Healthcare in Burundi
Burundi is a landlocked country in East Africa with a dense population of 11.89 million people. Due to overpopulation, an ongoing humanitarian crisis and more than 73% of the population in poverty, healthcare in Burundi is unstable, and the people of Burundi are highly susceptible to the wide variety of diseases that are plaguing the country. 

Current Health Risks in Burundi

Accessibility to healthcare in Burundi continues to be an issue for civilians, shown through the rise in deaths that diseases and epidemics caused. COVID-19 has affected the country as a whole and posed a threat to the already fragile healthcare system with records of 104 cases and one death as of June 16, 2020, although the need for more resources and vaccines was already in question long before this specific virus. Without proper treatment or preventative care, diseases like measles, malaria and many other infectious diseases put the population at risk.

In April 2019, the number of measles cases increased to 857 and refugees were reportedly spreading it to communities from refugee camps. Meanwhile, there were 504 cases as of March 2020. Out of the 18 provinces of Burundi, 63% of those districts face a high risk of infection. Low immunity and vaccination rates are two factors putting communities in compromising positions.

Malaria is an ongoing epidemic in Burundi that has claimed the lives of more than 3,170 people, and it continues to spread. Reports determine that the number of cases is 1.2 million, showing a slight decline in cases in comparison to the 1.7 million in 2019. Malaria is treatable and preventable through vaccination and the proper medication; however, access to these supplies and resources is scarce.

Focusing on the Issue  

The numbers on infection and mortality rates of treatable and preventable diseases in Burundi show a need for redirection. Seeing this need, various organizations have proposed ways to put a spotlight on the lack of funding for healthcare systems and supplies and provide the funding necessary to see progress. Here are a few ways organizations are addressing this:

  • In April of 2020, the World Bank and International Development Association (IDA) put into motion a $5 million grant to prevent and counter the spread of COVID-19 and reinforce the preparedness of the health care system of Burundi as a whole. These funds will assist the country’s healthcare system in receiving necessary testing and treatments for existing diseases and epidemics. In coordination with this, the World Bank will disburse $160 billion over the span of 15 months to “protect the poor and vulnerable, support businesses and bolster economic recovery.
  • Dr. Norbert Mugabo, a medical officer from Cibitoke province, set out to vaccinate more than 17,000 children as part of a measles vaccination initiative in April of 2020. Dr. Mugabo hopes to reach children between the ages of 9 months and 15 years in light of the outbreak in November 2019.
  • The International Rescue Committee (IRC) set many goals to aid Burundi in 2020. It determined that its main avenue for providing all-around better healthcare is starting with the basics. For example, the IRC intends to rebuild hand washing stations, boosting hygiene and addressing sanitation issues. These small steps forward have the ability to make a big difference long term.

The healthcare system in Burundi lacks the resources and funding needed to help the overall population thrive. However, with the help of dedicated professionals such as Dr. Mugabo and organizations such as the World Bank and the IRC, change in a positive direction is right around the corner.

Katie Mote-Preuss
Photo: Flickr

Measles in Bulgaria
Though the increased distribution of vaccines has nearly eradicated measles around the world, countries have recently seen returning outbreaks. Bulgaria’s outbreak is one of the worst. However, the nation is working to control the measles outbreak with the help of vaccinations and strict government procedures. Here are the top 7 facts about measles in Bulgaria.

