Madagascar’s devastating measles epidemic takes 1,200 lives

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As Madagascar faces its largest measles outbreak in history and cases soar well beyond 115,000, an IoL report says that resistance to vaccinating children is not the driving force. Just 58% of people on Madagascar’s main island have been vaccinated against measles, a major factor in the outbreak’s spread. With measles one of the most infectious diseases, immunisation rates need to be 90% to 95% or higher to prevent outbreaks. More than 1,200 people have died.

The report says, according to the World Health Organisation (WHO) the measles outbreak has killed mostly children under age 15 since it began in September. “The epidemic unfortunately continues to expand in size” though at a slower pace than a month ago, said Dr Dossou Vincent Sodjinou, a WHO epidemiologist in Madagascar. By mid-March, 117,075 cases had been reported by the Madagascan Health Ministry, affecting all regions of the country.

Some cases of resistance to vaccinations exist because of the influence of religion or of traditional health practitioners but they are isolated ones, he said. This epidemic is complicated by the fact that nearly 50% of children in Madagascar are malnourished. “Malnutrition is the bed of measles, ” Sodjinou said.

The report says simply reaching a clinic for help can be a challenge. Many people in Madagascar cannot afford to see a doctor or buy medicine, and health centres often are understaffed or have poorly qualified workers. As a result, information about health issues can be unreliable. Some parents are not aware that vaccines are free, at least in public health centres.

Measles, a highly infectious disease spread by coughing, sneezing, close contact or infected surfaces, has no specific treatment. The symptoms are treated instead. “Vitamin A is given to children to increase their immunity. We try to reduce the fever. If there is a cough, we give antibiotics,” said Dr Boniface Maronko, sent by WHO to Madagascar to supervise efforts to contain the outbreak. If the disease is not treated early enough, complications appear including diarrhoea, bronchitis, pneumonia and convulsions.

The report says Madagascar’s Health Ministry has sent free medications to regions most affected by the epidemic. Maronko reminded heads of health centres in the Ambalavao region not to make parents pay, saying he had seen some doctors asking for money. He said he feared the medicines wouldn’t be enough.

Late last month the WHO started a third mass measles vaccination campaign in the country with the overall goal of reaching 7.2m children aged 6 months to 9 years. “But immunisation is not the only strategy for the response to this epidemic. We still need resources for care, monitoring and social mobilisation,” said Sodjinou.

 

The WHO notes that measles cases have continued to climb into 2019. Preliminary global data shows that reported cases rose by 300 percent in the first three months of 2019, compared to the same period in 2018. This follows consecutive increases over the past two years.

While this data is provisional and not yet complete, it indicates a clear trend. Many countries are in the midst of sizeable measles outbreaks, with all regions of the world experiencing sustained rises in cases. Current outbreaks include the Democratic Republic of the Congo, Ethiopia, Georgia, Kazakhstan, Kyrgyzstan, Madagascar, Myanmar, Philippines, Sudan, Thailand and Ukraine, causing many deaths – mostly among young children.

Over recent months, spikes in case numbers have also occurred in countries with high overall vaccination coverage, including the US as well as Israel, Thailand, and Tunisia, as the disease has spread fast among clusters of unvaccinated people.

Measles is one of the world’s most contagious diseases, with the potential to be extremely severe. In 2017, the most recent year for which estimates are available, it caused close to 110 000 deaths. Even in high-income countries, complications result in hospitalization in up to a quarter of cases, and can lead to lifelong disability, from brain damage and blindness to hearing loss.

The disease is almost entirely preventable through two doses of a safe and effective vaccine. For several years, however, global coverage with the first dose of measles vaccine has stalled at 85%. This is still short of the 95% needed to prevent outbreaks, and leaves many people, in many communities, at risk. Second dose coverage, while increasing, stands at 67 percent.

With governments and partners such as the Measles & Rubella Initiative, Gavi, the Vaccine Alliance, UNICEF and others, response operations are underway to bring country outbreaks under control, strengthen health services, and increase vaccine coverage.

After conducting emergency vaccination campaigns targeting 7m children from 6 months through 9 years of age, Madagascar is now seeing overall declines in measles cases and deaths. In the Philippines, over 3,890,000 doses of the measles and rubella vaccine have been given to children aged under 5 years. In the Democratic Republic of the Congo, the country is preparing to launch a combined response with polio vaccine.

In collaboration with local health authorities, WHO and UNICEF conducted a nationwide measles and rubella vaccination campaign in Yemen reaching more than 11.6m (90%) children aged 6 months–16 years across the country.

Responding to measles requires a range of approaches to ensure all children get their vaccines on time, with particular attention to access, quality and affordability of primary care services. It will also take effective public-facing communication and engagement on the critical importance of vaccination, and the dangers of the diseases they prevent.

WHO also recommends tailored approaches that ensure immunisation services meet the needs of everyone – making sure that clinics are accessible to all areas, at the right times and to all population groups – especially those who face systemic discrimination and disadvantage.

Coverage of the 2nd vaccine dose also needs to increase globally, to maximise a population’s protection against the disease. Today, 25 countries still need to make the 2nd dose part of their essential immunisation programme.

IoL report
WHO material

 


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