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measles in democratic republic of congoThe Democratic Republic of the Congo declared a measles outbreak in June 2019. Since then, more than 310,000 have been affected by this epidemic. Measles is an extremely contagious and airborne disease that can cause rashes, fevers and coughing. The virus is especially dangerous for children. Most developed countries can combat measles through vaccinations, but developing countries aren’t able to fully eradicate and achieve a herd immunity of a sizeable population majority, leading to constant outbreaks.

How COVID-19 is Affecting the Situation

Due to COVID-19, more than 117 million children could not receive their measles vaccine following the halt of vaccination campaigns. Measles may kill more people in developing countries than COVID-19 if outbreaks continue. At least 6,500 children have already died from measles in the DRC. Most world leaders are focusing on COVID-19 rather than the vaccine-preventable diseases that could potentially wreak havoc on developing nations. The Democratic Republic of the Congo is currently leading the world in the highest numbers of measles cases. This trend is likely to continue without significant aid and the continuation of vaccination campaigns. The DRC also has an incredibly weak healthcare system, so it greatly relies on NGOs and foreign aid to administer vaccines & life-saving medicines to the country.

Other Diseases in the DRC

In addition to measles, the DRC is currently combating cholera, polio, COVID-19 and Ebola. “On June 1, 2020, the Democratic Republic of the Congo declared its eleventh Ebola outbreak.” This is before the tenth outbreak was declared over on June 25, 2020; however, WHO has stated that these two outbreaks are separate. Due to the limited resources caused by the COVID-19 pandemic, this outbreak will be harder to contain than previous outbreaks.

In the past, multiple Ebola outbreaks have drawn more attention than the measles in the Democratic Republic of the Congo. Now, COVID-19 is drawing more attention than measles. However, all three diseases need to be dealt with alongside the other diseases harming the DRC. During an Ebola outbreak in earlier months, measles was overlooked, which led to a resurgence. Measles in the Democratic Republic of the Congo must receive the attention necessary to combat it. In addition to the disease itself, the DRC is also suffering from malnutrition, food insecurity and economic uncertainty. All of these factors make the population more vulnerable to other diseases, particularly children.

How To Help

The best way to help combat measles in the DRC is to ensure vaccination campaigns can start again. An increase in foreign aid will help the nation reach this goal. The DRC needs to achieve 95% vaccination to recover, but that goal seems incredibly unlikely due to the current COVID-19 panic. With the majority of the world also focused on COVID-19, it is unlikely that the DRC will receive all the international aid they require at this time. An additional $40 million will be needed on top of the $27.6 million received to successfully fight measles in the Democratic Republic of the Congo.

Organizations like Doctors Without Borders are continuously working to fight measles outbreaks in DRC. As of June 2020, the organization has succeeded in vaccinating 82,000 children after “three back-to-back campaigns.” Doctors Without Borders cautions the world that measles cannot be ignored even with the current COVID-19 crisis. They are taking extra precautions during this time to reduce the risk of co-infection.

While COVID-19 is an important and urgent issue, it is imperative that leaders continue to send help to those abroad struggling with the fall-outs of poverty whenever possible. Measles in the Democratic Republic of Congo is one example of how important foreign assistance and vaccination campaigns are in saving lives in developing countries.

– Jacquelyn Burrer
Photo: Flickr

Maternal and Neonatal Tetanus
The silent killer, otherwise known as maternal and neonatal tetanus, is a life-threatening bacterial infection in newborns and their mothers that is associated with nonsterile delivery and cord-care practices. Although it is vaccine-preventable, when tetanus develops, mortality rates are extremely high. This is especially true when the appropriate medical care is not available, which is often the case in low-income counties. In 1999, there were 57 countries where tetanus posed a considerable risk for women giving birth. Today, that number has dropped significantly, but maternal and neonatal tetanus remains a public health threat in 13 countries: Afghanistan, Angola, Central African Republic, the Democratic Republic of the Congo, Guinea, Mali, Nigeria, Pakistan, Papua New Guinea, Somalia, South Sudan, Sudan and Yemen.

