Global & Disaster Medicine

Archive for the ‘Measles’ Category

Bangladesh steps up vaccination for new Rohingya arrivals as measles cases rise

WHO

Press release 1671

 

Bangladesh steps up vaccination for new Rohingya arrivals as measles cases rise

Cox’s Bazar, Bangladesh, 10 November 2017 – An increase in the number of suspected measles cases among the newly arrived Rohingya and their host communities in southern Bangladesh has prompted the Government and UN partners to step up immunization efforts in overcrowded camps and makeshift shelters close to the border with Myanmar.
Nearly 360 000 people in the age group of six months to 15 years among the new Rohingya arrivals in Cox’s Bazar and their host communities, irrespective of their immunization status, would be administered measles and rubella  vaccine through fixed health facilities, outreach vaccination teams, and at entry points into Bangladesh.
Measles, a childhood killer disease which can be particularly dangerous among unimmunized and malnourished children,  is one of the major health risks among the over  611 000 people who have crossed over to Bangladesh from Myanmar since late August and are now living in cramped and insanitary conditions  in Cox’s Bazar district.

As of 4 November, one death and 412 suspected cases of measles have been reported among the vulnerable populations living in camps, settlements, and among the host communities in Cox’s Bazar. Of them, 352 cases are from Ukhia and 46 from Teknaf sub-districts, and 11 have been reported from the district hospital. Majority of cases – 398 – are among the new arrivals and 14 among the host communities. As many as 82% cases are among children under five years of age.
“Children are especially at risk from outbreaks of measles and other communicable diseases that result from the crowded living conditions, malnutrition and severe lack of water and sanitation in the camps and other sites,” said Edouard Beigbeder, UNICEF Bangladesh Representative. “To halt any wider outbreak, it’s essential that coordinated efforts begin immediately to protect as many children as possible.”
With the risk of measles being high during such health emergencies, Ministry of Health and Family Welfare (MoHFW), with support of WHO, UNICEF and other local partners, was quick to roll out a measles and rubella (MR) vaccination campaign, between 16 September and 4 October, within weeks of the start of the recent influx of Rohingyas from Myanmar. Nearly 136 000 children between six months and 15 years were administered MR vaccine. Additionally, around 72 000 children up to five years of age were given bivalent oral polio vaccine (bOPV) and a dose of Vitamin A to help prevent measles related complication. The number of new arrivals has increased since the MR campaign, which also had challenges reaching out to all children in view of movement of people within the camps and settlements.
“As part of stepped up vaccination efforts, 43 fixed health facility sites, 56 outreach vaccination teams and  vaccination teams at main border entry points will administer MR vaccine to population aged six months to 15 years, along with oral polio vaccine to children under five years and TT vaccine to pregnant women. These efforts are aimed at protecting and preventing the spread of measles among the vulnerable population,” WHO Representative to Bangladesh, Dr N Paranietharan, said.
More than 70 vaccinators from government and partners have been trained to deliver routine vaccination though fixed sites and outreach teams beginning tomorrow, while vaccination at entry points at Subrang, Teknaf, is ongoing since 1 November.
The fixed sites and outreach teams will also cover under two year olds with vaccines available in Bangladesh  EPI schedule, such as BCG, pentavalent vaccine, oral polio vaccine, pneumococcal vaccine and two doses of MR vaccine.
As an additional measure, resources to treat measles cases are being reinforced with the distribution of vitamin A supplements, antibiotics for pneumonia and Oral Rehydration Salt (ORS) for diarrhoea related to measles. To improve hygiene conditions among the refugee population, 3.2 million water purification tablets and a total of 18,418 hygiene kits have been distributed benefitting 92,090 people.
The current initiative is yet another massive vaccination drive being rolled out for the new arrivals from Myanmar and their host communities in Cox’s Bazar since 25 August this year.  After covering 136 000 people in the September- October MR campaign, MoHFW and partners administered 900 000 doses of oral cholera vaccine to these vulnerable populations in two phases. The first phase that started 10 October covered over 700 000 people aged one year and above  – both the new arrivals and their host communities, while the second phase from 4 – 9 November provided an additional dose of OCV to 199,472 children between one and five years, for added protection  and bOPV to 236,696 children under 5 years of age.

