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Médecins Sans Frontières Responds to Congo Measles Outbreak

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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

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Sudan’s Measles Crisis

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 a 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 organizations 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

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Can the Measles Vaccine Ward Off ‘Immune Amnesia’?

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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

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Measles Eradication Progress Stalled

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 make 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