Kenya has put in great effort to eliminate maternal and neonatal tetanus where it once was a common problem. The commitment the country made has drawn global attention and is inspiring other countries to do the same.

Kenya’s Initiative

As of 2018, Kenya has been removed from the list of countries that sees maternal and neonatal tetanus as a public health threat by attaining elimination status. Elimination is only attained when there is a reduction of neonatal tetanus incidences to below one case per 1,000 live births per year. Kenya’s progress towards achieving this important public health milestone began in 2001, proving that this process takes time. A pre-validation assessment took place in Kenya in September 201 by the Ministry of Health with the support of the World Health Organization (WHO) and UNICEF. A WHO-led validation process took place in 2018 to confirm the elimination of the disease.

Eliminating maternal and neonatal tetanus takes a lot of planning, and Kenya has set a great example. In 2002, Kenya introduced a five-dose tetanus toxoid vaccination schedule and in 2003, the country began to implement immunization campaigns in high-risk areas. Kenya also focused on providing free maternity services to increase skilled birth attendants. Over time, they began including tetanus toxoid vaccines into the routine antenatal care packages. Today, Kenya is still working on strengthening health facilities and resources and plans to provide free medical care to children under five years of age.

The involvement of schools is another factor that helped Kenya eliminate maternal and neonatal tetanus. Aliaphonse’s Katuit primary school is a prime example of the success seen from the campaign. Ann Talam, one of Katuit primary school’s teachers, explained in an interview with UNICEF that the campaign not only reaches members of the student body but also their sisters or relatives who may not attend school. Education ensures that all girls, even those from poverty-filled communities, are immunized.

Kenya’s Impact

Reducing deaths from neonatal tetanus is one of the simplest and most cost-effective ways to reduce the neonatal mortality rate. As of 2012, Kenya’s immunization coverage for newborns protected against tetanus reached 73 percent — and it continues to rise. WHO estimates a 94 percent reduction in neonatal deaths from 1988, when an estimated 787,000 newborn babies died of tetanus within their first month of life.

As Kenya eliminates maternal and neonatal tetanus, it has inspired the country to combat other diseases as well. They plan to identify the unreached and design an innovative approach to reach these populations with immunizations. On February 22, 2019, WHO representative, Dr. Rudi Eggers, addressed the recent measles outbreak in the country, attributing it to lapses in the routine immunization system since the previous measles and rubella outbreak in 2016.

“There is an urgent need for all stakeholders to come together and work to increase immunization coverage and address inequities,” Eggers said.

The Kenya campaign also aims to vaccinate nearly 14 million children between the ages of nine months and 14 years — nearly 40 percent of the population — for other common viruses.

Since Kenya’s elimination of maternal and neonatal tetanus, more than 153 million women around the world have been immunized with two or more doses of vaccines fighting against tetanus. The Eliminate Project, funded by the Kiwanis Children’s Fund, plans to learn from Kenya’s success and use it to inspire other countries to follow their lead. In 2018, The Eliminate Project raised a total of $502.282.72 to save and protect mothers and their babies worldwide.

Along with planning and taking initiative, Kenya recommends planning outreach activities for remote places, promoting delivery in health facilities and strengthening knowledge of health workers on the immunization schedule. Kenya sets an example of how small changes can overcome the silent killer of maternal and neonatal tetanus.

– Grace Arnold
Photo: Flickr

 

Vaccines Prevent Disease and PovertyVaccines are known to save lives and protect against diseases, but now can be credited for preventing poverty as well. A study done at Harvard University alongside Gavi, the Vaccine Alliance researched the economic effects of vaccines for 10 different diseases in 41 developing countries. The study concluded that vaccines would help to prevent 24 million people throughout the world’s poorest countries from falling into poverty by the year 2030. The study also estimated that vaccines given between 2016 and 2030 would prevent the deaths of 36 million people.

