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MEASLES UPDATE 2011 (20)
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[1] Congo DR (Maniema)
Date: Fri 24 Jun 2011
Source: Afriqhinfos, Xinhua report [In French, trans. & edited]
<http://www.afriquinfos.com/articles/201 ... 180835.asp>


Measles outbreak causes 40 deaths in Maniema
--------------------------------------------
Kinshasa: The outbreak of measles which has broke out in Maniema
province [of the Democratic Republic of Congo] has been responsible,
in less than a month, for some 40 deaths. According to a medical
soutce in Kindu, the capital of the province, most of the fatalities
have been children, but there have been also adult fatalities in the
14 health areas of the province.

Dr Jean Baptiste Shuli Tchombe, physician-coordinator of the National
Programme on Immunization (EPI) said that the situation is under
control in 5 of the 14 health zones. The 5 are Kindu, the capital of
the province, Alunguli in the center of Maniema, and Samba, Kasongo,
and Kibombo in southern Maniema. Control efforts are now directed
towards the situation in the health zones in the north of the
province, close to Ubundu in the Eastern Province, where the epidemic
began.

Dr Shuli Tchombe stated that the situation is worrisome in the health
zone of Kindu. "Sporadic cases are still being reported there and a
coordinated management sytem is being implemented using health centers
and public hospitals]". He further stated that a vaccination campaign
will be required in the health zones in the north of the province,
notably Lubutu Ferekeni, Obokote, and Punia, because they lie adjacent
to Lowa health in the Eastern Province where the epidemic has not yet
been controlled.

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[A map showing the location of Maniema province can be accessed at
<http://www.mapsofworld.com/democratic-r ... l-map.html>.
- Mod.CP]

******
[2] Tanzania (Mainland)
Date: Sat 25 Jun 2011
Source: The Citizen [edited]
<http://thecitizen.co.tz/news/4-national ... asles.html>


Alarm as 18 die of measles
--------------------------
Dar es Salaam: The government yesterday [24 Jun 2011] announced a
fresh outbreak of deadly measles that has so far killed 18 people
since it was reported earlier this year.

No fewer than 1573 cases have been reported in about 6 regions of
Mainland Tanzania as authorities struggle to control further spread of
the disease which affects the skin and the respiratory system.

Confirming the report to journalists yesterday, the permanent
secretary [PS] in the ministry of Health and Social Welfare, Ms
Blandina Nyoni, said the government has decided it would vaccinate all
children between the ages of 9 months and 15 years starting in October
this year, as part of measures to control the disease.

The PS said Arusha's Ngorongoro and Karatu districts, Dar es Salaam,
Iringa municipality, Coast Region's Kisarawe District, Morogoro
Municipality, Kilosa District and Tanga have reported a high number of
cases.

Accompanied by the director of prevention services, Dr Donan Mmbando,
Ms Nyoni said out of 1573 cases reported since January, children under
the age of 5 who are at the highest risk of being affected by the
highly-infectious disease accounted for 68 per cent of the total
cases. Some 1062 cases were reported among children under 5, she
said.

According to the PS, Arusha leads with 10 deaths and 642 patients,
followed by Dar es Salam where 7 have already died out of 349 cases
reported.

The disease mostly affects those who have not been immunised against
it,”Ms Nyoni said. Public health experts say the emergence of measles
in Tanzania could be part of a global outbreak of the disease which
continues to spread across the world, with more cases being reported
in Europe. The outbreak is a serious setback to global health experts
who believed they were close to eradicating the disease worldwide, but
the World Health Organization (WHO) has pushed the target date for
eliminating it to 2015. However, many experts say the time is still
not enough to vanquish the scourge. In Europe, 6500 people in 30
countries have been infected with measles -- largely in France, which
has declared it an official epidemic. More than 5000 cases were
reported between January and March 2011, nearly as many cases reported
during the whole of 2010. Over 98 cases of the disease have been
reported in 23 American states, according to the US Centre for Disease
Control and Prevention. The disease is also spreading through India
and the Philippines.Yesterday, the PS said about 85 per cent of the
reported patients had not been vaccinated.