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For further information please contact:

  • Catalin-Constantin Bercaru, WHO Bangladesh, bercaruc@who.int  +88 01787693318
  • Shamila Sharma, WHO South-East Asia Regional Office, sharmasha@who.int +91 9818287256
  • Jean Jacques Simon, UNICEF Bangladesh, jsimon@unicef.org, +880 01713043478
  • AM Sakil Faizullah, UNICEF Bangladesh, asfaizullah@unicef.org +880 1713 049900
  • Faria Selim, UNICEF Bangladesh, fselim@unicef.org +880 1817 586 096

Global Measles: For the first time, annual estimated measles deaths were fewer than 100,000, in 2016.

CDC

Progress Toward Regional Measles Elimination — Worldwide, 2000–2016

 Measles image

Alya Dabbagh, PhD1; Minal K. Patel, MD1; Laure Dumolard, PhD1; Marta Gacic-Dobo, MSc1; Mick N. Mulders, PhD1; Jean-Marie Okwo-Bele, MD1; Katrina Kretsinger, MD1; Mark J. Papania, MD2; Paul A. Rota, PhD3; James L. Goodson, MPH2

 

Summary

What is already known about this topic?

The fourth United Nations Millennium Development Goal, adopted in 2000, set a target to reduce child mortality by two thirds by 2015. One indicator of progress toward this target was measles vaccination coverage.

What is added by this report?

For the first time, annual estimated measles deaths were fewer than 100,000, in 2016. This achievement follows an increase in the number of countries providing the second dose of measles-containing vaccine (MCV2) nationally through routine immunization services to 164 (85%) of 194 countries, and the vaccination of approximately 119 million persons against measles during supplementary immunization activities in 2016. During 2000–2016, annual reported measles incidence decreased 87%, from 145 to 19 cases per million persons, annual estimated measles deaths decreased 84%, from 550,100 to 89,780, and an estimated 20.4 million deaths were prevented. However, the 2015 measles elimination milestones have not yet been met, and only one World Health Organization region has been verified as having eliminated measles.

What are the implications for public health practice?

To achieve measles elimination goals, countries and their partners need to act urgently to secure political commitment, raise the visibility of measles elimination, increase vaccination coverage, strengthen surveillance, and mitigate the threat of decreasing resources once polio eradication is achieved. Polio eradication resources have supported routine immunization services and surveillance activities.

The fourth United Nations Millennium Development Goal, adopted in 2000, set a target to reduce child mortality by two thirds by 2015. One indicator of progress toward this target was measles vaccination coverage (1). In 2010, the World Health Assembly (WHA) set three milestones for measles control by 2015: 1) increase routine coverage with the first dose of a measles-containing vaccine (MCV1) among children aged 1 year to ≥90% at the national level and to ≥80% in every district; 2) reduce global annual measles incidence to <5 cases per million population; and 3) reduce global measles mortality by 95% from the 2000 estimate (2).* In 2012, WHA endorsed the Global Vaccine Action Plan, with the objective of eliminating measles in four World Health Organization (WHO) regions by 2015 and in five regions by 2020. Countries in all six WHO regions have adopted goals for measles elimination by or before 2020. Measles elimination is defined as the absence of endemic measles virus transmission in a region or other defined geographic area for ≥12 months, in the presence of a high quality surveillance system that meets targets of key performance indicators. This report updates a previous report (3) and describes progress toward global measles control milestones and regional measles elimination goals during 2000–2016. During this period, annual reported measles incidence decreased 87%, from 145 to 19 cases per million persons, and annual estimated measles deaths decreased 84%, from 550,100 to 89,780; measles vaccination prevented an estimated 20.4 million deaths. However, the 2015 milestones have not yet been met; only one WHO region has been verified as having eliminated measles. Improved implementation of elimination strategies by countries and their partners is needed, with focus on increasing vaccination coverage through substantial and sustained additional investments in health systems, strengthening surveillance systems, using surveillance data to drive programmatic actions, securing political commitment, and raising the visibility of measles elimination goals.