7 Facts About Measles in Bulgaria

  1. Between 2009 and 2011, Bulgaria faced a sizable measles outbreak after not reporting any cases since 2001. This outbreak was the largest in Bulgaria since 1992. All regions in Bulgaria were affected and a total of 24,364 cases were reported during this time.
  2. The Ministry of Health (MoH) and the Bulgarian National Programme for the Elimination of Measles and Congenital Rubella Infection managed the outbreak well. Both teams contacted physicians who reached out to families and educated them on the importance of timely vaccinations. These teams also advised the hospitalization of patients with measles to avoid spreading the disease to the community.
  3. Following the outbreak, the MoH distributed information about measles prevention to the national media. MoH also distributed educational materials on measles to all Bulgarians. These efforts made families in remote areas aware of the vaccinations their children should receive.
  4. Bulgaria’s measles vaccine was introduced in 1969, and the second dose was introduced in 1983. Between 2003 and 2008, more than 94 percent of the Bulgarian population had received the first dose, and more than 89 percent had received the second. Following the 2009 outbreak, health officials distributed the vaccine to those aged 13 months to 20 years who had not yet received the two doses. It also became available to those over the age of 30 who were in need of it.
  5. Children that have parents with low education levels have less access to vaccinations. This was found by a study performed by the European Journal of Public Health. Although Bulgaria has consistent access to measles vaccinations, the education level of parents appears to have an impact on vaccination access. In a survey of 206 Bulgarians from the region of Burgas, the mean number of years of education mothers completed was 5.20, while fathers on average completed 7.02. 40.8 percent of children surveyed had no measles vaccination, 45.1 percent received a single dose and only 12.1 percent received a second dose.
  6. Along with other standard, up-to-date vaccinations, measles vaccines are required by the CDC for all travelers visiting Bulgaria. This measure is to protect not only the traveler but also vulnerable Bulgarians. It also helps ensure that measles does not make its way to other countries.
  7. Bulgarians are required to notify health officials if they have measles. The Regional Inspection for Prevention and Control of Public Health (RIPCPH) and the National Center for Infectious and Parasitic Diseases (NCIPD) are then notified. The sooner individuals report cases, the sooner national health organizations can prevent outbreaks. Health officials also proactively study the demographics of measles patients to figure out where the disease came from and other risk factors.

Though Bulgaria’s recent measles outbreaks are distressing, the country has worked hard to protect as many people as possible. Additional efforts are aimed towards preparedness for the possibility of future outbreaks of measles in Bulgaria. With an increase in vaccines and a focus on the disease by medical professionals, Bulgaria will be able to keep measles under control.

– Alyson Kaufman
Photo: Pexels

Countries Affected by the Measles OutbreakIn 2019, countries around the world faced a significant increase in measles outbreaks. Besides cases in the United States, people in places like the Democratic Republic of the Congo (DRC), Brazil, the Philippines and Somalia have suffered from a resurgence of this preventable disease. There are many causes of the global measles outbreak including the mistrust of vaccines, inadequate access to health care and the global childhood immunization gap.

Measles is caused by a virus and spread through respiratory transmission. It is highly contagious but mostly preventable through childhood vaccinations. Mild symptoms of measles include high fever and a rash. More severe effects of the disease include pneumonia, diarrhea and even deafness.

4 Countries Affected by the Measles Outbreak

  1. The Democratic Republic of the Congo (DRC): In the DRC, measles has killed 5,000 people so far in 2019, which is more than twice as many people as Ebola. More than 90 percent of these deaths are children under the age of 5. Further, the measles outbreak has spread throughout all provinces. Lack of access to health care and a shortage of measles vaccines contribute to these deaths. Additionally, weakened immune systems in malnourished children, deficiencies in vitamin A and diseases such as HIV/AIDS also lead to death. UNICEF and other NGOs have distributed more than 1,300 measles kits containing antibiotics, rehydration salts and other drugs to the most impacted areas. UNICEF has also advocated for a longer-term strategy to address the outbreak.

  2. Brazil: Though Brazil had been deemed free of measles in 2015, as of November 2019 the country has had an estimated 50,000 cases of the disease. The highest concentration of measles cases occurred in Sao Paulo, the state with the highest population. Brazilian officials are concerned that people in an isolated tribe in the Amazon may have contracted the disease. This is of particular concern since these people have a low resistance to measles and other diseases. Health officials in Brazil have implemented a measles vaccination campaign to vaccinate millions of young people between the ages of 20-29 in order to contain the outbreak.

