Measles in Costa RicaThe ninth century marked the first diagnosed case of measles globally. Since then, innumerable cases of measles have been reported across the world, including Costa Rica.

What is Measles?

Measles is viral and highly contagious. An issue surrounding the spread of measles is the length of time between contraction of the virus and the first signs of symptoms. After infection, symptoms are not necessarily present for an additional week or two. Astonishingly, the virus can survive in the air for two to four hours after a cough or sneeze by someone infected by it. Thus, the transmission of measles is enabled in places even when the person is no longer there.

At first, many of the symptoms of measles could be mistaken for a cold: fever, coughing, runny nose and watery eyes. However, running an especially high fever of 104 degrees Fahrenheit or higher is an indicator of measles. Additionally, the associated rash is incredibly troublesome. Fevers spike according to the severity of the rash.

Over many years, measles has been problematic for countries across the globe. One such country that has faced an ongoing battle with measles is Costa Rica.

History of Measles in Costa Rica

  • In 1967, Costa Rica implemented its first measles vaccination program. For approximately 10 years, the number of diagnosed cases of measles decreased. However, in 1977 there was an outbreak of the disease.
  • Following the 1977 epidemic, further programs were instituted with the goal of preventing another outbreak. Yet, another outbreak occurred in 1979. These new cases were primarily found in children too young to receive the vaccine in accordance with the program; they were under the age of 1.
  • In 1983, 90 percent of children over the age of 2 were vaccinated for measles. The country continued in its mission to eradicate measles in Costa Rica.
  • The last native case of measles was in 2006. Since 2014, when the last imported case was diagnosed, there had been no new cases of measles.
  • Concern arose during 2018 that imported cases of measles would arise, due to the number of cases in Europe and the United States. Due to travel and tourism, the number of reported cases of measles in Latin America had increased. Luckily, no new cases were reported for five years. However, 2019 has seen the reintroduction of measles to Costa Rica.

Recent Cases of Measles in Costa Rica

As of January 2019, Costa Rica continued providing vaccinations for children ranging from 15 months old to 9 years old. However, this vaccination program did not prove wholly successful.

On February 18, 2019 measles was reintroduced to Costa Rica. A young child from France, with classmates that had measles, came to Costa Rica on vacation with his family. The boy developed a rash and was seen by a local doctor. He tested positive for measles.

The Costa Rican Ministry of Health is taking preventative measures to ensure that this possible outbreak is contained. The family was placed in isolation at a hospital because neither the mother nor son had been vaccinated for measles. Additionally, the Costa Rican Ministry of Health has contacted those who were on the same inbound flight and in the same hotels as the family to hinder the spread of measles.

Hopefully, with such plans in place and the measures taken to protect others, measles will be contained. Due to fast action by the Costa Rican Ministry of Health, the spread of measles is likely to be reduced with this new, introduced case.

– Carolyn Newsome
Photo: Pixabay

Vaccinations in Egypt
Vaccinations have been proven to be the most powerful and most cost-effective health intervention that can be provided to a population. Vaccinations have been proven to reduce disease, disabilities and deaths, especially in children under the age of five. The majority of unvaccinated children reside in low to middle-income countries where health systems are compromised, such as Egypt. Vaccinations in Egypt have proven incredibly successful, but the country still has a ways to go.

There are three main organizations that supply vaccinations to low-income countries. These are UNICEF, the Pan American Health Organization and the Gavi, the Vaccine Alliance. These organizations understand the impact vaccinations have on the eradication of disease.

Vaccinations in Egypt Have a Track Record of Success

Vaccinations have had a large impact on the health of children in Egypt. The vaccinations in Egypt that have been the most successful are poliomyelitis and neonatal tetanus. These vaccinations are responsible for nearly eradicating these diseases. The last case of polio was recorded in 2004, and by 2005, only 25 cases of neonatal tetanus were recorded.

Egypt established the National Immunization Program in the 1950s, and the first vaccinations introduced to the population were tuberculosis and diphtheria. Pertussis and tetanus vaccinations in Egypt became available in the 1960s. In 1977, the measles vaccination was introduced, followed by the measles, mumps, and rubella (MMR) combination in 1999.