Dr Mmbando said the outbreak usually occurs between September and
December every year, noting however that such a trend was not noticed
last year. He speculated that the current outbreak could be part of
what was supposed to happen last year.

In Tanzania, the measles vaccination rate stands at 85 per cent and
Dr Mmbando fears that the 15 per cent of those who have not been
vaccinated could be responsible for the current eruption. He announced
that the government has introduced ring vaccination to affected areas
to control further spread of the disease, warning that there was no
specific treatment for the disease yet.

[byline: Mkinga Mkinga]

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[The HealthMap/ProMED-mail interactive map of Tanzania can be
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Kongo, Republik - Masern
27.06.2011

In der Region Pointe Noire Kouilou (S) sind durch einen Ausbruch 800 Menschen erkrankt, 32 sind bislang gestorben. Zweimalige MMR-Impfung für Reisende beachten. / Quelle: crm
__________________

Tansania - Masern
27.06.2011

Ein Ausbruch hat bislang zu über 1.500 Erkrankten (überwiegend nicht geimpfte Kinder unter 5 Jahren) und 18 Todesfällen geführt. 6 Regionen des Landes sind betroffen: Arusha, Dar es Salaam, Iringa, Pwani, Morogoro und Tanga. Impfschutz beachten. Die STIKO empfiehlt 2 Impfungen (MMR) für alle Personen. / Quelle: crm

MEASLES UPDATE 2011 (21)
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[1] Chad
Date: Wed 29 Jun 2011
Source: AlertNet, IRIN [abbreviated & edited]
<http://www.trust.org/alertnet/news/chad ... ya-fallout>


[This is an extract from a longer article concerning families who had
returned home to escape the conflict in Libya.]

Many migrants arrived with measles, leading IRC, WHO, and UNICEF to
launch vaccination campaigns for children aged 6 months to 15 years. A
national measles vaccination campaign will soon be launched to contain
the spread of the disease. As of 19 Jun 2011, some 5311 people had
contracted the disease across 20 of Chad's 22 regions since the
beginning of the year [2011], with 63 deaths thus far, according to
Chad's Health Ministry.

"We are vaccinating children as soon as they arrive at transit
centres, so the disease should not spread further," Felix Liger, IRC
Chad country director, told IRIN. Many migrants are arriving run-down,
malnourished and dehydrated, he said, increasing their receptiveness
to the disease.

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[This major outbreak appears to be another unintended consequence of
the current conflict in Libya. The HealthMap/ProMED-mail interactive
map of Chad can be accessed at <http://healthmap.org/r/009u>. -
Mod.CP]

******
[2] Tanzania
Date: Thu 30 Jun 2011
Source: Daily News online [edited]
<http://www.dailynews.co.tz/home/?n=21265&cat=home>


A measles outbreak has left 20 children dead in Ngorongoro district
in the last 10 weeks, the district's medical officer, Dr Kennedy
Israel, has said. Dr Israel said on Wednesday [29 Jun 2011] that the
highly contagious disease, also known as "rubeola", was 1st reported
in the Kakesio Village in late April 2011. He said that, from then
onwards, the disease has been spreading and that the 20 children who
have lost their lives were among the 650 infections recorded in the
area.

"And that is only the number of [those] that have been officially
reported, but we suspect that the death toll could be higher because
Ngorongoro is a vast district with much of its localities hidden in
remote thickets," said the DMO. Ngorongoro, which is mostly a
conservation area with a fraction of its geographical area inhabited,
has a population of 170 000 people.

The death toll figure surpasses the overall measles deaths reported
by the government last week, whereby 10 people had died in the
district, 7 in Dar es Salaam and one in the Southern Highlands.

