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How prepared is Nigeria as measles returns with vengeance?

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A Child with measles. Photo: Pixabay

Nigeria has every reason to be concerned as measles return with vengeance in northern Nigeria and other parts of the world especially in Europe.

The World Health Organization (WHO), penultimate week, reported cases of the highly contagious and potentially deadly virus almost quadrupled in Europe in 2017 (21,000 cases) compared to the year before (5,273 cases), with the highest rates in Italy, Romania and Ukraine.

In Nigeria, though there has been a substantial decline in global measles death, the country still tops the chart of far too many children who are still missing their first vaccine dose.

A report published last year by the WHO indicated that 20.8 million children worldwide are still missing their first measles vaccine dose and more than half of these unvaccinated children live in six countries.

Nigeria tops the list of countries with unvaccinated children from measles with 3.3 million children, followed by India – 2.9 million, Pakistan – 2.0 million, Indonesia – 1.2 million, Ethiopia – 0.9 million and Democratic Republic of Congo, DRC, with 0.7 million.

Executive Director, National Primary Health Care Development Agency (NPHCDA), Dr. Faisal Shuaib, told journalists that a surveillance data shows that measles incidence among children under five years increased in the northern part of Nigeria from 190 million in 2014 to 527 million in 2016.

Before the introduction of measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately every two–three years and measles caused an estimated 2.6 million deaths each year.

According to the WHO, the disease remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. Approximately 89 780 people died from measles in 2016 – mostly children under the age of five years.

A virus in the paramyxovirus family causes measles and it is normally passed through direct contact and through the air. The virus infects the respiratory tract, and then spreads throughout the body. Measles is a human disease and is not known to occur in animals.

According to the WHO, large outbreaks continue to occur in these countries including Nigeria resulting in some deaths. The overwhelming majority (more than 95 per cent) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.

The WHO said measles outbreaks could be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection.

Indeed, measles outbreaks in the affected countries and other countries in Europe and North America put children at risk of severe health complications such as pneumonia, diarrhoea, encephalitis, blindness and death.

According to the WHO, since 2000, an estimate of 5.5 billion doses of measles containing vaccines have been provided for children through routine immunisation services and mass vaccination campaigns, saving an estimated 20.4 million lives.

Figures from the WHO and United Nations Children Fund (UNICEF) indicate that there was a decline in global death from the disease in 2016 as an estimated 90,000 people died from measles. This is 84 per cent drop from more than 550,000 deaths in 2000.

However, the recent upsurge in Europe and Northern Nigeria has raised fresh concerns.

Unlike in Nigeria where the major reason for having high numbers of unvaccinated children is due to poor logistics and funding, in Europe, the reason parents may not be vaccinating their children could be due to a widely discredited research paper that was published 20 years ago last week.

In 1998, the journal Lancet published former British doctor Andrew Wakefield’s article, which linked the measles, mumps and rubella vaccine to autism. In his study, Wakefield said 12 children showed that the three vaccines taken together could alter immune systems causing brain damage.

The publication of the study led to a widespread increase in the number of parents choosing not to vaccinate their children for fear of its link to autism.

The WHO says there have been declines in overall routine immunisation coverage, as well as consistently low coverage among some marginalised groups and interruptions in vaccine supply or underperforming disease surveillance systems.

Meanwhile, recent estimates by the Nigeria Centre for Disease Control (NCDC) showed, so far, 1,943 suspected measles cases and 20 deaths with Case Fatality Ratio (CFR) of 1.03 per cent were reported from 36 States and Federal Capital Territory (FCT) compared with 2,548 suspected cases with 35 laboratory confirmed and 22 deaths with CFR of 0.86 per cent from 36 States during the same period in 2017.

To curtail the spread of the disease and prevent death of children under five, the federal government had last year released N3.5 billion for vaccination programme and a nationwide measles campaign.

The 2017/2018 measles immunisation campaign was kick started in Kaduna, November last year, by the Federal Ministry of Health (FMoH), NPHCDA and other partners.

The ceremony, which took place at Miyetti-Allah Primary Healthcare Centre in Rigasa ward of Igabi Local Government area of Kaduna State, was a clear demonstration of the level of ownership and involvement of government and partners to ensure all eligible children aged nine months to 59 months are vaccinated with measles vaccine in the country.

