more than two years ago as "worst-affected" by measles, accounting for 98 per cent of global deaths from the infection.

All the countries were advised to introduce a second dose of the measles vaccine through their immunisation programmes that would help protect nearly all children.

Among the countries that have taken the action to reduce measles mortality are Angola, Burkina Faso, Cambodia, Ethiopia, Kenya, Nigeria, Somalia, Vietnam, Yemen and Pakistan, public health experts have said.

India remains the only country in the world that has not systematically introduced the second dose of the measles vaccine, two experts said in a commentary in Indian Pediatrics, a journal of the Indian Academy of Pediatrics.

"This is certainly a shame," Panna Choudhury, a co-author and president of the academy, told Newspapers. "India has the resources, the infrastructure and the measles vaccine is widely and easily available."

A single dose of the measles vaccine given to children at about nine months of age protects only 85 per cent of immunised children. The second dose between 15 and 18 months is dubbed as a "second opportunity" expected to protect 99 per cent children.

The early public health advisories for a second dose emerged in 2004 and were reiterated by the WHO's strategic advisory group of experts on immunisation in November 2008.

But the health ministry still has not introduced the second dose in the public immunisation programme, although it is routinely provided by doctors in the private sector.

"We expect this (a second dose) will start sometime in 2010," said T. Jacob John, co-chair of the National Technical Advisory Group on Immunisation, which has asked the health ministry to introduce the second dose through two strategies.

States where routine immunisation coverage is higher than 80 per cent have been asked to deliver the second measles dose when a child comes to get a booster dose of the diphtheria-pertussis-tetanus vaccine at 18 months. The other states may need to introduce the second dose through mass immunisation campaigns of the type used to deliver the oral polio vaccine, John said.

Public health experts believe poor routine immunisation, lack of diagnosis and access to proper treatment and poor awareness among people are among the factors that have frustrated efforts to reduce measles mortality in the country. "A dose of vitamin A can reduce the risk of complications and mortality in measles infection but many children do not get this vitamin A as part of routine therapy," a public health expert said.

"The immunisation programme also appears understaffed," John said. The advisory group on immunisation has asked a panel of experts to examine the human resource requirements to improve immunisation coverage.

"Measles can cause life-threatening pneumonia in children but many parents still appear unaware of this," Choudhury said. "Action against measles could significantly reduce mortality in children below five years of age," he said.