Vaccines contain the same antigens that are responsible for causing diseases. The antigens in the vaccines are killed or severely weakened and are unable to cause the disease, but are strong enough to allow the body’s immune system to produce the antibodies needed to become immune to the disease. Therefore, the protection comes without the child having to be sick or suffer from a disease. This reduces the cost of healthcare for families and allows them to save and spend more money, boosting the country’s economy.

Dr. Seth Berkley, the CEO of Gavi, talked about the effects on a child who receives vaccinations and their school attendance. He stated that a child who is healthy is more likely to attend school and become a productive member of society, and their families will not be obligated to pay the expensive healthcare costs that come with diseases. Healthcare expenses cause about 100 million people to fall into poverty each year, as medical treatment is one of the main reasons families are forced below the poverty line. With the use of vaccines, countries will be better protected from both disease and poverty.

The greatest poverty reducer will be vaccinations, by reducing the number of people who are living in poverty due to hepatitis B. Gavi anticipates this will help 14 million people avoid medical impoverishment. Poverty cases that are due to measles will be reduced by vaccines, which is anticipated to prevent 5 million cases as well as preventing 22 million deaths. Disease and poverty are linked through a cause and effect in that medical costs cause poverty in many developing countries.

The study also showed that the poorest 20 percent of the global population represented more than one-fourth of deaths that can be prevented by vaccinations. Furthermore, the study concluded that introducing vaccines in the poorest countries would have the largest impact on lowering the number of deaths and the number of people falling into poverty due to their medical expenses. Therefore, vaccines prevent both disease and poverty.

– Chloe Turner

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
The Democratic Republic of Congo is facing the worst measles outbreak since 2011, according to Doctors Without Borders. So far this year, over 23,000 cases of measles were reported in the Katanga region of the country. The UN and Doctors Without Borders have calculated over 400 deaths.

The epidemic started in February of this year. In just one village with a population of 500, 30 children died in just 2 months. Despite the number of deaths, the central government in Kinshasa hadn’t recognized the measles epidemic and the deaths caused by it until earlier this month.

Doctors Without Borders has vaccinated over 300,000 children, despite the difficulties of having to keep the vaccine cold and requiring 2 shots, weeks apart for effectiveness.

An additional difficulty has been the lack of infrastructure with bad roads and railroads that are usually never fixed or where fuel runs low. Some villages are hardly accessible, only way to get there is by foot, motorcycle or canoe.

The UN has estimated $2.4 million to vaccinate everyone. The vaccine is effective enough it has wiped out the measles outbreak in western countries. The problem in countries such as the DR of Congo is children’s immune systems have been weakened from malnutrition, malaria and cholera.

The vaccine while effective, cannot prevent death when complications such as blindness, encephalitis, severe diarrhea and related dehydration, or severe respiratory infections.

In addition, vaccination has proved difficult in a region which has tried to become independent from the rest of the country. The ongoing fighting between local militia and Congolese army over mining areas leads to villagers fleeing for days or weeks. However, efforts are ongoing to improve the current living conditions for Congolese citizens, especially children.

Paula Acevedo

Sources: New York Times, Yahoo
Photo: CDN

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 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

vaccination_campaign
In January 2015, the Myanmar government launched the first stage of the largest national campaign to eradicate and control Measles and Rubella by the year 2020.

The second stage took place in February 2015. Initially, these beginning stages were concentrated on Measles, but from May 2015 onward, the national campaign will offer the Measles and Rubella vaccine jointly.

The campaign is supported by the WHO, GAVI, American Red Cross, the U.N. Foundation, the U.S. Centers for Disease Control and Prevention and UNICEF. The goal is to reach 94 percent of the population through vaccination teams of 12,000 health care professionals. The aim is to reach 17 million children between nine months and 15 years in 65,000 villages and 45,000 schools.

Myanmar has remained committed to vaccinating its population against fatal and debilitating diseases. In 2013, a polio immunization campaign was launched and 370,00 children under five years were vaccinated using the oral drops method. In early 2014, Myanmar, along with many other states in Southeast Asia, was declared polio-free.