However, better access to vaccinations in Egypt is critical. Measles and rubella were the most common diseases prior to vaccination programs in 1977, and even though it has been estimated that as of 1999, 95 percent of children were vaccinated with MMR, there were still major outbreaks of measles and rubella in Egypt between 2005 and 2007. Measles was considered endemic until 2008, when measles cases were estimated at less than one per every 100,000 people.

International Efforts to Increase Access to Vaccines in Egypt

Egypt has developed a strategy to increase access to vaccinations for the general population. The main organizations that coordinated and funded this plan are the Ministry of Health and Population, UNICEF and the World Health Organization. The plan is to increase access to vaccinations in Egypt in these ways:

  • Target 36 million children between the ages of two and 19
  • Maintain coverage of the vaccinations already supplied
  • Strengthen and increase school immunization programs
  • Obtain stronger disease surveillance
  • Improve social mobilization
  • Establish the Interagency Coordinating Committee

Egypt has put forth great effort to provide vaccinations to all of its children. However, there is still a substantial need for more vaccinations in Egypt.

There are nonprofit organizations that are working to improve this situation for Egypt and other countries in need. The Access to Medicine Foundation is motivating the pharmaceutical industry to aid low to middle-income countries such as Egypt. In 2008, the Access to Medicine Foundation published the first Access to Vaccines Index. This index acknowledges the pharmaceutical companies that are responding to the need for vaccination in low-income countries and highlights each company’s progress. There are many positive actions that are improving access to vaccinations in Egypt and other low-income countries. However, the need is still present and crucial.

– Kristen Hibbett
Photo: Flickr

The Fight Against Measles and Polio in Yemen
After two-and-a-half years of war, Yemen is left in ruins and struggling to overcome health, social and economic problems within the country. Demolished hospitals, crippled bridges, bombed industries, and poor sanitation and nutrition contribute to the devastating situation imparted by the war on the country and its citizens.

A Failing Healthcare System in Yemen

The health status of the population in Yemen is currently described as “catastrophic.” Damage from the war has transformed the nation into a fertile environment for cholera due to the highly contaminated water, which amplified the proliferation of fecal bacterial infections.

Since sewage systems have failed and garbage has piled up to cover entire neighborhoods and regions of the country, more Yemenis rely on polluted water sources for drinking and cooking. Alongside cholera, a quarter of all health facilities in Yemen are no longer operating or have already closed down; this situation escalated rates of morbidity and mortality among citizens, particularly those needing surgery or emergency care such as patients with chronic kidney failure who are dependent on life-saving support.

The shortage of qualified health professionals and physicians created a gap in primary healthcare — especially among children — as lower immunization rates led to a significant rise in the number of polio and measles cases reported.

To create a temporary and effective solution, the World Health Organization (WHO) trained more than 50 mobile medical teams and 20 fixed emergency care teams to provide people with increased access to primary health care services, and to support the operation of 72 health facilities as a way to prevent their closure.

The Fight Against Measles and Polio in Yemen

On August 15, 2017, WHO launched the fight against measles and polio in Yemen through its nationwide vaccination campaign. More than 3.9 million children under 5 years go age were vaccinated against polio and around 860,000 children aged 6 months to 15 years were immunized against measles in high-risk areas.

UNICEF also joined efforts toward the fight against measles and polio in Yemen by collaborating with WHO to ensure effective vaccination interventions for vulnerable populations, such as children and pregnant women. Julien Harneis, UNICEF Representative in Yemen, asserted that UNICEF’s mobile teams and staffs sacrifice their lives and endanger their health during their daily outreach activities within the community due to the hazardous conditions present in the country.

The medical and public health professionals work to overcome all obstacles in preventing additional deaths and morbidities associated with preventable diseases such as polio and measles.

Dr. Gamila Hibatulla, Nutrition and Health Officer for UNICEF in Aden-Yemen, explained that mobile teams rely on public sites, such as mosques, to deliver necessary health services. Vaccination is a central goal to both international agencies of WHO & UNICEF so as to prevent and manage any infectious diseases that could create an additional burden for the government and a crumbling healthcare system. Ms. Hibatulla praised the parents of young children for collaborating with the agency’s work by ensuring that their kids get immunized against serious diseases.

