Nigeria, DR Congo Among Top 10 Countries With ‘Zero-dose’ Children

From Nigeria to Europe, the United Kingdom and the U.S., measles is on the rise across the globe. Experts blame the situation on lack of vaccination and warn that if a case is not properly managed, it could lead to blindness, seizures, ‘deadly’ complications and lasting scars. They, however, call for more vaccination to avoid imminent nationwide outbreak since Nigeria is among the top 10 countries with unvaccinated or “zero-dose” children.

Travelling during the holidays comes with many risks such as overbooked flights, delays, bad weather and exposure to COVID-19. Now, people can add exposure to measles to the list. Measles is a viral disease that causes a characteristic rash.

Measles is endemic to Nigeria and outbreaks peak during the dry, hot season, between November and March. The situation is worsened by vaccine hesitancy and rejection. Till now, some parents reject the Measles Mumps Rubella (MMR) vaccine because of its association with developmental problems in Nigeria. The vaccine is also costly and is not always available for free on the routine immunisation programme.

However, the MMR vaccine is no stranger to controversy. In 1998, a study published in The Lancet linked the vaccine to serious health risks in children, including autism and inflammatory bowel disease. But in 2010, the journal debunked that study, citing unethical practices and incorrect information. Since then, many research studies have looked for a connection between the MMR vaccine and these conditions. No connection has been found.

With an “alarming” nearly 45-fold increase in measles cases in Europe last year, the World Health Organisation (WHO) has warned that Nigeria and other countries with near zero immunisation rate are at risk. Health chiefs are warning that cases are still rising and “urgent measures” are needed to prevent further spread. Some 42,200 people were infected in 2023, compared to 941 during the whole of 2022.

Despite reports of outbreaks in Abia and Sokoto states, experts believe that measles cases and fatalities have been under-reported in Nigeria and pose risk for disease management.
The WHO believes this is a result of fewer children being vaccinated against the disease during the COVID-19 pandemic.

In the UK, health officials said last week that an outbreak of highly contagious measles in the West Midlands could spread rapidly to other towns and cities with low vaccination rates.

Millions of parents and caregivers are being contacted and urged to make an appointment to ensure their children are fully vaccinated against measles. The MMR vaccine is given in two doses – the first around the age of one and the second when a child is about three years and four months old.

Speaking about the situation in Europe, Dr. Hans Kluge, Regional Director at the WHO, said: “We have seen, in the region, not only a 30-fold increase in measles cases, but also nearly 21,000 hospitalisations and five measles-related deaths. This is concerning. Vaccination is the only way to protect children from this potentially dangerous disease.”

According to the WHO Fact Sheet on Measles, symptoms of measles usually begin 10 to14 days after exposure to the virus. A prominent rash is the most visible symptom. Early symptoms usually last for four to seven days. They include running nose, cough, red and watery eyes and small white spots inside the cheeks.

The rash begins about seven to18 days after exposure, usually on the face and upper neck. It spreads over within three days, eventually to the hands and feet. It usually lasts five to six days before fading.

Most deaths from measles are from complications related to the disease. Complications can include blindness, encephalitis (an infection causing brain swelling and potentially brain damage), severe diarrhoea and related dehydration, ear infections and severe breathing problems including pneumonia.

If a woman catches measles during pregnancy, this can be dangerous for the mother and can result in her baby being born prematurely with a low birth weight.

Complications are most common in children under five years and adults over 30 years. They are more likely in children who are malnourished, especially those without enough Vitamin A or with a weak immune system from Human Immuno-deficiency Virus (HIV) or other diseases. Measles itself also weakens the immune system and can make the body “forget” how to protect itself against infections, leaving children extremely vulnerable.

Who is at risk? Any non-immune person (not vaccinated or vaccinated but did not develop immunity) can become infected. Unvaccinated young children and pregnant persons are at highest risk of severe measles complications.

According to a new report released by WHO and the U.S. Centre for Disease Control and Prevention (CDC), more children died from measles in 2022 than 2021. The data serves as an urgent call to action – placing renewed attention on the importance of life-saving vaccines.