Health care is reported to be expensive, of a poor quality and has difficulty in providing attentive care toward patients in Myanmar.

This vaccination campaign is also incredibly important because the population has been neglected in terms of health care due to the ongoing conflict and political issues. There are 587,000 internally displaced persons. There are 800,000 living in the western state, Rakhine state, who are stateless and 140,000 who have fled from their homes. Nevertheless, this campaign is attempting to reach those living in Rakhine state, which has been in an increasingly violent conflict-ridden state since 2012 as there are numerous clashes between Muslims and Buddhists. The vaccination campaign aims to reach populations in this region at a higher rate to match the national level.

While there are political hurdles to achieving an overall better health care system, the coordination of efforts between the state, local and international bodies in regard to vaccination is successful. This vaccination campaign is a major stride for Myanmar investing in the betterment of its people.

– Courteney Leinonen

Sources: Global Polio Eradication Initiative, Reliefweb, WHO, BBC, Salon
Photo: Measles & Rubella Initiative

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

mmr vaccine
Measles, mumps and rubella are all viral diseases that can interrupt the development of children and adolescents. Accessing reliable information about the MMR vaccine is the most cost-effective method to increasing its uptake.

The MMR vaccine is recommended in childhood. The three-in-one vaccine is necessary for most children to enter school and can be given as early as 11-15 months, and children should get two doses. In addition, adults born after 1956 or 18 years or older should also receive one dose of the vaccination unless they have already had all three diseases.

The MMR vaccine can be given at the same time as other vaccines. Young children (under 12 years) can get a combination of vaccines known as the MMRV (measles, mumps, rubella and chicken pox).

Upon receiving the vaccination, there are some risks involved, but most people who receive the vaccine do not develop any problems.

Mild issues can occur 6-14 days after receiving the vaccine and can include any of the following: fevers, mild rashes, and swelling of cheek/neck glands. Moderate issues can range from: seizures, stiffness/ pain in joints, temporary low platelet count that leads to a bleeding disorder (1 in every 30,000 doses). Some severe and very rare problems are: serious allergic reaction (1 in every million doses), deafness, permanent brain damage, and long-term seizures/comas. There is no evidence that the vaccine causes childhood autism.

All of these listed risks are small however, in comparison with the risks of contracting measles: severe illness, hospitalization and death. The vaccine itself has brought huge leaps in early childhood disease prevention, providing vaccination to over 500 million people worldwide in over 100 countries. Before the vaccine, mumps was the most common cause of viral meningitis in children and rubella caused terrible damage to unborn babies.

Now, both mumps and rubella are virtually non-existent in children.

The Measles Outbreak

With concern to the current measles outbreak of 2014, two doses are recommended because 2-5 percent of vaccinated people do not respond to their first dose. More than 99 percent of people develop immunity after
the second dose.

Out of the 593 confirmed cases of measles, very few were from people who had been vaccinated twice.

The virus itself can stay in the air for two hours after a person with measles symptoms have left the area and is spread by respiratory droplets. The people infected are contagious four days before and after receiving the rash.

International Outbreak

In the third world countries of the world, measles outbreaks have been spreading more freely, with thousands of cases. In the Philippines, there were 50,000 registered cases and 77 deaths. In Vietnam, there are at least
8,700 cases with 112 deaths in children. In Pakistan, over 30,000 people have caught measles and 290 people have died, with the number increasing daily for children alone. The effect of measles has been spreading due to a lack of proper vaccination, more vulnerable immune systems and misinformation (MMR vaccine may produce autism).

In Africa, the number of measles-related deaths have decreased by 91 percent due to a surge in immunization. However, cases have still been growing, a number well into the thousands.

The potential benefits of the vaccine outweigh the risks. Parents should understand that the MMR vaccine is the best way to protect their children from these diseases, especially if traveling to an affected area, or the family resides in an affected area.

Ashley Riley

Sources: About, About 2, CDC, CDC 2
Photo: Medimoon