• World body calls for Collective Response
In recent times the world has witnessed a spike in measles epidemic. Over the years vaccination against this deadly childhood disease has generally been stalled especially as a major manufacturer of an anti-dengue vaccine once stated that it’s adverse effects could pose deadly consequences. With the continued loss of faith in the measles vaccine and the consequent resurgence of measles in most parts of the world, experts say there is definitely reason for us to be alarmed and be on the red alert. In this month’s cover, PharmaTimes Editor, MORGAN NWANGUMA examines the reality and depth of the looming danger.
The rising wave of measles epidemic worldwide has understandably given global health watchers cause for worry. Meanwhile experts say there seems to be two kinds of measles problems depending on location.
In poorer countries such as Madagascar and in countries which have suffered much of conflicts such as Yemen, measles deals a devastating blow due to the fact that vaccines are hard to come by; when they are available they are not just affordable. For instance, Madagascar alone has had almost 80,000 cases resulting in about 900 deaths since September of 2018.
The Rising cases of Measles
Observers say even right now, the cases of measles in many other countries including and especially richer countries, have assumed a steady rise due to what is referred to as “vaccine hesitancy.” It has been observed too that parents are beginning to jettison the usual vaccination exercise, which they have been accessing since 1963 and attributed to being responsible for the near total eradication of the disease.
Experts seem to agree that that delay is largely responsible for the recent global outbreaks. As it is, with at least 221 cases, Japan has on her hands the worst measles outbreak since the last ten years. Official reports state that from the beginning of 2019, more than 70 people have come down with measles in southwest Washington State; Vancouver in British Columbia has had 17 cases while in Costa Rica an unvaccinated French boy has been identified as being the one who imported the first case of the disease into the country since the last five years.
The Philippines are victims of the two problems mentioned earlier: the lingering difficulty of having to access vaccine, and the uncertainty of having it. In 2017 so many people began to lose faith in vaccines as soon as an anti-dengue vaccine manufacturer stated that it is likely to heighten risks of very serious infections. And recently, research discovered that in the Philippines, those who still trusted in the efficacy of vaccines came down from almost 82 percent in 2015 to 22 percent in 2018. As a result of this experts say, more than 12,700 measles cases have been reported since the start of 2019, and with no less than 203 deaths. Not less than 55 children below 4 years have died since the year began at one hospital in Manila lone.
“The vaccine hesitancy movement has really reached this level in certain countries — the United States, European countries, even in the Philippines — where we now are having difficult-to-control measles outbreaks occur, because the level of immunity has fallen,” says Amesh Adalja, senior scholar at Johns Hopkins University Centre for Health Security and an infectious disease physician.
For the World Health Organisation (WHO) this is rather an alarming situation. Earlier in January, the world body acknowledged that vaccine hesitancy is one of the top 10 threats to global health, categorising it with such big health threats as the Ebola virus and antibiotic resistant bacteria.
Without a doubt, having made progress after a number of years in children immunisation and eradication or near eradication of measles in some countries, those gains have slowed down. WHO reports that cases of measles have indeed increased by more than 30 percent from 2016 to 2017. 173,330 was the total cases reported globally in 2017.
Measles is a viral disease that can spread rapidly; also known as rubeola or morbilli, measles is an endemic disease, which means it is continually present in a community, and many people develop resistance. It could be an unpleasant condition, but the disease normally would pass without treatment within 7 to 10 days. Fact is, once a person has gone through a bout of measles, he/ she acquires immunity for the rest of their life. They are very unlikely to contract the disease a second time.
There are two types of measles: Measles, being the standard form caused by the rubeola virus; there is also the Rubella, or German measles, which is caused by the rubella virus.
Causes of Measles infection
Measles is caused by infection with the rubeola virus. The virus lives in the mucus of the nose and throat of an infected child or adult. The disease is contagious for 4 days before the rash appears, and it continues to be contagious for about 4 to 5 days after. Experts say infections are likely to spreads through the following methods:
• physical contact with an infected person
• being near infected people if they cough or sneeze
• touching a surface that has infected droplets of mucus and then putting fingers into the mouth, or rubbing the nose or eyes
The virus remains active on an object for 2 hours.