Challenges & Setbacks

Despite the national campaign’s accomplishments in the fight against measles and polio in Yemen, Dr. Ahmed Shadoul, the WHO Representative from Yemen, stated that the positive results generated from the campaign were only “the tip of the iceberg” in terms of the international organization’s response. According to Dr. Shadoul, only a portion of the population was reached by these efforts, as a result of limited funding and failure to reach people residing in war zone areas.

Future plans are being developed to render vaccination and primary prevention efforts more effective, and through continuous coordination, cooperation and collaboration between international agencies and the Yemeni community at large, such a goal can be obtained.

– Lea Sacca

Photo: Flickr

How to Bring Medicine to the PoorThere are many diseases plaguing the developing nations of the world. There is also much that can be done to improve the state of health across the globe. This is especially true with regards to measles. Measles is a serious problem, particularly in African nations, including Nigeria. Nigeria desperately needs people to bring medicine to the poor.

The CDC reported 176,785 confirmed cases of measles in Africa between 2013 and 2016. While the frequency of measles cases has been on the decline since 2013, the disease is still too widespread to be considered a solved problem. This is especially true for children between nine and 59 months old; they are the most vulnerable to this disease.

Starting in 2013, Nigeria had 50,585 known cases of measles. By 2016, this number had dropped to 11,499 known measles cases, leaving it still the most highly infected African nation. This seems like an exceptionally great dilemma to members of the developed world who are accustomed to the high cost of vaccines. In the United States, the CDC’s five recommended childhood shots can cost an average of $937 per person. Considering how much these vaccines cost Americans, how could it be possible to combat an epidemic in a nation as poor as Nigeria?

According to the World Health Organization, it is actually quite cost-effective to immunize nations such as Nigeria from measles. While vaccines are quite expensive in nations such as the United States, they are relatively inexpensive to use when manufactured for mass immunization projects. The World Health Organization has estimated that mass immunizations could be performed in countries such as Nigeria for roughly $1 per child vaccine.

What can be done to bring medicine to Nigeria? A simple solution would be to write and call your Congress representatives to encourage them to support immunization projects. Donating to the Borgen Project is also a great way to put forth efforts to increase U.S. spending on global disease prevention. To make a direct impact, it is also possible to contact the World Health Organization to ask how you can contribute to the fight against measles. From these steps, there will be an improved capacity by many organizations to bring medicine to the poor.

Tim Sherwood

Photo: Flickr

Eradicate Measles
Besides a particularly horrific outbreak in California in 2014, measles has been largely eradicated in most affluent countries. Deaths from measles have dropped by 79 percent since 2000, but the disease is still common in many developing countries, particularly in parts of Africa and Asia.

Measles claims the lives of 15 people every hour — most are children under the age of 5. In fact, according to the World Health Organization (WHO), “measles is one of the leading causes of death among young children even though a safe and cost-effective vaccination is available.”

Since 2000, the measles vaccination has reached an increasing rate of young children. In 2015, 85 percent of children received one dose of the vaccination before their first birthday. This rate went up twelve percent since 2000 and has saved over 20 million lives as a result.

There is still room for improvement. WHO established three milestones toward the elimination of measles in 2010 that were to be achieved by 2015. Because the disease is still a persistent problem in many countries, the WHO now seeks to eradicate measles by 2020.

WHO’s first milestone calls for the increase in routine coverage of the measles vaccine. The organization hopes to increase the administration of the first dose to one-year-old children by 90 percent on a national level and at least 80 percent in every district.

Their second goal is to reduce the incidence of measles to five cases per every million.

The organization’s third and final milestone hopes for a 95 percent reduction in the global death toll of the disease.

With support from associated organizations, the World Health Organization is hopeful in making the outcomes of these milestones a reality. WHO is currently working with the American Red Cross, UNICEF, the U.N. Foundation and the Centers for Disease Control and Prevention. These organizations have teamed up to form the Measles and Rubella Initiative that has raised money for vaccinations to combat the incidence of measles and rubella among children since 2001.

