The World Health Organization’s goal was lofty but achievable: eliminate measles from five of the world’s six regions by 2020. But recent outbreaks — even in places where elimination had been achieved — are making that goal a distant dream.
In the first four months of 2019, 179 countries reported 168,193 cases of measles. That’s almost 117,000 more cases reported during the same period last year. Actual numbers are probably much higher; the WHO estimates that only 1 in 10 cases are reported. With this uptick, none of the regions will meet the 2020 goal, says pediatrician Ann Lindstrand, vaccine lead for immunization systems at the WHO in Geneva.
Special report: Measles roars back
This story is part of a package that explores the complex forces driving measles' resurgence. For more:
Even after a country attains elimination — defined as the absence of the continuous transmission of measles for a year or more — maintenance programs must be relentless, says Robert Linkins, a global measles expert at the U.S. Centers for Disease Control and Prevention in Atlanta. “Kids are born every day needing vaccines.… You have to keep up.”
The Americas is learning this lesson the hard way. In 2016, the region became the first to eliminate measles after its 35 countries immunized 95 percent or more of their populations (SN Online: 9/27/16). That’s the point at which herd immunity can keep safe those who aren’t immunized (often for health reasons or because they are too young). But across the region, vaccination rates have since dipped, and outbreaks in Brazil and Venezuela have cost the region its elimination status, according to a May 10 report in Science.
Reasons for recent failures vary across the world. Political instability, conflict and poverty can lead to shortages of vaccines (which must be refrigerated) and clinic closings. When civil war broke out in Côte d’Ivoire in late 2010, for example, the percentage of individuals getting vaccinated against measles plummeted, from an already low 70 percent in 2010 to 49 percent in 2011.
Top 10
Some countries hardest hit by measles in the first three months of 2019 had very few cases the year before, according to provisional WHO data posted May 15, 2019.
Countries with the highest measles counts from January through March 2019
And vaccine hesitancy, cited by the WHO as one of the top 10 threats to global health in 2019, is a factor that needs to be addressed, in both high- and low-income countries, says Siddhartha Datta, vaccine-preventable disease and immunization program manager for the WHO’s European region.
The global rise in measles cases also suggests that health systems around the world are not working well. “Where you have cases, that’s where you have weaknesses of the system,” Lindstrand says. Many countries are facing stressors and challenges to vaccination. Here are snapshots from a few countries that are in the thick of it.
Philippines
A dengue vaccine crisis dealt a blow to measles vaccination in the Philippines. Soon after the government approved a dengue vaccine in 2015, news emerged that it was making children sick. And there were reports that some children were dying from rare but serious reactions. The dengue vaccination program was suspended less than two years later. The episode led to “a huge upsurge in the Philippines of anti-vaxxers,” says Lotta Sylwander, a UNICEF representative who was based in the Philippines until March. Even before the debacle, other challenges to vaccination existed, including corrupt government officials, supply shortages and distributing the vaccine to the country’s thousands of far-flung islands, Sylwander says.
These issues plus growing vaccine hesitancy triggered a severe measles outbreak in late 2017 that still rages today. As of late March, the country had reported 23,000 cases this year and 333 deaths, mainly in young children.
Ukraine
Hit hard by political turmoil and vaccine hesitancy, Ukraine has seen a jump in measles cases in recent months. The first three months of 2019 witnessed more than 34,000 cases in Ukraine. The outbreak is no surprise, Datta says: In 2016, only 42 percent of children who needed the shot had received even a first dose of the vaccine. (A single dose protects about 95 percent of people who get the shot; a second dose ups protection to 99 percent.)
Several factors explain the low vaccination rates, says Sylwander, who is now based in Kiev, Ukraine’s capital. From 2009 to 2016, the country often ran out of vaccines, especially in the country’s conflict-ridden eastern region.
Ukrainians also have a history of vaccine skepticism. During the Soviet era, the government vaccinated everyone. But many children received faulty vaccines that had not been properly refrigerated. “Even though children were vaccinated, they became sick,” Sylwander says. Mistrust of government vaccination programs remains high (the recent U.S. measles outbreak in Washington state was focused in a tight-knit community of Ukrainian and Russian immigrants). Sylwander has even heard stories of medical staff in Ukraine falsely filling out children’s immunization cards to say they had administered a vaccine when they had not.
The country’s outbreak has spurred people to get vaccinated. And government programs over the last few years targeting vulnerable communities appear to be taking hold. The percentage of Ukrainian children who had received the measles vaccine jumped to 86 percent in 2017, according to WHO estimates. The challenge is reaching older children and teens who never got the shot.
Colombia
On March 8, 2018, a 14-month-old Venezuelan boy arrived in Medellin, Colombia, and soon developed spots. Lab testing confirmed he had measles. Colombia hadn’t seen a case of measles since 2015. Public health officials went on high alert.
Amid a political and economic crisis that has thrown Venezuela’s health system into disarray, the country’s vaccination rates fell, Linkins says. With Venezuelans fleeing home by the thousands, Colombian officials knew the disease could cross into their country.
In 2017, the Colombian government began monitoring migrant health. Working closely with the CDC and the WHO, officials sent vaccinators to high-risk municipalities and set up vaccination stations at the Venezuela-Colombia border. From May to July 2018, more than 11,000 Venezuelans were vaccinated as they entered Colombia.
From March 2018 through April 2019, Colombia has reported only 302 cases of measles and no deaths. Colombian officials “were able to recognize people quickly and launch a charge,” Linkins says. “That’s a success story in my mind.”