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Immunization Activities

To estimate coverage with MCV1 and the second dose of measles-containing vaccine (MCV2) through routine immunization services,§ WHO and the United Nations Children’s Fund (UNICEF) use data from administrative records (administrative coverage is calculated by dividing the vaccine doses administered by the estimated target population) and immunization coverage surveys reported annually by 194 countries. During 2000–2016, estimated MCV1 coverage increased globally from 72% to 85% (Table 1), although coverage has not increased since 2009. Considerable variability in regional coverage exists. Since 2012, MCV1 coverage has remained essentially unchanged in the African Region (AFR) (72%), the Region of the Americas (AMR) (92%), and the Eastern Mediterranean Region (EMR) (77%). In the European Region (EUR), MCV1 coverage has declined from 95% to 93% since 2012, with 51% of EUR member states reporting lower coverage since 2013. In the South-East Asia Region (SEAR), MCV1 coverage increased slightly since 2012, from 84% to 87%. The Western Pacific Region (WPR) is the only region that has achieved and sustained MCV1 coverage >95% (since 2008). Since 2000, the number of countries with MCV1 coverage of ≥90% increased globally from 85 (44%) in 2000 to 119 (61%) in 2015, and to 123 (63%) in 2016. However, among countries with ≥90% MCV1 coverage nationally, the percentage with ≥80% MCV1 coverage in all districts declined from 46% (52 of 112) in 2010 to 45% (49 of 110) in 2015 and 36% (44 of 123) in 2016. Among the estimated 20.8 million infants who did not receive MCV1 through routine immunization services in 2016, approximately 11 million (53%) were in six countries with large birth cohorts and suboptimal coverage: Nigeria (3.3 million), India (2.9 million), Pakistan (2.0 million), Indonesia (1.2 million), Ethiopia (0.9 million), and the Democratic Republic of the Congo (0.7 million).

During 2000–2016, the number of countries providing MCV2 nationally through routine services increased from 98 (51%) to 164 (85%), with four countries (Guatemala, Haiti, Papua New Guinea, and Timor-Leste) introducing MCV2 in 2016. Estimated global MCV2 coverage steadily increased from 15% in 2000 to 60% in 2015 and 64% in 2016 (Table 1). During 2016, approximately 119 million persons received supplementary doses of measles-containing vaccine (MCV) during 33 mass immunization campaigns, known as supplementary immunization activities (SIAs), implemented in 31 countries (Table 2). Based on doses administered, SIA coverage was ≥95% in 20 (61%) SIAs. Among the six countries that conducted post-SIA coverage surveys, estimated coverage was ≥95% in three, 90%–94% in two, and 84% in one.

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Disease Incidence

Countries report the aggregate number of incident measles cases**,†† to WHO and UNICEF annually through the Joint Reporting Form. In 2016, 189 (97%) countries conducted case-based surveillance in at least part of the country, and 191 (98%) had access to standardized quality-controlled testing through the WHO Global Measles and Rubella Laboratory Network. Nonetheless, surveillance was weak in many countries; fewer than half of countries (64 of 134; 48%) achieved the sensitivity indicator target of two or more discarded measles and rubella§§ cases per 100,000 population in 2016 compared with 2015 (80 of 135; 59%).

During 2000–2016, the number of measles cases reported annually worldwide decreased 85%, from 853,479 in 2000 to 214,812 in 2015 and then to 132,137 in 2016; measles incidence decreased 87%, from 145 to 19 cases per 1 million population (Table 1). Compared with 2015, 2016 incidence decreased from 29 to 19 cases per million, although three fewer countries (173 of 194; 89%) reported case data in 2016 than did in 2015 (176 of 194; 92%).¶¶ The percentage of reporting countries with fewer than five measles cases per million population increased from 38% (64/169) in 2000 to 69% (119/173) in 2016. During 2000–2016, measles incidence of fewer than five cases per million was sustained in AMR (Table 1).