"All the necessary steps towards containing the outbreak have been
taken," said Dr Israel, adding that children in the district are
currently being vaccinated with MMR immunization. However, the efforts
to vaccinate the juvenile population in Ngorongoro district is being
challenged by the fact that most of the area residents are nomadic
pastoralists, tending livestock and searching for both water and
greener pastures. "As a result, whenever we visit a household or
village, chances are the occupants would be gone, and in the remote
areas of Ngorongoro, villages are usually located up to 50 km from
each other," explained the DMO.

The Ngorongoro District Hospital's health secretary Ms Josephine
Elikashe said that in addition to the efforts being taken to contain
the situation, her hospital had initiated outreach programmes to
educate people on how to identify early signs of measles and what
action to take. Medical experts say that there is no specific
treatment for measles, but most patients with uncomplicated measles
will recover with rest and supportive treatment.

For his part, the area member of parliament, Mr Saning'o Ole Telele,
said that while precautions are being taken at the district level, his
office has taken things to a higher level by presenting the matter to
both regional and national levels.

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[Ngorongoro district is one of the 5 districts of the Arusha region
of Tanzania. It is bordered to the north by Kenya, to the east by the
Monduli district, to the south by the Karatu district and to the west
by the Mara region. Its location is shown in the map of the Arusha
region of Tanzania at
<http://en.wikipedia.org/wiki/Ngorongoro_District>.

According to the 2002 Tanzania National Census, the population of the
Ngorongoro region was 129 776. The major ethnic group in the district
are the Maasai people. - Mod.CP]

******
[3] Nepal (Mahottari)
Date: Tue 28 Jun 2011
Source: Republica (Nepal) [edited]
<http://www.myrepublica.com/portal/index ... s_id=32879>


An outbreak of measles has badly affected Sikwakataiya VDC [village
development community] in Mahottari district. The disease has affected
more than 400 children of wards no. 2, 3 and 4 in the VDC
simultaneously.

The majority of the population belong to the Muslim community in the
VDC. The disease has affected mostly children aged 1 to 5 years. Two
months ago, the disease was seen only in 5 children in the VDC, but
now it has affected 80 per cent of children in the village.

According to social worker Yunus Ansari, the VDC was [alarmed] by the
disease situation [following the appearance of] the outbreak of the
disease in the VDC and [because] vaccine against measles [had] not
reached the VDC. The [Nepalese] Ministry of Health and Population is
administering a programme of free measles vaccination.

Health worker Ram Pratap Mandal said that among the disease-affected
children, 80 per cent [had not been vaccinated].

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[It would seen that this outbreak may have been exacerbated both by
logistical problems in the distribution of measles vaccine and
possibly by religious-based resistance to vaccination.

The location of Mahottari can be found in the map of the districts of
Nepal at <http://en.wikipedia.org/wiki/Mahottari_District>. The
HealthMap/ProMED-mail interactive map of Nepal can be accessed at
<http://healthmap.org/r/018D>. - Mod.CP]

MEASLES UPDATE 2011 (22)
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******
[1] Libya (Sabha), Chad
Date: Tue 5 Jul 2011
Source: sur.es [in Spanish, machine trans., abbreviated & edited]
<http://www.diariosur.es/agencias/201107 ... 51639.html>


The International Red Cross said today [5 Jul 2011] that an outbreak
of measles had reached epidemic proportions in the Libyan city of
Sabha and has quickly spread [via returning migrant workers] to Chad.
The situation is difficult to control due to a shortage of medical
supplies and because it involves a nomadic population.

In a press conference today [5 Jul 2011] in Geneva, Paul Castella,
head of the delegation of the International Committee of the Red Cross
(ICRC) in Libya, said that the Tuareg tribe is the most affected
segment of the population because their nomadic way of life has
complicated routine vaccination [The Tuareg are a Berber nomadic
pastoralist people. They are the principal inhabitants of the Saharan
interior of North Africa. - Mod.CP].

Castella said that measles is the 2nd leading cause of child
mortality in Africa, after malaria, and warned that if the situation
is not controlled in Sabha, "it could become a catastrophe."