  3. The Philippines: Yet another country that has faced a measles outbreak due to distrust in vaccines is the Philippines. The New York Times reports that measles vaccination rates in the country declined from above 80 percent in 2008 to below 70 percent in 2017. Officials have reported nearly 44,000 measles cases in Manila and the surrounding areas as of November 2019. In response to the measles outbreak, along with outbreaks of polio and dengue, the Philippines Red Cross has sought to expand its efforts. This will require recruiting and training some 2,600 volunteers. In the long-term, the Department of Health aims to increase immunization coverage so that 95 percent of children are vaccinated.

  4. Somalia: According to a November 2019 U.N. article, there have been 3,616 suspected cases of measles in Somalia in 2019. In particular, people in IDP camps (for internally displaced people), areas with high population density and nomadic communities are at greater risk. The illness is particularly deadly for children under 5 in Somalia. Unfortunately, one in seven of these children dies before they turn 5. To combat this outbreak, the Somali government has partnered with UNICEF and the WHO to launch a campaign to vaccinate 1.7 million Somali children.

Several countries have faced measles outbreaks in 2019. Increased immunization coverage during childhood could prevent these outbreaks. As these countries affected by the measles outbreak show, access to vaccines and health care is vitally important. In fact, these ailments are often a matter of life and death. Fortunately, NGOs and governments are working together to prevent future measles outbreaks.

Sarah Frazer
Photo: Flickr

Child Mortality Globally
People have made significant progress in improving child survival rates globally. According to UNICEF, “one in 26 children died before reaching age five in 2018, compared to one in 11 in 1990.” However, far too many children who live in poor and vulnerable regions continue to die prematurely from preventable illnesses every day. Keep reading to learn the top five causes of child mortality globally.