During 2015–2016, the number of reported measles cases declined globally and in all regions (AFR, 31%; AMR, 98%; EMR, 71%; EUR, 84%; SEAR, 44%, and WPR, 11%). In addition to aggregate reporting, countries report measles case-based data to WHO monthly. In some countries large discrepancies exist between the two reporting systems. During 2016, some countries either did not report or reported only a fraction of monthly reported measles cases through the Joint Reporting Form (e.g., India reported 70,798 measles cases through monthly reporting, but only 17,250 through the Joint Reporting Form).

Genotypes of viruses isolated from measles cases were reported by 60 (55%) of the 110 countries that reported at least one measles case in 2016. Among the 24 recognized measles virus genotypes, 11 were detected during 2005–2008, eight during 2009–2014, six in 2015, and five in 2016, excluding those from vaccine reactions and cases of subacute sclerosing panencephalitis, a fatal progressive neurologic disorder caused by persistent measles infection (4).*** In 2016, among 4,796 reported measles virus sequences,††† 666 were genotype B3 (36 countries); 44 were D4 (four); 1,407 were D8 (43); 87 were D9 (four); and 2,592 were H1 (13).

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Disease and Mortality Estimates

A previously described model for estimating measles disease and mortality was updated with new measles vaccination coverage data, case data, and United Nations population estimates for all countries during 2000–2016, enabling derivation of a new series of disease and mortality estimates (5). Based on the updated data, the estimated number of measles cases declined from 29,068,400 (95% confidence interval [CI] = 20,606,800–55,859,000) in 2000 to 6,976,800 (95% CI = 4,190,500–28,657,300) in 2016. During this period, the number of estimated measles deaths declined 84%, from 550,100 (95% CI = 374,000–896,500) in 2000 to 89,780 (95% CI = 45,700–269,600) in 2016 (Table 1). Compared with no measles vaccination, measles vaccination prevented an estimated 20.4 million deaths during 2000–2016 (Figure).

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Regional Verification of Measles Elimination

In 2016, four WHO regions had functioning regional verification commissions. In September 2016, the AMR regional verification commission declared the region free of endemic measles (6). In 2016, the EUR commission verified measles elimination in 24 countries (7). Two SEAR countries (Bhutan and Maldives) were verified as having eliminated measles in 2017 (8). The WPR commission reclassified Mongolia as having reestablished endemic measles virus transmission because of an outbreak that lasted >12 months; thus, five WPR countries (Australia, Brunei, Cambodia, Japan, and South Korea) and two areas (Macao Special Autonomous Region [SAR] [China] and Hong Kong SAR [China]) had verified measles elimination status in 2016 (9).

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Discussion

During 2000–2016, increased coverage with MCV administered through routine immunization programs worldwide, combined with SIAs, contributed to an 87% decrease in reported measles incidence and an 84% reduction in estimated measles mortality. Measles vaccination prevented an estimated 20.4 million deaths during this period, and during 2016, for the first time ever, estimated measles deaths declined to fewer than 100,000. Furthermore, the number of countries with measles incidence of fewer than five per million population has increased, although considerable underreporting occurred, and AMR has maintained an incidence of fewer than five cases per million population during 2000–2016. The decreasing number of circulating measles virus genotypes suggests interruption of some chains of transmission. However, the 2015 global control milestones were not met, global MCV1 coverage has stagnated, global MCV2 coverage has reached only 64%, and SIA quality was inadequate to achieve ≥95% coverage in several countries. With suboptimal MCV coverage, outbreaks continued to occur among unvaccinated persons, including school-aged children and young adults.

The 2016 Mid-term Review of the Global Measles and Rubella Strategic Plan 2012–2020 concluded that measles elimination strategies were sound, and the WHO Strategic Advisory Group of Experts on Immunization endorsed its findings. The review noted, however, that implementation of the strategies needs improvement. Measures should focus on strengthening immunization and surveillance systems. The Measles and Rubella Initiative should increase its emphasis on using surveillance data to drive programmatic actions.