The Measles and Rubella Initiative has also set out their own plan for the eradication of measles. The Global Measles and Rubella Strategic Plan 2012-2020 seeks to reduce the rate of measles deaths by 95 percent by 2020. The plan will also work with immunization managers and partners in order to achieve their goals.

Coverage gaps in the administration of the measles immunization was the leading cause of WHO’s failure to meet their goals in 2015. With help from the Measles and Rubella Initiative, WHO’s goal to eradicate measles by 2020 is becoming a feasible reality.

Laura Cassin

Photo: Flickr

measles in developing countries
The measles vaccine has saved approximately 17.1 million lives since 2000, however, global targets to eradicate the disease are still off track according to Gavi, the Vaccine Alliance.

Notably, the World Health Organization (WHO) recently reported that while global measles vaccination coverage increased from 72 percent to 85 percent between 2000 and 2010, it has remained unchanged for the past 4 years.

Founded by the Bill and Melinda Gates Foundation, Gavi recently approved a new support package that aims to end measles in developing countries.

The organization’s new support package will help install a strong immunization routine with high coverage. The new Gavin Vaccine will also take advantage of children’s visits to health care facilities to increase the coverage rates of the vaccine.

Gavi will also support data-driven campaigns on measles and rubella to reach children not protected by immunization. These campaigns will be synchronized with other immunization activities to better reach children in isolated communities.

In developing countries measles vaccination involves a series of strategies and large-scale campaigns which rely on the support of the Measles & Rubella Initiative (M&RI).

In 2014, campaigns and immunization activities reached 221 million children. In the African Region, cases of measles dropped from over 171,000 in 2013 to under 74,000 in 2014.

This new support package also requires developing countries to have a five-year rolling measles and rubella plan, together with their long-term routine immunization plans, all of which will be updated annually.

“Countries cannot begin to hope to eliminate measles until they get epidemics under control,” said Dagfinn Høybråten, Chair of the Gavi Board, “The package of support we have agreed on today will save lives and give developing countries a golden opportunity to reform how they protect their children against measles.”

Marie Helene Ngom

Sources: Gavi, WHO
Photo: Flickr

Measles_outbreak
A measles outbreak has been occurring in the Democratic Republic of Congo since the beginning of the year, with 16,500 cases reported from January to June.

The Médecins Sans Frontières (MSF – also known as Doctors Without Borders in the U.S.) was able to take responsive measures starting in March, vaccinating over 287,000 children either to combat measles or to prevent it.

Since May, all of the children aged 6 months to 10 years in the Malemba Nkulu health zone – 101,000 in total – were vaccinated.

Over 500 members of the MSF team have been deployed to respond to the measles outbreak in the Congolese provinces. They are working to transport and administer vaccines and care for those afflicted by the disease. But the fight against measles calls for more than just brave, skillful responders.

The challenges in treating the epidemic are great and many, but organizations like MSF overcome them by being aware of these challenges so that they can be addressed.

The last time that Katanga (the Congolese province where the most cases are being seen) had a measles outbreak this serious was in 2011. MSF and other organizations involved in treating this outbreak are drawing on the lessons they learned from 2011 to treat this outbreak more efficiently.

The head of the MSF mission in the Congo, Jean-Guy Vataux, cites several barriers to fighting the disease: “shortage of funds, running out of vaccines, problems maintaining the cold chain. . . and a lack of qualified human resources.”

Shortage of funds is a problem humanitarian organizations have always been familiar with. Organizations like the Central Emergency Response Fund (CERF) and the Measles and Rubella Immunization Initiative provide grants to humanitarian organizations – they have funded several vaccination campaigns during the current outbreak.

Donations from governments, organizations, corporations, and individuals can be sent to groups like these, or also straight to the organizations fighting the disease on the ground (MSF, WHO, etc.)

Beyond the scope of finance, organizations are working together to make sure they reach as many people as possible.

In Sudan, health professionals involved in the response have noted the increased effectiveness of response when different organizations, such as MSF and UNICEF, work together. It is through the teamwork of different organizations that barriers, like marshy roads that make villages difficult to access, can be evaluated and worked through.