Measles mass campaigns were conducted in seven North West and North East States from November 9–14, 2017 and November 30 –December 5, 2017 respectively.

Measles mass campaigns for North Central States were conducted from February 8 – 20, 2018 while proposed Measles mass campaign for southern states is scheduled for March 8 – 20, 2018.

Response measures include immunization for all vaccine-preventable diseases in some selected/affected wards/Local Government Areas (LGAs) during Supplementary Immunisation Activities (SIAs), as well as case management

Shuaib, told journalists: “Measles is one of the leading causes of death among young children especially those under five years of age. Despite the availability of safe and effective vaccines, Nigeria accounts for the highest burden of measles globally and Nigeria accounts for the highest burden of measles globally with 3.3 million unimmunized children.”

He further stated: “Due to persistently low routine immunization coverage, supplemental immunization campaigns are conducted to provide a second opportunity to reach unimmunized children.”

Team Leader of the Expanded Programme on Immunization (EPI) of the WHO Dr. Fiona Braka gave assurance that WHO and partners are in full support of the government efforts to achieve measles elimination in Nigeria. Braka underscored the combined effort required to achieve 95 per cent coverage at sub national level during the campaign and through routine immunization to build up population immunity sustainably.

In Anambra, for a successful Measles vaccination this period, the Governor Willie Obiano led administration and the UNICEF have set aside the total sum of about N94.4 million to run the March 2018 Measles vaccination campaign.

In addition, no fewer than 1,169,800 children are to be vaccinated under the measles vaccination campaign, covering children between the ages of nine months to 59 months.

Addressing newsmen during a media chat on measles vaccination campaign sensitization in Awka, the state capital, the Head of department (HOD), immunization and disease control, Anambra State Primary Health care development agency (ASPHCDA), Dr. Nnamdi Uliagbafusi disclosed that the state government has approved and released the sum of N27.4millon as its counterparts funding for the exercise.

Declaring the vaccines safe and free, Uliagbafusi stated that the exercise which would commence in the three senatorial districts as follows: March 8 to 20, Anambra Central and South senatorial zones while March 15 to 20, would be the turn for the North senatorial zones

He said, “The exercise will be carried out in fixed posts in Public health facilities, mission and some private health facilities, temporary fixed post like schools, churches, markets and mosques” adding that it was earlier scheduled to start from the March 1, but has been shifted to give room for proper planning, public sensitization and implementation.

The HOD, ASPHCDA urged parents and guardians as well as caregivers to make their children and wards available even if they have been vaccinated before.

In his speech at the event, the UNICEF Measles consultant in Anambra state, Peter Onyekachi, disclosed that the Agency had invested about N67 million for the programme, which he said covers logistics, transport, training of ad hoc staff, social activities, fuel and so on hoping that it would encourage a successful campaign in Anambra.

Also speaking, the state coordinator, World Health Organization (WHO) office, Dr. Willy Onuorah, explained that the interest of the organization was to ensure that no child was omitted in the exercise, saying it is working in teams comprising of seven health officers, just as he informed that health personnel were at alert to handle emergencies like adverse reactions from the vaccine on any child.

“We are working in synergy with tertiary hospitals: our medical teams are placed at alert, they are capable to manage any child reaction from the vaccination.

“The vaccination is the most effective way to tackling the disease among children, vaccine is 99 per cent safe, and have no side effects. Remove vaccination, over 25 per cent children would be prone to measles,” Onuora said.

To combat measles disease across the nooks and crannies of Ondo State, the state government is set to vaccinate 700,000 children between the ages of nine months to five years to fight the virulent disease.

The State Commissioner of Health, Alhaji Wahab Adegbenro, who briefed journalists during a media sensitisation meeting on measles vaccination last week said that the campaign shall take place in all the 203 wards across the 18 local government area in the state.

“About N30 million had been earmarked by the state government for the exercise,” he disclosed. “This is to ensure all the children between the ages of nine months and five years are vaccinated.”

According to the him, the exercise would commence between 8 and 20, March 2018, while he said the vaccination would be administered on the children free of charge.

He said the first phase of the exercise which will kick off in Idanre, would take place in ten local government area of the state between March 8 to 13 while the second phase would take place in other eight LGAs between March 15 to 20, 2018.


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