The findings in this report are subject to at least three limitations. First, SIA coverage data might be biased by inaccurate reports of the number of doses delivered, doses administered to children outside the target age group, and inaccurate estimates of the target population size. Second, large differences between the estimated and reported incidence indicate variable surveillance sensitivity, making comparisons between countries and regions difficult to interpret. Finally, the accuracy of the results from the measles mortality model is affected by biases in all model inputs, including country-specific measles vaccination coverage and measles case-based surveillance data.

The decrease in measles mortality to fewer than 100,000 deaths in 2016 is one of five main contributors (along with decreases in mortality from diarrhea, malaria, pneumonia, and neonatal intrapartum deaths) to the decline in overall child mortality worldwide and progress toward the fourth United Nations Millennium Development Goal, but continued work is needed to help achieve measles elimination goals (10). Of concern is the possibility that the gains made and future progress in measles elimination could be reversed when polio-funded resources supporting routine immunization services, measles SIAs, and measles surveillance diminish and disappear after polio eradication. Countries with the highest measles mortality rely most heavily on polio-funded resources and are at highest risk for reversal of progress after polio eradication is achieved. Improved implementation of elimination strategies by countries and their partners is needed, with focus on increasing vaccination coverage with substantial and sustained additional investments in health systems, strengthening surveillance systems, using surveillance data to drive programmatic actions, securing political commitment, and raising the visibility of measles elimination goals.


WHO & Somalia working together to curb measles epidemic (almost 19 000 suspected cases reported in 2017)

WHO

WHO enhances surveillance capacity in Somalia ahead of nationwide measles campaign

25 October 2017, Puntland, Somalia—The World Health Organization (WHO) and Somali Federal Ministry of Health have conducted a series of trainings to enhance national capacity in early outbreak detection and response for measles ahead of a nationwide measles vaccination campaign in November.

The trainings aim to enhance measles case-based surveillance and laboratory confirmation, improve measles case management during seasonal outbreaks, and achieve the minimum routine measles vaccination coverage of 95%.

Somalia is currently facing its worst measles outbreak in 4 years, with almost 19 000 suspected cases reported in 2017 (as of 24 October). More than 80% of those affected by the current outbreak are children under 10 years of age. Minimum routine measles vaccination coverage is only 60%.

In early 2017, WHO and partners, in collaboration with national health authorities, vaccinated almost 600 000 children aged 6 months to 5 years for measles in hard-to-reach and hotspot areas across the country. Despite these efforts, the transmission of measles continues, compounded by the ongoing pre-famine situation, continued mass displacement, and undernourished children living in unhygienic conditions.

In order to contain the outbreak, a nationwide campaign is planned for November 2017 to stop transmission of the disease, targeting 4.2 million children. The campaign will also intensify efforts to strengthen routine immunization and reach unvaccinated children to boost their immunity.

“The Federal Ministry of Health (FMOH) has repeatedly highlighted the importance of surveillance in public health. Based on this national vision, public health professionals in Somalia are being updated on the measles case-based surveillance process,” said Dr Ghulam Popal, WHO Representative in Somalia. “FMOH and WHO are actively scaling up efforts to improve measles case management during outbreaks in general and ensure the proper implementation and high coverage of the upcoming measles campaign in particular,” he added.

On 24 October, WHO and FMOH concluded a 3-day training course on case-based surveillance for 35 health workers in Puntland. A training of trainers on measles campaign preparation and implementation was conducted in Mogadishu for 18 participants from the Ministry of Health, EPI Directorate, and other health partners on 16 October. At the regional level, a 2-day training course on measles epidemiology and outbreak response took place on 17–18 October for 68 participants from the South Central zones and the two States of Hiran Shabelle and Southwest.

WHO’s response to disease outbreaks, drought, and nutrition needs in Somalia has been made possible through the generous support of Japan, Germany, the Vaccine Alliance (GAVI), the Polio Global Eradication Initiative, the UN Central Emergency Relief Fund (CERF), and the UK Department for International Development (DFID).