The Ministry of Health in Sudan and WHO are working together on a plan of action to help about 180,000 people in the Zamzam camp. Currently, the camp has ongoing routine immunizations for children and pregnant women. Eight different vaccination centers are up and running, staffed by 20 vaccinators.

Areas such as case investigation and response measures are also being reevaluated for efficiency. Investigations are particularly pertinent because oftentimes, the disease goes untreated, ad thus deaths go unreported and statistics are inaccurate. Without a proper understanding of the situation, resources can’t be allocated to where they are needed.

According to Dr. Malik Alabbasi, Director-General of the Public Health Care Directorate in the Federal Ministry of Health, recent reports have already reflected improvement in case management and implementation of vaccines.

The situation in the Congo and Sudan is grim in many ways, but through the collective effort of organizations determined to make a difference, the fight against measles is making slow and steady progress.

Emily Dieckman

Sources: All Africa, WHO, MSF 1, MSF 2, Reuters, Time, OCHA, Vaccine News Daily
Photo: Doctors Without Borders

Measles
The Nuba Mountains in Sudan were once seen as a sanctuary but because of their remoteness and ongoing military struggle in the area, the largest measles crisis in years is currently sweeping across Sudan. Due to the power struggle between the government and rebels, children have been denied access to immunization.

The measles virus is spread by respiratory transmission and is highly contagious. Up to 90 percent of people without immunity who are sharing a house with an infected person will catch it.

According to UNICEF, Sudan has already seen 2,700 cases of measles this year. “Of these roughly one in 10 will die. The fear now is that, with around 150,000 children under 5 in the Nuba Mountains who have had no reliable access to immunization since 2011, the situation could explode.”

Without immunization, there is a real potential that more lives will be lost to measles than to the recent Ebola outbreak in West Africa. However in this case, the majority of lives lost will be children.

Sudan’s recent outbreak of measles is not caused by lack of immunization efforts. In April 2015, UNICEF launched an immunization campaign to first vaccinate children in the highest risk states, and then expanding into other areas identified to be at risk.

Geert Cappelaere, UNICEF Representative in Sudan said, “Measles is a life threatening disease but on that can easily be prevented with timely immunization. Every girl and boy must be reached no matter where they live. There are no excuses and no child can be left out.”

Children are the most at risk for contracting measles; children who are malnourished are even more vulnerable. For malnourished children, measles can cause serious health complications including blindness, ear infections, pneumonia, and severe diarrhea.

“In Sudan, some 36 percent of children are stunted and the country has one of the highest levels of malnutrition in Africa. Of the total number of reported measles cases in Sudan 69 percent are below 15 years of age, including 52 percent under the age of five.” A large portion of the children in Sudan is at risk to contract measles.
With the dispute over border territory around the South Kordofan region, the region has struggled to see vital humanitarian aid that is a crucial lifeline. Since 2011, the region has not seen food and medical supplies.

For the partners of Gavi, the Vaccine Alliance, there are few options left to deliver the much-needed vaccines. UNICEF and the World Health Organization have put their support behind the efforts of the Ministry of Health.

Another option is to try to get vaccines delivered by partner organizations that are still working in the area. These organizations include Doctors Without Borders and faith based organization such as Caritas. However, these organizations are not given immunity and vaccines cannot be promised to be delivered.

In light of this situation, it is also a learning opportunity. Governments must be more proactive about not just responding to humanitarian disasters but by also preventing them. The warning signs need to be recognized. “After all, for any country to have a future it must protect its children.”

Kerri Szulak

Sources: CNN, UNICEF
Photo: Flickr

measles_vaccine
Scientists are speculating that the measles vaccine does more than prevent measles. A new study published in the journal “Science” found that children that were vaccinated did not just avoid the measles, they also eluded infectious illnesses such as pneumonia, influenza and tuberculosis.

Historically, each time the measles vaccine was introduced, childhood mortality dramatically went down by 30 to 50 percent in some countries and by 90 percent in severely destitute nations.

Today the vaccine is hailed as one of the most effective operations in public health in recent history.