In addition, the ICRC delegate said that, at present, there is a food
crisis situation in Libya, and in the areas controlled by the
government, families are dependent on government subsides. Castella
said it is impossible to predict the outcome but stressed that his
organization "is closely monitoring developments to avoid an impending
crisis." In areas controlled by the Transitional Government, the
situation is more complicated because the authorities cannot, for
example, pay wages, and people are dependent on international aid. "In
Benghazi (the Libyan capital of the rebels), there is a clear effort
by the opposition to respond to the needs of the population," he
said.

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[Sabha is a city in southwestern Libya with a population of 130 000.
It can be located in the HealthMap/ProMED-mail interactive map of
Libya at: <http://healthmap.org/r/10Be>. The Republic of Chad, is a
landlocked country in Central Africa, bordered on the north by Libya.
The HealthMap/ProMED-mail interactive map of Chad can be accessed at:
<http://healthmap.org/r/009u>. - Mod.CP]

******
[2] Congo DR (Katanga)
Date: Thu 7 Jul 2011
Source: Le Potentiel [in French, trans. & edited]
<http://www.lepotentiel.com/afficher_art ... cle=112251>


The administrator of the interim territory of Kongolo, Gregory Ebondo
Mutombo, citing medical sources, announced the occurrence of a measles
epidemic at a place about 350 km on the rail route northwest of the
city of Kalemie, in Katanga province. The outbreak has caused the
deaths 6 children; hundreds of others are affected according to the
CPA.

The territorial authorities have asked the public to be more vigilant
and to take suspected cases to the local hospital for treatment. The 6
deaths occurred a week and a half ago in Kongolo. The epidemic has
also affected 230 other children under 3 years. A significant number
of the affected children live in the centre of Kongolo.

Fearing the spread of the disease, the administrator has urged
residents to cooperate with the nearest health facilities. Any
suspected case of persistent fever with the occurrence of a skin rash
should be referred to a local hospital without delay.

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[Unfortunately, this report gives no indication of the vaccination
status of the local population.

A map showing the location of Kongolo in Katanga province of the
Democratic Republic of Congo can be found at:
<http://en.wikipedia.org/wiki/Railway_st ... in_DRCongo>. The
HealthMap/ProMED-mail interactive map of the Democratic Republic of
Congo can be accessed at: <http://healthmap.org/r/01ek>. - Mod.CP]

MEASLES UPDATE 2011(23)
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In this update:

******
[1] Congo DR
Date: Tue 12 Jul 2011
Source: New Media Radio [abbreviated & edited]
<http://www.unmultimedia.org/radio/engli ... -dr-congo/>


An outbreak of measles and cholera is sweeping across the Democratic
Republic of Congo [Congo DR] according to the World Health
Organization (WHO). The diseases have already claimed over 2500 lives.
WHO says efforts to contain the outbreaks through vaccination and
provision of hygiene kits have been hampered by lack of adequate
funding.

The measles outbreak is spreading through 7 provinces in Eastern
Congo DR. Tarik Jasarevic from WHO says [a sum of] USD 9 million is
required to undertake vaccination campaigns to contain the measles
outbreak. "The 1st 2 campaigns are planned this month [July 2011],
targeting 915 000 children in 9 provinces. The 1st campaign should
take place from 14-19 Jul 2011 in Kasai Occidental, Bas Congo,
Equateur and Provence Orientale, and the 2nd campaign on 21-25 Jul
2011 in Kasai Occidental, Kasai Oriental, Katanga, Maniema and Sud
Kivu." The vaccination campaigns will be undertaken jointly by the
World Health Organization and the UN Children's agency UNICEF.