Related links

WHO and Federal Ministry of Health of Somalia call for urgent support to address measles outbreak in Somalia
16 August 2017

WHO and partners scale up response in Somalia to protect children from deadly measles outbreak 
25 July 2017

WHO conducts measles surveillance workshop in Hargeisa
13 June 2017

Measles vaccination campaign launched in Mogadishu
21 May 2017

For more information, contact:

Ajyal Sultany, Communications Officer, sultanya@who.int


From January 1 to September 9, 2017, 119 people from 15 states were reported to have measles.

CDC

Measles image  Measles image

People with confirmed or probable Campylobacter infection linked to puppies, by date of illness onset, as of October 3, 2017

Number of measles cases by year since 2010

Year Cases
2010 63
2011 220
2012 55
2013 187
2014 667
2015 188
2016* 70
2017** 119

Somalia in crisis: Measles, Cholera, Drought, Famine

WHO

WHO and Federal Ministry of Health of Somalia call for urgent support to address measles outbreak in Somalia

16 August 2017 – As millions of people in Somalia remain trapped in a devastating cycle of hunger and disease, WHO and health partners are working with national health authorities to save lives and reach the most vulnerable with essential health services.

More than 2 years of insufficient rainfall and poor harvests have led to drought, food insecurity and a real risk of famine. Malnutrition, mass displacement as a result of the drought, and lack of access to clean water and sanitation have created ideal conditions for infectious disease outbreaks.

“Somalia is facing one of the worst humanitarian crises in the world. Millions of people, already on the brink of famine, are now at risk of rapidly spreading infectious diseases like cholera and measles. Normally, these diseases are easy to treat and prevent, but they can turn deadly when people are living in overcrowded spaces and are too weak to fight off infection,” said Dr Ghulam Popal, WHO Representative in Somalia.

Drought has led to a lack of clean water and the largest cholera outbreak in the last 5 years, with more than 57 000 cases and 809 cumulative deaths reported as of 31 July 2017. Health partners, together with national health authorities, scaled up its efforts to respond to this event by setting up cholera treatment centers in affected districts and providing support in water and sanitation to prevent the spread of the disease. In March, WHO and partners conducted Somalia’s first national oral cholera vaccination campaign, and successfully reached over 450 000 vulnerable people. Due to ongoing efforts, the number of cholera cases in Somalia has declined, from 13 656 cases of acute watery diarrhoea/cholera in May 2017 to 11 228 cases in June 2017.

Somalia is also facing its worst measles outbreak in 4 years, with over 14 823 suspected cases reported in 2017 (as of 31 July), compared to 5000–10 000 cases per year since 2014. The situation is especially critical for millions of under-vaccinated, weak and hungry children who are more susceptible to contracting infectious diseases. More than 80% of those affected by the current outbreak are children under 10 year of age.

In early 2017, WHO and partners, in collaboration with national health authorities, vaccinated almost 600 000 children aged 6 months to 5 years for measles in hard-to-reach and hotspot areas across the country. Despite these efforts, the transmission of measles continues, compounded by the ongoing pre-famine situation, continued mass displacement, and undernourished children living in unhygienic conditions.

In order to contain the outbreak, a nationwide campaign is planned for November 2017 to stop transmission of the disease, targeting 4.2 million children. The campaign will also intensify efforts to strengthen routine immunization and reach unvaccinated children to boost their immunity. As shown by the response to the cholera outbreak, with the right interventions, health authorities are confident that similar success may be seen in controlling the measles outbreak.

US$ 14.4 million (a cost of US$ 3.36 per child) is required by WHO and health partners to conduct the measles vaccination campaign in November 2017, of which WHO required US$ 6.8 million. To date, no funding has been received.


South Sudan: 15 children die in botched measles vaccine campaign

ITV

  • The health ministry blamed the deaths on human error.
  • One syringe was used for all the children
  • The vaccine was not stored properly.
  • All of the children who died were under the age of 5.

