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By David E. Hubler
Contributor, EDM Digest
The island nation of Madagascar is battling the worst measles epidemic in its history. More than 1,200 people – mostly children under the age of 15 – have died since the highly contagious virus was first detected last September, the Associated Press reports.
“The epidemic unfortunately continues to expand in size, though at a slower pace than a month ago,” Dr. Dossou Vincent Sodjinou, a World Health Organization epidemiologist in Madagascar, told AP. By mid-March, 117,075 cases had been reported by the health ministry, affecting all regions of the country.
“Only 58% of people on Madagascar’s main island have been vaccinated against measles, a major factor in the outbreak’s spread,” AP noted.
First Outbreak of Measles in Madagascar in a Decade
“Madagascar had not reported a measles outbreak in the past 10 years. The current epidemic underscores the necessity of vigilance,” a WHO statement said. “The measles epidemic that was declared on 4 October 2018 has affected 105 of the country's 114 health districts. Nearly 117,075 cases and 1,205 deaths have been recorded to date. Of the reported cases, 77% were children younger than 14 years, and 79% of the deaths were among children in the same age range.”
Some families who live in hard-to-reach areas typically walk for hours to reach the nearest health facility, the WHO statement emphasized. “Vola, 28, and a mother of two children aged 9 and 5, who lives in a remote corner of the Diana region, walked with them and her younger siblings 30 kilometres [18.7 miles], carrying her daughter on her back, to reach the measles vaccination point. It took them six hours in the rain. They left home the day before the vaccination day.”
Vola said, “I want to protect my children and family from measles so they don't die like other children. Even if I have to walk 5 to 6 hours both ways, it's not a problem. The most important thing is [for my children] to stay healthy.”
International Relief Agencies and Madagascar Health Ministry Initiate Vaccination Campaign
Measles kills almost 90,000 people each year and is a leading cause of death in children under five, according to the Measles and Rubella Initiative (MRI). But “a safe and effective measles vaccine that can prevent suffering and death has been available for more than 50 years.”
Children “who are malnourished, very young, or have little or no access to medical care are at greatest risk of dying from measles,” MRI added.
Rubella (German measles) causes mild symptoms of a rash or fever in most people. But it’s a leading cause of birth defects when women contract the virus during pregnancy, according to MRI. Women infected during their first trimester of pregnancy have up to a 90% chance of delivering an infant with congenital rubella syndrome (CRS). Infants born with CRS can have multiple birth defects, including heart disorders, blindness, deafness or brain damage.
Three-Part International Vaccination Campaign Began in February
The Madagascar Ministry of Health, supported by WHO, Gavi, the Vaccine Alliance; the Measles and Rubella Initiative; UNICEF; the U.S. Agency for International Development (USAID) and other partners have initiated the three-part vaccination campaign to ultimately target all seven million children in the country ages six months to nine years.
Madagascar President Andry Rajoelina opened the vaccination campaign in the northern Diana region in February.
The difficulty of stemming measles in Madagascar might be better understood when comparing it to the current measles outbreaks in several states in the U.S., where measles was first eradicated in 2000.
“Unfortunately, the disease continues to be brought here every year by travelers. It then spreads locally, mostly among the unvaccinated. This is a tragic public health reality that could easily be prevented,” says Dr. Marc Siegel, a practicing internist and professor of medicine.
One way to overcome objections to vaccination, he believes, is to teach “that fear of a virus like measles should be worse than the fear of the vaccine to prevent it.”