Top 5 Causes of Child Mortality Globally

  1. Tuberculosis (TB) – Tuberculosis is currently one of the biggest causes of child mortality globally. A bacteria called mycobacterium causes TB. It mostly attacks the lungs but can affect other parts of the body as well. People can transmit the illness through the air when coughing, sneezing or talking. More than 600 children under the age of 15 die every day as a result of TB and around 80 percent of these deaths occur in children under the age of 5. Currently, only 96 percent of those children do not receive adequate treatment and as a result, die from the disease. UNICEF has created an agenda for action on childhood TB to help prevent children from dying on a global scale as part of the Sustainable Development Goals. To accomplish this objective, UNICEF needs funding support and investment from global and national decision-makers, governments and researchers.
  2. MeaslesMeasles is an infectious disease that a virus causes and people can contract it through the air, sneezes or coughs. It causes severe complications that can lead to death and is an extremely contagious disease killing children globally. It can last in the air up to two hours and if it affects one person, there is a 90 percent chance that those around them will contract it too. The measles caused 110,000 deaths among children globally in 2017 and most of these deaths were in children under the age of 5. From 2000 to 2017, people developed many preventative measures to stop measles and one of these measures was a vaccine. The vaccine was a major factor in reducing measles deaths among children. It prevented 21.1 million deaths between 2000 and 2017. To continue to prevent measles from taking more young lives, children should receive the vaccine routinely. In 2017, 85 percent of children around the world obtained the vaccine in one dosage. Two doses are ideal to protect children from contracting the disease. The World Health Organization played a huge role in distributing the vaccine. The WHO’s Assembly backed the Global Vaccine Action Plan by endorsing it in 2012. With this endorsement, WHO hopes to eradicate measles in five regions by 2020.
  3. HIV/AIDS – With a compromised immune system, AIDS can develop after contracting HIV. It can transmit to children from mothers through childbirth as well. HIV/AIDS greatly affects adolescent children, especially young women ages 15 to 19. Worldwide, two out of three adolescent girls of key populations have HIV. They are at the highest risk of contracting the disease and most likely do not have access to treatment. Without investment in HIV treatment and prevention programs, projections determine that 270,000 adolescents will contract HIV and 56,000 will die by 2030. Children are dying globally and reports in 2017 stated that the virus infected 430,000 children and killed 130,000 from complications. UNICEF plans to help stop the transmission of HIV from mother-to-child, close the HIV treatment gap and prevent the rise of HIV in adolescent children. UNICEF will do this by supporting governments and communities that fight to reduce inequities in HIV treatment. The organization also provides governments with technical assistance that strengthens their HIV services which include, treatment, prevention, programs and testing.
  4. Neonatal Deaths – Neonatal death refers to the death of a baby within the first 28 days of its life. It is a global phenomenon because children are at their most vulnerable during this time. Neonatal deaths account for 47 percent of deaths under the age of 5. Most neonatal deaths happen in the first day or week after birth. This averages out to about 1 million dying within the first day and close to a million dying within the first 6 days. Prevention of these deaths is important because there is an increasing rate of deaths under the age of 5. Although people cannot prevent most neonatal deaths, they can prevent some. Prevention methods include improving medical management by managing premature labor that can harm by the fetus and monitoring the heart rate of the fetus. Other preventative methods include neonatal intensive care referrals and monitoring possible respiratory complications during pregnancy.
  5. MeningitisMeningitis is an infection of the membrane surrounding the brain and spinal cord. Viral infections can cause it, but other causes include bacterial, parasitic and fungal infections. Meningitis symptoms can also spread quite quickly. Fifteen percent of children who have developed meningitis become unconscious once the virus spreads. In newborns, the symptoms can be vomiting, rash, very high temperature or inactivity. Around 25 percent of newborns who have meningitis develop increased fluid around the brain that can last up to one or two days and can cause them to be near death within 24 hours. If left untreated 50 percent of patients suffering from meningitis die within 24 to 48 hours. Even with the right treatment, about 5 to 10 percent of patients still die, resulting in many children dying globally. Prevention of this disease begins with getting routinely vaccinated to lower the chances of contracting it. All young children must receive the vaccination in the hopes of preventing the disease from taking their lives.

There are many diseases that cause child mortality globally every day. The world needs to work together to end the epidemic of preventable diseases that are taking the lives of children everywhere. Investing in treatment for preventable diseases in countries that may not have access to it is the first step.

  Jessica Jones
Photo: Flickr

Cost of Measles
A virus spreads measles; the disease is highly contagious and can cause further serious health problems, including death. Globally, 111,000 deaths occurred from measles in 2017 and most of these deaths were of children under the age of 5. While there is a cost-effective and safe vaccination available, there are gaps in vaccination coverage, especially in developing countries. This allows outbreaks of measles to continue to ravage communities and causes the death toll to rise.

Measles in the Developing World

The global cost of measles is high, but it is highest in the developing world. It is estimated that in the United Kingdom, the medical cost of a single measles case is $307, while the vaccine costs are $1.93. Estimates also determine that currently in the developed world, the cost of a measles outbreak can range between $4,091 and $10,228 per day, depending on the size of the outbreak. Each of these outbreaks can last an average of 17.5 days as well. Economies spending little on health care funding might find the cost of quarantining and ending a measles outbreak daunting and that it would cost more resources and funding than is available.

In 2014, the Federated States of Micronesia saw its first measles outbreak in 20 years. Starting with two confirmed cases of measles, the outbreak grew to over 50,000 people, causing 110 deaths. The cost of this measles outbreak matched the cost of measles outbreaks in the industrialized world; the total costs to treat and contain these 50,000 cases were nearly $4 million costing roughly $10,000 per case. Medical costs accounted for approximately a quarter of the total cost of measles in this example. The other costs came from the loss of productivity for those measles infected as well as their caregivers, and the majority of the cost of this measles epidemic was to contain the outbreak. In total, the country spent around $3.5 million on containment. Containment costs are high for countries struggling to provide health care for their citizens, and the loss of productivity for many families in the developing world can mean the difference between feeding their family and starvation.