The World Health Organization has asserted that the vaccine is linked to a hefty decrease in child mortality no matter what the infectious illness is. Following widespread vaccination, childhood deaths due to infectious disease fall by 50 percent.

Michael Mina is a post-doctorate at Princeton University and a medical student at Emory University. He and his team performed a recent study using computer models to predict the mortality rate for infectious diseases in the next few years.

The team looked at figures collected from the U.S, Denmark, England and Wales. Numbers dated back to the 1940s.

In every location, the presence of measles was linked by some degree to the rate of mortality. The magnitude of the affect was different for each country because, most likely, health care underwent changes during the 70-year stretch.

From the evidence, Mina and his colleagues concluded that being infected with measles leaves children susceptible to other infectious diseases for an average time span of 28.3 months, or about two or three years.

Measles is a severe immunosuppressor, increases a host’s likelihood of contracting other diseases. Most viruses have this effect, but measles takes it even further. It actually obliterates any immunity the host once had.

After going through a measles infection, “the immune system kind of comes back. The only problem is that it has forgotten what it once knew,” Mina explains.

For example, if a child gets sick with pneumonia, they build up antibodies which prevent the child from contracting the disease again. But if that child then catches the measles, their immune system loses that protection and they could contract pneumonia once more.

Persuasive evidence from the new study contributes to the belief that measles affects a person’s immunity and, therefore, their overall mortality. Thus, the measles vaccine could decrease mortality to a much larger degree than originally thought.

Still, scientists still have not been able to supply enough evidence as to why this phenomenon happens. They have only come up with “immune amnesia” as a theory. There is still more testing to be done.

Even so, no one can ignore the overwhelming evidence that eliminating measles lessens the risk of contracting other infectious diseases. It is just another incentive for people, especially children, to be vaccinated.

Reductions in mortality have been observed in the U.S., England and other parts of Europe and are still seen in developing countries each time the vaccine is instituted.

– Lillian Sickler

Sources: NPR, U.S. National Library of Medicine, Research Gate, Online Post, ARS Technical
Photo: Flickr

Measles Eradication
The World Health Organization recently announced that progress toward eradicating measles has stalled. Since 2012, measles-related deaths have increased from 122,000 to almost 148,000 worldwide. According to the WHO, this means that 2015 eradication targets will not be met.

Overall, the number of measles deaths in 2013 shows a 75 percent decrease since the year 2000. However, this is significantly lower than the Millennium Development Goal of a 95 percent decrease between 2000 and 2015.

Global coverage of initial measles vaccines expanded to 83 percent by 2009, but this number has since remained stagnant.

Failed efforts to vaccinate children from measles makes them prone to serious health issues including pneumonia, encephalitis, diarrhea and blindness. Developing countries currently account for the highest percentage of measles related deaths. The latest statistics from 2013 report that 70 percent of measles deaths took place in just 6 countries including India, Nigeria, Pakistan, Ethiopia, Indonesia and the Democratic Republic of Congo.

The last decade has seen impressive advancements toward eradicating measles, and approximately 15.6 million deaths have been avoided from 2000 to 2013. Still, reports show that these leaps in progress have lately been diminishing.

Recent increases in measles cases were due in part to considerable outbreaks in China, the Democratic Republic of Congo and Nigeria. Many countries around Europe have also seen a re-emergence in disease diagnoses including Georgia, Turkey and Ukraine. These regions are burdened by poor healthcare systems, conflict and population displacement, causing forestallments to vaccination efforts.

In addition, many countries are now experiencing reduced funding for measles eradication campaigns. This lack of support has hindered progress in eliminating the disease, causing measles cases to rise.

“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,” said UNICEF’s Senior Health Advisor, Robert Kezaala.

Members of the Measles & Rubella Initiative state that in order to recommence progress in eliminating the disease, organizations must promote measles awareness and the dangers surrounding the disease.

Additionally, obstacles that are preventing vaccination advancements must be addressed.

Dr. Peter Strebel of the Department of Immunization, Vaccines and Biologicals urges countries to take action against measles. “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,” says Strebel.

Meagan Douches

Sources: Think Progress, Reuters, Measles Rubella Initiative, WHO
Photo: Karmavision