 


WHO calls for immediate action to save lives in Somalia

WHO

News release

WHO is concerned by the chronic shortage of funding for life-saving work in Somalia in response to the ongoing drought that has plunged the country further towards famine, disease, and health insecurity. Drought in Somalia led to the destruction of crops and livestock, leaving more than 3.3 million people hungry every day. If the current situation continues, famine could soon be a reality, creating a devastating cycle of hunger and disease as the health of people deteriorates and they become more susceptible to infection. Drought has also led to lack of clean water and the largest outbreak of cholera Somalia has seen in the last 5 years, with more than 36 000 cases and almost 690 deaths so far in 2017 alone. With the beginning of the expected rainy season and floods this month, these numbers are expected to increase to 50 000 cases by the end of June. Cases of measles are also on the rise, with nearly 6 500 cases reported this year, 71% of them children under the age of 5 years.

“History has shown the terrible consequences of inaction, or action that comes too late. More than a quarter of a million lives – half of them children – were lost as a result of the devastating famine of 2011. This year, a much larger percentage of the population is now at risk. We will not stand by and watch millions of already vulnerable men, women, and children become victims of an avoidable catastrophe,” said Dr. Peter Salama, WHO Executive Director for Emergencies.

WHO commends the Government of the United Kingdom for its leadership in hosting an international conference today to tackle the country’s most urgent challenges, and calls on the international community to take decisive action to help avoid a humanitarian catastrophe. So far in 2017, health sector requirements of US$ 103 million are only 23% funded and WHO has received less than 10% of US$ 25 million required for an organizational response. WHO urgently appeals for additional support from the international community to ensure the health response can continue and expand, to save lives and alleviate the suffering of millions of Somalis.

Background

Whilst the operating environment in Somalia remains challenging, and humanitarian access restricted as a result of ongoing conflict and violence in many parts of the country, WHO and health partners continue to scale up their response, with coordination hubs established in Mogadishu, Garowe, Hargeisa and Baidoa. In March and April 2017, WHO delivered nearly 50 tons of medicines and medical supplies to provide life-saving support for almost 4.3 million people. Cholera treatment centres are now operational in 40 districts, and the numbers of surveillance sites for epidemic-prone diseases have been increased across the country, with Rapid Response Teams deployed to support investigation and response activities. In March, WHO and partners conducted the first national oral cholera vaccination campaign in Somalia, reaching over 450 000 vulnerable people. A second campaign is ongoing in South West State and Middle Shebelle, targeting 463 000 vulnerable people.


A Minneapolis-area measles outbreak that has been fueled by low vaccination rates in Somali-Americans grew to 44

Minnesota Department of Health

Measles (Rubeola)

Updated 5/5/17

Confirmed cases as of May 5, 2017: 44
(Updated Monday-Friday at 1 p.m.)

    • 44 total cases:
      • 41 in Hennepin County
      • 2 in Ramsey County
      • 1 in Crow Wing County
  • Vaccination status:
    • 42 confirmed to be unvaccinated
    • 2 had 2 doses of MMR
  • Age:
    • 43 in children ages 0 through 10 years
    • 1 case in an adult
  • 38 of the cases are Somali Minnesotan

Measles outbreaks across Europe : Over 500 cases

WHO

Measles outbreaks across Europe threaten progress towards elimination

Copenhagen, 28 March 2017

Over 500 measles cases were reported for January 2017 in the WHO European Region. Measles continues to spread within and among European countries, with the potential to cause large outbreaks wherever immunization coverage has dropped below the necessary threshold of 95%.

“With steady progress towards elimination over the past 2 years, it is of particular concern that measles cases are climbing in Europe,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “Today’s travel patterns put no person or country beyond the reach of the measles virus. Outbreaks will continue in Europe, as elsewhere, until every country reaches the level of immunization needed to fully protect their populations.”

Two-thirds of the Region’s 53 countries have interrupted endemic transmission of measles; however, 14 remain endemic, according to the Regional Verification Commission for Measles and Rubella Elimination (RVC).

