Measles outbreak in Malawi
The BBC is running a story on the outbreak of measles in Malawi right now, more than 9,000 reported cases, which is being responded to by MSF (“doctors without borders”). MSF plans to vaccinate 2.5 million Malawi children in response to this crisis, with 1.3 million having already been vaccinated since May.
Much of the continent of Africa is currently experiencing outbreaks as funding dwindles. MSF says that,
[a]ccording to the World Health Organization, the deaths of 12.7 million people, mostly children, have been avoided between 2000 and 2008 thanks to prevention campaigns around the world. There is no dispute over this achievement.
We are probably paying for this success now. Since measles is no longer a massive cause of death, this disease is no longer a political priority. Not in the Ministries of Health who have to make priorities and not for the donors who are now reducing their contributions.
There has also been a decrease in vigilance among health actors. More and more often, practitioners have never seen a case of measles! However, with this disease (as with others), a constant effort must be maintained. If not, all the gains made can quickly disappear.
This success, real but fragile, might be strengthened and sustained, but only if adequate support and commitment are provided continuously at every level. In order to strengthen and maintain immunization coverage and improve case management and epidemic response, measles must be re-cast as a major health challenge at every level of the national health system and the competent institutions (WHO and UNICEF), as well as in the eyes of the donors.
The WHO just released some south and eastern Africa numbers for measles this year. Measles data are difficult to parse as well, since many cases go unreported (once you contract measles there is no active treatment, although complications can still be treated). The raw numbers as of June 15, 2010: Zimbabwe (8,173 cases, 517 deaths), Zambia (817 cases, 33 deaths), Tanzania (20 cases, 1 death) , Swaziland ( 529 cases, 0 death), South Africa (15,520 cases, 18 deaths), Namibia (3,722 cases, 58 deaths), Mozambique (434 cases, 0 death), Malawi (11,461 cases, 68 deaths), Lesotho (2,406 cases, 28 deaths), Kenya (295 cases, 0 death) Ethiopia (2,108 cases, 8 deaths), Botswana (1,048 cases, 0 death).
Mortality in developed countries is generally accepted to be around 1 in 1000 (.1% mortality). Looking at some of the numbers above, the mortality rate in developing nations appears as low as .5%[1] and as high as 6.6% — obviously there are a lot of factors that affect the prevalence of measles deaths, accurate reporting being only one of them. A much more narrow study[1] of three Gambian villages, published in The Lancet found, “5% of measles cases died before the initial investigation of the outbreaks and a further 10% of cases died during the ensuing 9 months. Only 1% of children who did not contract measles died in the 9 months after the outbreaks. Case-fatality rates were highest for measles patients less than 1 year old (64%) and fell with age. Measles remains a significant source of acute and delayed mortality in unvaccinated African populations.” I should caution that this study is from 1983, however, and thus may have only limited applicability.
Also comes the news that Zimbabwe has just launched a campaign to inoculate 5 million kids (funding made possible by UN CERF).
[1]MEASLES MORTALITY AND VACCINE EFFICACY IN RURAL WEST AFRICA, The Lancet, Volume 321, Issue 8331, Pages 972 – 975, 30 April 1983
[…] in Dowa, Malawi after church leaders prevented the children from receiving vaccinations. As we previously reported, Doctors Without Borders is in the process of vaccinating nearly three million children in an […]