India
In the last eight years, India has eliminated polio, maternal and neonatal tetanus and yaws, a tropRead More – Source
The World Health Organization’s goal was lofty but achievable: eliminate measles from five of the world’s six regions by 2020. But recent outbreaks — even in places where elimination had been achieved — are making that goal a distant dream.
In the first four months of 2019, 179 countries reported 168,193 cases of measles. That’s almost 117,000 more cases reported during the same period last year. Actual numbers are probably much higher; the WHO estimates that only 1 in 10 cases are reported. With this uptick, none of the regions will meet the 2020 goal, says pediatrician Ann Lindstrand, vaccine lead for immunization systems at the WHO in Geneva.
Special report: Measles roars back
This story is part of a package that explores the complex forces driving measles' resurgence. For more:
Even after a country attains elimination — defined as the absence of the continuous transmission of measles for a year or more — maintenance programs must be relentless, says Robert Linkins, a global measles expert at the U.S. Centers for Disease Control and Prevention in Atlanta. “Kids are born every day needing vaccines.… You have to keep up.”
The Americas is learning this lesson the hard way. In 2016, the region became the first to eliminate measles after its 35 countries immunized 95 percent or more of their populations (SN Online: 9/27/16). That’s the point at which herd immunity can keep safe those who aren’t immunized (often for health reasons or because they are too young). But across the region, vaccination rates have since dipped, and outbreaks in Brazil and Venezuela have cost the region its elimination status, according to a May 10 report in Science.
Reasons for recent failures vary across the world. Political instability, conflict and poverty can lead to shortages of vaccines (which must be refrigerated) and clinic closings. When civil war broke out in Côte d’Ivoire in late 2010, for example, the percentage of individuals getting vaccinated against measles plummeted, from an already low 70 percent in 2010 to 49 percent in 2011.
Top 10
Some countries hardest hit by measles in the first three months of 2019 had very few cases the year before, according to provisional WHO data posted May 15, 2019.
Countries with the highest measles counts from January through March 2019
And vaccine hesitancy, cited by the WHO as one of the top 10 threats to global health in 2019, is a factor that needs to be addressed, in both high- and low-income countries, says Siddhartha Datta, vaccine-preventable disease and immunization program manager for the WHO’s European region.
The global rise in measles cases also suggests that health systems around the world are not working well. “Where you have cases, that’s where you have weaknesses of the system,” Lindstrand says. Many countries are facing stressors and challenges to vaccination. Here are snapshots from a few countries that are in the thick of it.
Philippines
A dengue vaccine crisis dealt a blow to measles vaccination in the Philippines. Soon after the government approved a dengue vaccine in 2015, news emerged that it was making children sick. And there were reports that some children were dying from rare but serious reactions. The dengue vaccination program was suspended less than two years later. The episode led to “a huge upsurge in the Philippines of anti-vaxxers,” says Lotta Sylwander, a UNICEF representative who was based in the Philippines until March. Even before the debacle, other challenges to vaccination existed, including corrupt government officials, supply shortages and distributing the vaccine to the country’s thousands of far-flung islands, Sylwander says.
These issues plus growing vaccine hesitancy triggered a severe measles outbreak in late 2017 that still rages today. As of late March, the country had reported 23,000 cases this year and 333 deaths, mainly in young children.
Ukraine
Hit hard by political turmoil and vaccine hesitancy, Ukraine has seen a jump in measles cases in recent months. The first three months of 2019 witnessed more than 34,000 cases in Ukraine. The outbreak is no surprise, Datta says: In 2016, only 42 percent of children who needed the shot had received even a first dose of the vaccine. (A single dose protects about 95 percent of people who get the shot; a second dose ups protection to 99 percent.)
Several factors explain the low vaccination rates, says Sylwander, who is now based in Kiev, Ukraine’s capital. From 2009 to 2016, the country often ran out of vaccines, especially in the country’s conflict-ridden eastern region.
Ukrainians also have a history of vaccine skepticism. During the Soviet era, the government vaccinated everyone. But many children received faulty vaccines that had not been properly refrigerated. “Even though children were vaccinated, they became sick,” Sylwander says. Mistrust of government vaccination programs remains high (the recent U.S. measles outbreak in Washington state was focused in a tight-knit community of Ukrainian and Russian immigrants). Sylwander has even heard stories of medical staff in Ukraine falsely filling out children’s immunization cards to say they had administered a vaccine when they had not.
The country’s outbreak has spurred people to get vaccinated. And government programs over the last few years targeting vulnerable communities appear to be taking hold. The percentage of Ukrainian children who had received the measles vaccine jumped to 86 percent in 2017, according to WHO estimates. The challenge is reaching older children and teens who never got the shot.
Colombia
On March 8, 2018, a 14-month-old Venezuelan boy arrived in Medellin, Colombia, and soon developed spots. Lab testing confirmed he had measles. Colombia hadn’t seen a case of measles since 2015. Public health officials went on high alert.
Amid a political and economic crisis that has thrown Venezuela’s health system into disarray, the country’s vaccination rates fell, Linkins says. With Venezuelans fleeing home by the thousands, Colombian officials knew the disease could cross into their country.
In 2017, the Colombian government began monitoring migrant health. Working closely with the CDC and the WHO, officials sent vaccinators to high-risk municipalities and set up vaccination stations at the Venezuela-Colombia border. From May to July 2018, more than 11,000 Venezuelans were vaccinated as they entered Colombia.
From March 2018 through April 2019, Colombia has reported only 302 cases of measles and no deaths. Colombian officials “were able to recognize people quickly and launch a charge,” Linkins says. “That’s a success story in my mind.”
India
In the last eight years, India has eliminated polio, maternal and neonatal tetanus and yaws, a tropRead More – Source