Last year, 136,200 people, most of them children, died from measles. That is why it’s imperative that children everywhere get the necessary two doses of the measles vaccines, which are 97 per cent effective at preventing measles infections for life.

Measles cases are also on the rise; the data show a jump in the number of people with measles, surging from seven million in 2021 to nine million in 2022. The increases in both number of deaths and cases reflect the severity of the disruption of routine health services caused by the COVID-19 pandemic.

“Measles cases anywhere in the world pose a risk to all countries and communities where immunisation coverage is below 95 per cent. In 2022, 37 countries were affected by large or disruptive measles outbreaks, nearly double the number of countries in 2021. Because measles outbreaks most often occur in un- or under-vaccinated communities, outbreaks point to weaknesses and inequities in immunisation programmes and other essential health services. Understanding where and why outbreaks happen can help public health officials deliver tailored solutions to ensure measles and other vaccinations are available to and accessed by all,” the WHO said.

So far, nine lower-income countries have planned and rolled out follow-up vaccination campaigns in an accelerated effort with Gavi support: Democratic Republic of the Congo (DRC), South Sudan, Cameroon, Malawi, Mozambique, Papua New Guinea, Yemen, Syria and Nigeria. Two of these countries (DRC and Nigeria) are among the top 10 countries with unvaccinated or “zero-dose” children. An additional three countries are scheduled to roll out campaigns: Chad, Central African Republic and Sudan.

Meanwhile, the Abia State government last week raised awareness over the suspected outbreak of measles in Arochukwu and Umunneochi local councils of the state.

The Commissioner for Information and Culture, Okey Kanu, who briefed journalists after the Executive Council meeting last week, said the Commissioner for Health, Dr. Ngozi Okoronkwo, and her team, were actively working to contain the disease from spreading.

Explaining the situation, the health commissioner, Okoronkwo, said the state government was in control of the reported outbreak involving three persons in the two local councils. She pointed out that her ministry was at a mop up stage to ensure that the disease does not spread to other parts of the state, adding that the outbreak may be connected with the dry season.

The Director-General, Nigeria Centre for Disease Control (NCDC), Dr. Ifedayo Adetifa, has also harped on the importance of understanding the dynamics of diseases historically associated with outbreaks during the dry season like Lassa fever, meningitis and measles. He noted that heightened community awareness and environmental challenges from climate change and human activities contribute to the increased reported cases during this period.

As the nation continues to recover from the effects of the COVID-19 pandemic, the NCDC has launched a comprehensive five-year strategic plan to strengthen its capacity and optimise engagement with stakeholders. The plan serves as a roadmap to protect the health of Nigerians, building on lessons and infrastructural gains acquired during the pandemic.

Adetifa underscored the agency’s commitment to being strategic and ambitious, emphasising the need to scale with speed. He also highlighted the importance of strengthening collaborations with sub-national stakeholders, including the National Primary Health Care Development Agency (NPHCDA) recognising the vital role of states and local councils in ensuring health security.

According to the WHO, there is no specific treatment for measles. Caregiving should focus on relieving symptoms, making the person comfortable and preventing complications. Drinking enough water and treatments for dehydration can replace fluids lost to diarrhoea or vomiting. Eating a healthy diet is also important.

Doctors may use antibiotics to treat pneumonia and ear and eye infections. All children or adults with measles should receive two doses of vitamin A supplements, given 24 hours apart. This restores low vitamin A levels that occur even in well-nourished children. It can help prevent eye damage and blindness. Vitamin A supplements may also reduce the number of measles deaths.

Community-wide vaccination is the most effective way to prevent measles. All children should be vaccinated against measles. The vaccine is safe, effective and inexpensive.

Routine measles vaccination combined with mass immunisation campaigns in countries with high case rates are crucial for reducing global measles deaths. The measles vaccine has been in use for about 60 years and costs less than $1 per child. The measles vaccine is also used in emergencies to stop outbreaks from spreading. The risk of measles outbreaks is particularly high amongst refugees and Internally Displaced Persons, who should be vaccinated as soon as possible.