Hantavirus and Ebola are making headlines. But another deadly outbreak is unfolding that’s barely registered on the global scene – a devastating measles outbreak in Bangladesh, reports NPR.
“We’ve been crying out loud about this from the beginning, but it has been a silent situation,” said Hasina Rahman. “There hasn’t been much attention around it.”
Since the virus took off in mid-March, the country has tallied more than 60 000 suspected cases and 528 suspected measles-related deaths. Most of the sick and dead are children under five.
“It is huge, with just so much strain on the healthcare systems,” said Rahman, who is the International Rescue Committee’s deputy regional director for Asia.
Miftahul Zannat’s family knows how strained the healthcare system is first-hand. The two-year-old developed classic symptoms of measles, including a fever and rash, as well as vomiting and diarrhoea.
After two hospital stays near their home in Bhairab, she was not improving, became lethargic, and refused to eat. “She became completely bedridden, couldn’t even open her eyes,” said her father, Mohammad Kamal.
Her worried parents, like many other families, took her to the capital, Dhaka, where hospitals have the capacity to care for patients with a severe case. The journey took several hours. But once there, the child was turned away by two facilities already overwhelmed by the crush of measles patients.
While most people who get measles recover in a few weeks, the infection can be dangerous. It can lead to complications and lasting damage, including pneumonia, inflammation of the brain and blindness. And worldwide, in 2024, nearly 100 000 people died of the disease.
Children who are malnourished are especially vulnerable to measles – and in Bangladesh, one in four children under five are stunted, their growth impaired because of under-nutrition, and one in 10 suffer from acute malnutrition.
If such children do get the measles vaccine, it may be less effective.
Malnutrition and under-nutrition are why this outbreak has hit Bangladesh hard. It has contributed to the number of severe cases here being higher than typically seen in high-income countries – and the same with the death rate, around 1% in Bangladesh compared with between 0.1% and 0.3% in the US.
Miftahul’s father, Kamal, said they eventually found care in the third hospital they tried in Dhaka but he still worries about her condition.
From success story to outbreak
Before this outbreak, Bangladesh was making progress toward eliminating measles with its robust, community-led vaccine programme, and was held up as a model for lower resource counties.
In 2019, then-Prime Minister Sheikh Hasina Wazed received The Vaccine Hero Award from Gavi, the Vaccine Alliance in recognition of the country’s “tremendous strides”.
Then came 2024. The long-time regime was ousted and an interim government took charge. During its 18 months in power, the temporary leaders decided to revamp the vaccination system. The new plan did not go smoothly.
There were bureaucratic delays: the vaccine supply was disrupted, shots became unavailable; immunisation campaigns were postponed.
This did not go unnoticed. Rana Flowers – the Unicef representative to Bangladesh – said in a press conference on 20 May that she had repeatedly warned the government over the past two years that the delays could trigger a crisis. “I sat with the interim adviser and the staff at least 10 times, saying, “We are worried. I am worried. You’re going to face a mountain’,” she said.
Other groups, including the WHO and Gavi, also publicly urged the government last year to take action.
But nothing changed, says Dr Reaz Mobarok, a senior Professor and Head of the High Dependency and Isolation Unit of the Bangladesh Shishu Hospital and Institute, the largest children’s hospital in the country.
“The interim government did not bother about vaccination at all, so many children were not vaccinated for measles.”
The warnings and concerns turned out to be prescient.
Daily death counts
In early April, Bangladesh alerted WHO to a measles spike. There were close to 20 000 suspected cases in 58 of 64 districts, with more than 150 deaths.
Since then, the outbreak has continued to grow. Local news outlets now announce daily death counts, sometimes in the single digits but often higher. On one day – 4 May – 17 children died. The number of new suspected cases most days has topped 1 000 and on some days is more than 1 500. As of 25 May, the death count was 528.
The current outbreak is now the largest in Bangladesh in decades.
“This is a massive outbreak with a lot of mortality,” said Dr William Moss, an expert in measles at the Johns Hopkins Bloomberg School of Public Health in the US who has been tracking the situation.
“It’s not surprising at all that their hospitals are overwhelmed.”
He said that apart from the risks associated with measles infection, the virus weakens the immune system and patients can develop secondary infections needing medical attention.
IRC’s Rahman said the situation in Bangladesh has been compounded by the foreign aid cuts that hit global health this past year. She watched as many community health initiatives were terminated and staffing shortages exacerbated.
Now she’s seeing the impact as the buckling healthcare system turns families away: “Parents are sitting outside the child hospital wards just helpless, not knowing what to do,” she said, calling the situation “heartbreaking”.
A nine-month-old’s prognosis
When Mim Akhter suspected her nine-month-old child Rizvi Ahmed Raihan had developed a measles infection, she panicked, thinking of the news stories of the mounting death toll. As he struggled to breathe and grew dehydrated, she took him by car three hours away to Dhaka for medical care.
But the situation was grim at the hospital. There were so many measles patients she and her child could only get a spot on the floor with a thin mattress in front of the elevator. On the floor, the baby was given supplemental oxygen, fluids and rehydration as well as other supportive care, because there’s no specific treatment for measles. After five days his condition improved and he was released.
Patients interviewed by NPR, as well as a report published earlier this month from the United Nations office in Bangladesh, describe not just overcrowding but inadequate medical care.
There’s short staffing. Shortages of essential medical supplies. Two measles patients often share a single ICU bed, sometimes with both needing respiratory support.
And some hospitals are not able to fully isolate measles cases from other patients. For example, at the Infectious Diseases Hospital in Dhakah, HIV/Aids patients with already weakened immune systems are in the same compound, although on a different floor, as measles patients.
A few kilometres away, Mobarok says his hospital is converting administrative rooms into patient-care rooms. “We said to the doctors: ‘You will sit in other places if you need to sit and discuss something.”
Government’s response
The new government, elected in February, launched an enormous measles vaccination campaign on 5 April.
Now, officials say, they’ve already hit their target of vaccinating 18m children. Their next priority is tracking down any children missed in the mass campaign, said Dr Halimur Rashid, director of Disease Control in the Directorate General of Health Services (DGHS).
This effort has garnered widespread praise.
Rashid said his office has also been working to ensure hospitals respond appropriately. “They have all been instructed to open isolation units for these patients, and Vitamin A capsules are being administered to affected children,” he said.
Moss, of Johns Hopkins, saif this is the correct response. “Vitamin A therapy can actually significantly reduce the risk of death from measles,” he says, noting that while vitamin A deficiency is extremely rare in the US, it can be common in settings like Bangladesh.
Despite the government’s response, some parents and medical experts are frustrated. There have been calls for schools to be closed until the outbreak is under control and for the country to declare a state of health emergency.
Moss, though, expects things will improve. “It may take a month or more before you start really start seeing an impact of the vaccination campaign,” he says. “But hopefully, case numbers go down.”
However, for some, the outbreak is conjuring up memories from the height of the Covid pandemic, which killed nearly 30 000 there.
But there’s a big difference between that outbreak and this measles crisis.
Last time, Bangladeshis felt they were part of a global fight. This time, says Mobarok of the Bangladesh Shishu Hospital and Institute, Bangladesh feels far more alone: “We are not getting much help.”
See more from MedicalBrief archives:
Six countries lose WHO measles-free status
Worldwide measles cases almost double in a year
Global measles cases and deaths rising, warns WHO
WHO, CDC issue global measles warning