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[A map of the provinces of Congo DR can be accessed at:
<http://www.mapsofworld.com/democratic-r ... l-map.html>.
- Mod.CP]

******
[2] (Ethiopia & Kenya)
Date: Fri 15 Jul 2011
Source: Newser, via Associated Press [edited]
<http://www.newser.com/article/d9og1lf81 ... kenya.html>


UNICEF spokeswoman Marixie Mercado said on Friday [15 Jul 2011] that
at least 17 584 measles cases, including 114 deaths, have been
reported by Ethiopian health officials in the 1st half of the year
[2011]. Two million children in Ethiopia are at risk of contracting
measles.

World Health Organization spokesman Tarek Jasarevic says at least 462
cases of measles, including 11 deaths, have been confirmed in recent
months among Somali refugee children in the Kenyan refugee complex
known as Dadaab.

WHO has warned that the movement of people and poor sanitation in
overcrowded camps and towns due to drought and violence in East Africa
increase the risk of cholera, typhoid and measles epidemics.

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[A map of Africa showing the locations of Ethiopia and Kenya can be
accessed at: <http://www.worldatlas.com/webimage/countrys/af.htm>. -
Mod.CP]

Kongo, Demokratische Republik - Masern
18.07.2011

In 7 Provinzen des Landes sind durch die Epidemie seit September 2010 über 115.000 Erkrankungs- und 1.145 Todesfälle aufgetreten. Ärzte ohne Grenzen (MSF) hat bereits über 1,5 Millionen Kinder geimpft; weite Impfkampagnen sollen folgen. Fehlende Impfungen sollten gemäß den Empfehlungen der STIKO nachgeholt werden. / Quelle: crm

MEASLES UPDATE 2011(24)
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[1] Bulgaria
Date: Wed 20 Jul 2011
Source: CIDRAP [edited]
<http://www.cidrap.umn.edu/cidrap/conten ... sscan.html>


The measles virus strain called D4-Hamburg, which 1st reached
continental Europe in 2008, has caused more than 25 300 cases in 12
European countries over the past 27 months, with the vast majority of
them in Bulgaria, according to a report published online yesterday [19
Jul 2011] in Emerging Infectious Diseases (EID).

The virus spread from London to Hamburg in December 2008 and later
moved to Bulgaria, which has had 24 379 cases so far. The virus is
largely but not exclusively associated with travel by members of the
Roma ethnic group, says the report by a large international research
team. Cases have been identified in Poland, Ireland, Northern Ireland,
Austria, Greece, Romania, Turkey, Macedonia, Serbia, Switzerland, and
Belgium, and the virus was repeatedly re-imported to Germany. The
authors say their findings "underline the need for the development of
strategies to address this ethnic minority [the Roma] at the regional
level and to improve their integration into the respective national
health services." But they add that measles elimination "should not be
seen exclusively as a Roma-associated problem," as public health
authorities face a broader challenge of "closing vaccination gaps in a
setting of optional vaccination and vaccine skepticism." Last week,
the ECDC reported that Europe has had more than 21 000 measles cases
so far this year [2011], most of them related to a large epidemic in
France.

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[The citation for this article is: Mankertz A, Mihneva Z, Gold H,
Baumgarte S, Baillot A, Helble R, et al. Spread of measles virus
D4-Hamburg, Europe, 2008-2011. Emerg Infect Dis [serial on the
Internet]. August 2011 [date cited].
<http://www.cdc.gov/EID/content/17/8/101994.htm>

Abstract: "A new strain of measles virus, D4-Hamburg, was imported
from London to Hamburg in December 2008 and subsequently spread to
Bulgaria, where an outbreak of over 24 300 cases was observed. We
analyzed spread of the virus to demonstrate the importance of
addressing hard-to-reach communities within the World Health
Organization European Region regarding access to medical care and
vaccination campaigns. The D4-Hamburg strain appeared during 2009-2011
in Poland, Ireland, Northern Ireland, Austria, Greece, Romania,
Turkey, Macedonia, Serbia, Switzerland, and Belgium and was repeatedly
re-imported to Germany. The strain was present in Europe for over 27
months and led to over 25 000 cases in 12 countries. Spread of the
virus was prevalently but not exclusively associated with travel by
persons in the Roma ethnic group; because this travel extends beyond
the borders of any European country, measures to prevent the spread of
measles should be implemented by the region as a whole."