Unchecked transmission threatens progress

559 measles cases were reported in the Region for January 2017. Of these, 474 cases were reported in 7 of the 14 endemic countries (France, Germany, Italy, Poland, Romania, Switzerland and Ukraine). Preliminary information for February indicates that the number of new infections is sharply rising. In all of these countries, estimated national immunization coverage with the second dose of measles-containing vaccine is less than the 95% threshold.

“I urge all endemic countries to take urgent measures to stop transmission of measles within their borders, and all countries that have already achieved this to keep up their guard and sustain high immunization coverage. Together we must make sure that the hard-earned progress made towards regional elimination is not lost,” continues Dr Jakab.

Current major outbreaks

The largest current measles outbreaks in Europe are taking place in Romania and Italy.

Romania has reported over 3400 cases and 17 deaths since January 2016 (as of 10 March 2017). The majority of cases are concentrated in areas where immunization coverage is especially low.

According to reported data, the 3 measles genotypes circulating in Romania since January 2016 were not spreading in the country before, but were reported in several other European countries and elsewhere in 2015. Comprehensive laboratory and epidemiological data are needed before the origin of infection and routes of transmission can be concluded.

Italy has seen a sharp rise in cases in the first weeks of 2017. With 238 cases reported so far for January 2017 and preliminary information indicating at least as many cases for February, the total number of cases reported for 2016 (approximately 850) may soon be surpassed.

Countries at highest risk

Measles is a highly contagious virus that can cause potentially serious illness. As measles remains endemic in most parts of the world, it can spread to any country, including those that have eliminated the disease. Every un- or under-immunized person regardless of age is therefore at risk of contracting the disease; this is especially true in those countries where persistently low immunization rates increase the risk of a large outbreak with possible tragic consequences. National authorities should maximize their efforts to achieve and/or sustain at least 95% coverage with 2 doses of measles-containing vaccine to prevent circulation in the event of an importation.

The WHO Regional Office for Europe is working closely with the national health authorities of countries at risk and in the midst of large measles outbreaks to plan and implement appropriate response measures. These include enhancing surveillance and identifying and immunizing those at heightened risk of infection, especially susceptible persons who may be or come in contact with infected persons, as well as engaging communities to encourage vaccination for all those who need it.

Measles and rubella elimination in Europe

In adopting the European Vaccine Action Plan 2015–2020, all 53 Member States of the Region committed to eliminating measles and rubella as one of the Region’s priority immunization goals.

Progress towards this goal was confirmed at the 5th meeting of the RVC in 2016, which concluded that:

  • 37 of the 53 countries had interrupted endemic measles transmission;
  • of these, 24 countries maintained interruption for more than 36 months and were therefore considered to have eliminated the disease;
  • 14 countries remain endemic for measles transmission; and
  • 2 countries have not submitted annual status updates.

WHO technical experts cooperate closely with European countries to achieve this goal, providing comprehensive support to strengthen immunization programmes, increase population immunity and confidence in vaccines, build disease surveillance capacities, and respond to outbreaks in line with countries’ commitment to elimination.



Nigeria: WHO and health partners helped vaccinate more than 10 000 children against measles in 2 days in internally displaced persons (IDP) camps in the conflict-affected Borno State.

WHO

  • “…Since 6 June 2016, health clinics in IDP camps in Borno State have seen increasing numbers of measles cases. From early September until late October, 744 suspected cases of measles, and 2 deaths, were reported from WHO-established EWARS reporting sites. The majority of these children had never been vaccinated against measles and most of them were aged less than 5 years….”

Key facts

  • Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
  • In 2015, there were 134 200 measles deaths globally – about 367 deaths every day or 15 deaths every hour.
  • Measles vaccination resulted in a 79% drop in measles deaths between 2000 and 2015 worldwide.
  • In 2015, about 85% of the world’s children received one dose of measles vaccine by their first birthday through routine health services – up from 73% in 2000.
  • During 2000-2015, measles vaccination prevented an estimated 20.3 million deaths making measles vaccine one of the best buys in public health.

 


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