Measles and 2015 targets

Why do we bother about Measles and whether targets are met or not? Measles is a highly contagious viral disease, which affects mostly children. It is transmitted via droplets from the nose, mouth or throat of the infected persons. Initial symptoms, which usually appear 10–12 days after infection, include high fever, runny nose, bloodshot eyes, […]

Why do we bother about Measles and whether targets are met or not? Measles is a highly contagious viral disease, which affects mostly children. It is transmitted via droplets from the nose, mouth or throat of the infected persons.

Initial symptoms, which usually appear 10–12 days after infection, include high fever, runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards. There is no specific treatment for measles and most people recover within 2–3 weeks. However, particularly in malnourished children and people with reduced immunity, measles can cause serious complications, including blindness, encephalitis, severe diarrhoea, ear infection and pneumonia.
The disease remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. Approximately 145 700 people died from measles in 2013 – mostly children under the age of 5.
Measles is caused by a virus in the paramyxovirus family and it is normally passed through direct contact and through the air. The virus infects the mucous membranes, then spreads throughout the body. Measles is a human disease and is not known to occur in animals.
Who is at risk?
1.       Unvaccinated young children are at highest risk of measles and its complications, including death. Unvaccinated pregnant women are also at risk. Any non-immune person (who has not been vaccinated or was vaccinated but did not develop immunity) can become infected.
2.       Measles is still common in many developing countries – particularly in parts of Africa and Asia. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.
3. Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection.
Treatment: No specific antiviral treatment exists for measles virus. Severe complications from measles can be avoided though supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.
Prevention: Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths.
The WHO News release has warned that the progress towards the elimination of measles has stalled. The number of deaths from measles increased from an estimated 122 000 in 2012 to 145 700 in 2013, according to new data published in the WHO Weekly Epidemiological Report and the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report. The estimated number of measles deaths in 2013 represents a 75% decline in mortality since 2000, significantly below the target of a 95% reduction in deaths between 2000 and 2015.
Strebel said: “Poor progress in increasing measles vaccination coverage has resulted in large outbreaks of this highly contagious disease, throwing the 2015 elimination targets off-track,” said Dr Peter Strebel from the WHO Department of Immunization, Vaccines, and Biological.
“Countries urgently need to prioritize maintaining and improving immunization coverage. Failure to reverse this alarming trend could jeopardize the momentum generated by a decade of achievements in reducing measles mortality.”
“Member States of all 6 WHO Regions have set goals for measles elimination. “Countries urgently need to prioritize maintaining and improving immunization coverage. Failure to reverse this alarming trend could jeopardize the momentum generated by a decade of achievements in reducing measles mortality.”
The News Release emphasised that while the increase in the disease in 2013 was in large part due to outbreaks in China, the Democratic Republic of the Congo, and Nigeria, sizeable outbreaks were also reported in other parts of the world. Progress is stalled in the WHO Eastern Mediterranean region, where weak health systems and conflict and population displacement have hampered vaccination efforts. Meanwhile, the European region has seen measles re-emerge with outbreaks in a number of countries including Georgia, Turkey and Ukraine, and renewed high-level political commitment is needed to reverse this trend.
Reduced funding puts impressive gains at risk: Impressive gains have been made towards measles elimination in recent years and an estimated 15.6 million deaths were prevented through vaccination during 2000-2013. The huge reductions in mortality, however, are tapering off. “The net effect of reduced global funding by governments and partners has caused postponed and suboptimal immunization campaigns, resulting in large outbreaks that threaten our hard earned gains,” says Robert Kezaala, UNICEF’s Senior Health Advisor, for Immunization.
More than 60% of the estimated 21.5 million children who were not vaccinated against measles at 9 months of age last year come from 6 countries:
1. India (6.4 million)
2. Nigeria (2.7 million)
3. Pakistan (1.7 million)
4. Ethiopia (1.1 million)
5. Indonesia (0.7 million)
6. Democratic Republic of Congo (0.7 million)
The vast majority of deaths from measles occur in developing countries, and in 2013 over 70% of estimated global measles deaths occurred in the 6 countries listed above. This serves as a wakeup call for all of us, especially those from the 6 countries mentioned above.
Dr Aminu Magashi is the Publisher of Health Reporters ([email protected])