How a Measles infection develops
As soon as the virus enters the body, it multiplies in the back of the throat, lungs, and the lymphatic system. It later infects and replicates in the urinary tract, eyes, blood vessels, and central nervous system. The virus takes 1 to 3 weeks to establish itself, but symptoms appear between 9 and 11 days after initial infection.
Anyone who has never been infected or vaccinated is likely to become ill if they breathe in infected droplets or are in close physical contact with an infected person. Approximately 90 percent of people who are not immune will develop measles if they share a house with an infected person.
As far as medical science is concerned, there is no specific treatment for measles yet. If there are no complications, the doctor will usually suggest rest and plenty of fluids to prevent dehydration, and wait for symptoms to go away within a period of 7 to 10 days.
People who have already had measles are normally immune and they are unlikely to get it again. But as for people who are not immune to the disease, experts advise that you consider the measles vaccine. According to the UNO agency top officials, the situation for now calls for collective response from families and governments so as to once again raise the vaccination awareness and encourage families to fully participate whenever the opportunity avails itself.
Reasons for alarm
Considering that there is a 300 per cent surge in the number of measles cases during the first three months of this year, in contrast to the same period last year, experts have said we now have a “a global measles crisis” on our hands.
According to Henrietta Fore, Executive Director of the UN Children’s Fund (UNICEF) and Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation (WHO) “Cases have soared across the world, including in places where measles had previously been eliminated, like the United States”. Emphasising how desperate the situation is turning out to be, the officials say there has been two years of
The current pictorial data shows that Democratic Republic of the Congo (DRC), Ethiopia, Georgia, Kazakhstan, Kyrgyzstan, Madagascar, Myanmar, Philippines, Sudan, Thailand and Ukraine, are all in the midst of current outbreaks. It is also spreading fast among clusters of people, who are resisting vaccination, in countries with high overall vaccination rates, including the United States, Israel, Thailand and Tunisia.
“We’re worried not only because measles can be so severe, it still causes over 100,000 deaths every year, but also because it is extremely contagious” said the agency chiefs. Referring to measles as “the canary in the coalmine of vaccine preventable illnesses”, the UNICEF and WHO heads explained that, “around the world, millions of children are still missing out on lifesaving vaccines, leaving them and their communities vulnerable to disease and deadly outbreaks”.
Additionally, scientists and health advocates have even been harassed for sharing information, according to the agencies, while unproven so-called vaccine alternatives are being marketed for profit.
Call for Collective Response
Governments have therefore been asked to invest in primary care and immunisation, ensuring that these services are affordable, accessible and truly responsive to parents’ needs, especially those in the poorest, most disadvantaged communities. On the other hand, WHO and UNICEF are working with other partners, like the Vaccine Alliance, a public-private partnership known as GAVI, to guarantee vaccines reach more people in more countries than ever before.
“It will take long-term efforts, political commitment and continuous investment, in vaccine access, in service quality and in trust, to ensure we are, and remain, protected together”, said the agency heads.
On its part, the Nigeria Centre for Disease Control in its Epidemiological Report released this April states that: 2,113 suspected cases of measles and two deaths (CFR, 0.1%) were reported from 34 states compared with 542 suspected cases with three laboratory confirmed, and three deaths (CFR,0.55%) reported from 36 states during the same period in 2018.
Also, since the beginning of the year, 16,284 suspected measles cases with 535 laboratory confirmed and 31 deaths (CFR, 0.19%) were reported from 36 states and FCT compared with 6,091 suspected cases and 53 deaths (CFR, 0.87 %) from 36 States and FCT, during the same period in 2018.
In a bid to mitigate the new surge, response measures are being put in place. These include immunisation for all vaccine-preventable diseases in some selected/ affected wards and LGAs during Supplementary Immunisation Activities (SIAs), as well as case management. Following this, NCDC has equally deployed Rapid Response Team (RRT) to Yobe State to appraise the present state of affairs.
In addition, a National Measles multi-partner, multi-sectoral Emergency Operational Centre (EOC) has been activated to coordinate response activities.