Measles’ Recent Appearances

The first quarter of 2019 saw a huge upswing in reported measles cases worldwide versus the same time period a year prior. From January through March of 2019, there were over 112,000 cases, and the vast majority of these cases were from developing countries. For comparison, the same three-month time period in 2018 had only 28,000 reported cases of measles. If the cost of measles containment and medical treatment averaged $10,000 per case, as evidenced by the Federated States of Micronesia, then subject countries have spent at least $1.1 billion in a three-month time span to care for patients worldwide. The effects of the loss of productivity on impoverished families, including starvation, added a deficit of several million more dollars to the cost of measles in 2019.

Combatting Measles

To combat the rise of measles, five leading global health NGOs have formed a partnership to control measles deaths, giving support to immunization drives, and working to lower child mortality rates overall. The partnership includes the American Red Cross, United Nations Foundation (U.N. Foundation), Centers for Disease Control and Prevention (CDC), United Nations Children’s Fund (UNICEF), World Health Organization (WHO) and the Pan American Health Organization (PAHO).

When asked about the origins of the partnership, Timothy E. Wirth, President of the United Nations Foundation, said, “It is increasingly clear that every citizen, every sector and every nation has an interest in working together to promote progress in health, human rights, the economy and the environment. Those who think progress in these areas is elusive need look no further than this very tangible, impressive collaboration.” If ever there was a chance to lower child mortality rates, these five NGOs working in connection with one another would be the closest the world has seen.

Vaccination is the Key

Vaccination rates have drastically improved over the last few decades. Measles outbreaks have dropped 80 percent since the year 2000 thanks to increased vaccinations. One can partly attribute the recent increase in measles cases to a decrease in vaccinations worldwide. The cost of measles outbreaks is far too high to continue battling a disease that people can avoid with a vaccine costing less than $2. The cost of lost productivity can continue the cycle of poverty for developing nations for years to come. Measles vaccinations must increase and become available in all reaches of the world to counter the issues that measles outbreaks pose.

Kathryn Moffet
Photo: Flickr

Measles Outbreak in the PhilippinesIn January 2019, a measles outbreak in the Philippines began, leaving more than 450 dead and over 33,000 cases to date. Fifteen years after the near eradication of measles in the Philippines, the disease has returned with a vengeance in the Southeast Asian nation. The vaccination rate for measles in the Philippines has declined steadily, from more than 80 percent in 2008 to under 70 percent in 2017.

Several factors have led to a steady decline in the vaccination rate over the last decade. The issue of accessibility affects many people in rural areas of the country, putting them at risk of contracting diseases that are easily preventable with vaccination. The Philippines consists of 7,000 islands and does not have a secure health care budget in place, rendering it nearly impossible to ensure that all citizens are vaccinated.

Increasing misinformation concerning the negative side effects of vaccines has led many people to become skeptical about vaccinating themselves and their children. This drop in confidence in vaccinations has been quite significant. A 2018 study found that nearly 100 percent of participants were in favor of vaccines in 2015, believing them to be safe and effective only four years ago.

Who is at Risk?

Anyone who is not regularly vaccinated is at risk of contracting measles. The airborne virus can spread extremely easily and remains in a room for hours after an infected person has coughed or sneezed. The measles outbreak in the Philippines has affected thousands of people, including many young children who were not given the proper vaccination. Children under six months of age are especially in danger of contracting measles, as they are too young to receive the vaccine.

Pregnant women or those planning pregnancy run additional risks if they are not vaccinated against measles. If a woman wants to become pregnant — and is vaccinated beforehand — she should wait at least four weeks before attempting to conceive. This ensures that the vaccine is functioning properly and effectively. If a woman is not vaccinated against measles and becomes pregnant, a variety of side effects can occur. Common reactions include premature birth, miscarriages or stillbirths, and babies born underweight.

