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Measles back with a vengeance

A baby, held by his mother, cries as he receives a vaccine injection at a mobile outreach point in Zimbabwe's Masvingo District during the country's 2009 measles immunization drive UNICEF/Kun Li
"Out of sight, out of mind" explains why Southern Africa has been grappling with one of the biggest outbreaks of measles, a highly contagious viral disease, since 2009.

The outbreak has so far claimed 758 lives, mostly in Zimbabwe, Zambia, Malawi, Namibia, Lesotho and South Africa. Ahmadu Yakubu, Regional Immunization Adviser at the UN Children's Fund (UNICEF) told IRIN there had been lapses in the measles immunization programme because "countries were not seeing cases anymore".

Oladapo Walker, the Inter Country Support Coordinator for Eastern and Southern Africa at the World Health Organisation (WHO), told IRIN that at least 95 percent of all eligible children had not been vaccinated against the disease.

Walker said the outbreaks were "most likely the result of a build-up of susceptible children and adolescents who have missed immunization and escaped natural infection during the years of reduced transmission".

In developing countries, vaccination programmes are jointly funded by donors, but Yakubu said countries in the region had failed to raise adequate financial commitments because "there were no cases to report over the years", so they were unable to motivate funds.

The Measles Initiative, founded in 2001 to stem a rising number of cases, reported that a funding gap of US$59 million for 2010 had to be met to prevent a resurgence of measles deaths globally.

UNICEF noted in a statement in 2009 that more than 2.4 million children in eastern and southern Africa - about 20 percent of all children younger than one year - were not being reached by routine immunization.

WHO recommends two doses of vaccine to ensure immunity, with the first to be given by the child's first birthday, but about 15 percent of vaccinated children fail to develop immunity from the first dose.

Global slump

Southern Africa is not the only region grappling with the after-effects of a slump in measles vaccinations. Yakubu cited a recent article in Eurosurveillance, a scientific journal published by the European Centre for Disease Prevention and Control, which said measles was spreading in Europe because immunization had dropped well below the recommended levels.

About measles
Malnourished children, those suffering a lack of vitamin A, or whose immune systems have been weakened by HIV/AIDS, are most vulnerable to measles.

Most measles-related deaths are caused by complications from the disease, particularly in children younger than five or adults older than 20 years. The most serious complications include blindness, encephalitis, severe diarrhoea and related dehydration, ear infections or severe respiratory infections such as pneumonia.

The disease is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. The first sign of measles is usually a high fever. A runny nose, a cough, red and watery eyes, and small white spots inside the cheeks can develop in the initial stage. After several days, a rash erupts, usually on the face and upper neck.

SourceWorld Health Organisation
To ensure protection from outbreaks, WHO recommends that at least 90 percent of all children in each district and at national level be vaccinated in routine immunization.

Global vaccination levels dropped to 72 percent in 2000 but coverage returned to around 83 percent in 2008. According to WHO, in 2008 there were 164,000 measles deaths globally – nearly 450 deaths per day, or 18 deaths every hour.

The resurgence in Southern Africa could be partly ascribed to members of religious sects that did not believe in "modern western medicine" and prevented their children from being vaccinated, said Yakubu, who acknowledged that although the numbers were not substantial, "They are growing". Newspapers in Malawi reported that members of the Seventh Day Apostolic Church would not allow their children to be immunized against measles.

Walker said the last measles outbreak in some southern Africa countries occurred three years ago, and in others as much as six years ago. Namibia recorded its last wave of measles in 2002, while South Africa and Zimbabwe experienced one in 2005.

However, he noted that the "current outbreaks are much less frequent, and the level of incidence is much lower than outbreaks that used to occur before the measles control goals were adopted in 1998 in the Southern Africa Sub-region".

Measles "most probably have travelled through porous borders and trade", said Walker. "However, for an outbreak to occur following importation from a neighbouring province or country, it requires a sizable number of susceptible populations in both countries."

To prevent a resurgence, countries should run follow-up vaccination campaigns every two to four years until their healthcare systems could routinely provide two doses of measles vaccination to all children and offer treatment for the disease, said Luis Gomes Sambo, WHO Regional Director for Africa.

Prof Adrian Puren, Deputy Director of Virology at the South Africa-based National Institute for Communicable Diseases (NICD), said they were monitoring the epidemic in South Africa to gain insights into how it spread.

The NICD noted in a recent communiqué on communicable diseases that a French journalist covering the football world cup in South Africa had been diagnosed with a strain of measles that was of European and North American origin.

The communiqué noted that "This ... imported case of measles ... highlights the possibility of imported communicable diseases making an appearance during the football world cup event."


This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions

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