What Can be Done?

Fortunately, the growth rate of the measles outbreak seems to be slowing. New cases decreased to a few hundred per week in May, while thousands were infected each week in February and March. The decline in new cases largely due to local health officials visiting communities firsthand and checking residents’ vaccination statuses.

For children under six months of age who are unable to receive the necessary MMR (measles, mumps, and rubella) vaccine, the best precaution is to limit contact with anyone who is not a primary caregiver. Infants aged six to 11 months should have one dose of the vaccine, while children over one year and adults should have two doses of the vaccine given at least 28 days apart.

A Bright Side to the Measles Outbreak in the Philippines

Despite the tragic number of families that have been affected by the measles outbreak in the Philippines, there is a bright side. Since the outbreak began in early 2019, more than five million people have been vaccinated against the disease. The Filipino government hopes to boost that number to 20 million by the fall, which would mean one-fifth of the country’s population would be newly vaccinated this year. By immunizing such a significant percentage of the population, the Philippines can restore faith in the healthcare system, and prevent further illness and death.

– Emi Cormier
Photo: NPR

Madagascar Measles Outbreak

Between September 2018 and April 2019, Madagascar‘s measles outbreak has killed over 1,200 people. According to the World Health Organization, measles is a highly contagious viral disease that remains a significant cause of death among young children globally, despite the availability of vaccines.  Organizations are currently coming together to aid Madagascar against the outbreak and educate the public about the importance of vaccinations in protecting children from harm.

Recent Outbreak

Madagascar is facing the largest measles outbreak in its history, and only 58 percent of people on the island have been vaccinated against the disease. Dr. Dossou Vincent Sodjinou, a WHO epidemiologist in Madagascar, expressed concern about the expansion of the outbreak and the lack of vaccination.

“The epidemic unfortunately continues to expand in size, though at a slower pace than a month ago,” said Dr. Sodjinou. “Some cases of resistance to vaccinations exist because of the influence of religion or of traditional health practitioners but they are isolated ones.”

Measles is one of the leading causes of death for children, and WHO reports that 450 die each day worldwide due to the illness.

According to the Centers for Disease Control and Prevention, the symptoms of measles generally appear seven to 14 days after a person is infected. Measles begins with a fever, a cough, runny nose, a sore throat and red eyes. After a few days of symptoms, tiny white spots, medically known as Koplik’s spots, begin to appear inside the mouth.

The outbreak is complicated by the fact that nearly 50 percent of children in Madagascar are malnourished, which increases the likelihood of severe cases. Those whose immune systems have been weakened by HIV/AIDS or other diseases are also at risk.

Weak Healthcare and Shortage of Vaccines

According to United Nations Children’s Fund, once a child is infected, there is no specific treatment for measles, so vaccination is a life-saving tool for children.

“The Madagascar measles outbreak is a particularly precarious situation because many of the districts have weak health infrastructure and systems to begin with, which is now exacerbated with a shortage of vaccines,” said Michael L. Rich, a Harvard Medical School assistant professor and the chief clinical advisor at PIVOT, an organization partnering with the Madagascar Ministry of Health. “Without a reliable supply of vaccines, strong supply chains or facilities adequately staffed with trained personnel, an end to Madagascar’s ongoing measles crisis is difficult to foresee.”

Doing More to contain the outbreak

The United Nations Children’s Fund is issuing an urgent appeal to governments, health care providers, and parents to do more to contain Madagascar’s measles outbreak. Efforts against the outbreak include educating the public about the safety of vaccines, vaccinating all children between the ages of 6 months and 5 years, training and equipping health workers, and strengthening immunization programs.

PIVOT, an organization dedicated to providing healthcare to impoverished communities, aims to help Madagascar become a symbol of healthcare transformation. In the wake of the outbreak, PIVOT is aiding public systems and pushing for an era of medicine guided by the needs of the poor.

While organizations successfully fight measles in Madagascar, there is also hope around the world. Under the Global Vaccine Action Plan, the elimination of measles is a target in five WHO regions by 2020. WHO, as the lead agency responsible for achieving this goal, is giving children around the world hope for a healthier future.

– Carolina Chaves
Photo: Flickr

 

Measles Outbreak in Madagascar

Since April 14, 2019, a measles outbreak in Madagascar has killed more than 1,200 people. According to the WHO, measles is a highly contagious viral disease that remains an imminent cause of death among young children globally. This is despite the availability of a safe and effective vaccine. Organizations are aiding Madagascar to combat the outbreak. They are also educating the public to vaccinate their children to save children from further harm. The island country is located off the southeastern coast of Africa. It is the fourth largest island in the world.

How To Detect Measles

Madagascar is one of the poorest countries in the world with one of the weakest healthcare systems.

Symptoms of measles generally appear around seven to 14 days after a person becomes infected. Measles begins with a fever, cough, runny nose, a sore throat and red eyes. After a few days, tiny white spots (medically known as Koplik’s spots) begin to appear inside the mouth. Severe measles is more likely to be found among poorly nourished young children, especially those with insufficient vitamin A. They are also more likely to be found in those whose immune systems have been weakened by HIV/AIDS or other diseases.

Recent Outbreak

Madagascar is facing arguably the largest measles outbreak in its history. Only 58 percent of people on the main island received their vaccination against the disease, a reflection of the measles outbreak in Madagascar.

Dr. Dossou Vincent Sodjinou, a WHO epidemiologist in Madagascar, spoke concerning the Madagascar measles outbreak:

“The epidemic, unfortunately, continues to expand in size, though at a slower pace than a month ago. Some cases of resistance to vaccinations exist because of the influence of religion or of traditional health practitioners but they are isolated ones.”

Measles is one of the leading causes of death for children. WHO reports about 450 die each day worldwide due to the illness, according to Fox News.

The measles outbreak in Madagascar is complicated by the fact that nearly 50 percent of children in Madagascar are malnourished.

Weak Healthcare and Shortage of Vaccines

According to UNICEF, once a child is infected, there is no specific treatment for measles, so vaccination is a life-saving tool for children.

PIVOT, a partnership that aids communities in resource-poor areas, seeks to combine accessible and comprehensive health care services with rigorous scientific research to save lives and break cycles of poverty and disease.

Harvard Medical School (HMS) recently interviewed Michael L. Rich, an HMS assistant professor of medicine in the Brigham and Women’s Hospital Division of Global Health Equity and chief clinical advisor at PIVOT.

“The Madagascar measles outbreak is a particularly precarious situation because many of the districts have weak health infrastructure and systems to begin with, which is now exacerbated with a shortage of vaccines. Without a reliable supply of vaccines, strong supply chains or facilities adequately staffed with trained personnel, an end to Madagascar’s ongoing measles crisis is difficult to foresee.”

Doing more to contain the outbreak

As a result, UNICEF is issuing an urgent appeal to governments, health care providers, and parents to do more to contain the measles outbreak in Madagascar. This appeal contains:

  • explanations that not only are vaccines are safe and effective, but they can save a child’s life
  • the recommendation of vaccinating all children between the ages of six months to five years during outbreaks
  • training and equipping health workers so they can provide quality services
  • Strengthening immunization programs to deliver all life-saving vaccines.

Under the Global Vaccine Action Plan, measles is targeted for elimination in five WHO Regions by 2020. WHO is the lead technical agency responsible for the coordination of immunization and surveillance activities to achieve this goal.

By combining rights-based care delivery with strengthened public systems and a new era of science guided by the needs of the poor, PIVOT aims to help the country of Madagascar become a leader in health system transformation.

– Carolina Chaves
Photo: Flickr

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
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