The authors comment that: "Because sequencing results are not
available quickly in most countries, this transmission chain is
probably still ongoing. Epidemiologic data showed that the spread of
D4-Hamburg across Europe involved predominantly persons from the Roma
ethnic group in Bulgaria."

"Another transmission chain affecting the Roma population in
particular was recorded in 2004 in Romania. An outbreak of over 8000
cases associated with MVs/Bucharest.ROU/48.04[D4] commenced in the
Roma population. Subsequent spread of D4-Bucharest by traveling Roma
persons was observed until 2007. The pronounced sequence deviation of
D4-Bucharest and D4-Hamburg indicates the presence of at least 2
distinct and successive transmission chains in the Roma population.
Both chains were long lasting and associated with a high number of
cases, as well as several fatalities. This and other recent outbreaks
in Roma communities underline the need for the development of
strategies to address this ethnic minority at the regional level and
to improve their integration into the respective national health
services."

A map of the worldwide distribution of measles genotypes during the
period 1995-2006 can be viewed in the World Health Organization Manual
for the Laboratory Diagnosis of Measles and Rubella Virus Infection,
2nd ed [cited 22 Nov 2010].
(<http://www.who.int/immunization_monitor ... lFinal.pdf>. -
Mod.CP]

******
[2] India (UP)
Date: Fri 22 Jul 22011
Source: MSN News [edited]
<http://news.in.msn.com/national/article ... id=5309287>


A child died, and several others were taken ill after they were
administered measles vaccine here, officials said today [22 Jul 2011].
The 9-month-old child died, and several others were taken ill
yesterday when they were administered the vaccine during a drive in
Avadhupr Hazipur village in Ghungter area here. The condition of 2
children is serious.

The child's father has lodged a complaint against the medical
officer, ANM [auxiliary nurse] and a health worker in this regard. In
a preliminary inquiry, health officials have admitted that the vaccine
vials were left open for long hours.

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[This is a tragic consequence of medical negligence. Measles vaccines
in general use, if properly handled, are safe without adverse
side-effects.

The Barabanki District can be located (in the centre) of the map of
the districts of Uttar Pradesh at:
<http://www.mapsofindia.com/maps/uttarpr ... strict.htm>.
- Mod.CP]

MEASLES UPDATE 2011 (25)
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[1] Angola (KS)
Date: Tue 26 Jul 2011
Source: allAfrica.com [edited]
<http://allafrica.com/stories/201107270032.html>


Health authorities in the municipality of Amboim, Kwanza Sul province,
registered a reduction of 38 cases of measles in the 2nd quarter of
this year [2011], fruit of the vaccination campaigns held in the
district. The cases of measles, according to the supervisor of public
health and control of endemic diseases, J. Alfinete, decreased from 40
to only 2 cases. He said that 2 children are hospitalised with measles
and are receiving treatment at the municipal hospital of Amboim.
[Their condition is satisfactory].

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[Amboim is a coastal city in Angola with a population of 65 000. Its
location in Kwanza Sul province can be found in the map of Angola at:
<http://en.wikipedia.org/wiki/Porto_Amboim>. - Mod.CP]

******
[2] Congo DR
Date: Mon 25 Jul 2011
Source: France 24, Agence France-Presse report [edited]
<http://www.france24.com/en/20110725-mea ... january-un>


A measles epidemic has killed 1145 children in the Democratic Republic
of Congo [Congo DR] since January 2011, the UN's Humanitarian Affairs
mission in Kinshasa said Monday [25 Jul 2011]. The epidemic "has
already affected 115 600 children and killed 1145" between January and
June 2011, the UN Office for the Coordination of Humanitarian Affairs
(OCHA) said in a statement.

This prompted the vaccination of 3.1 million children across 5
provinces, it added. The campaign swung into action in May 2011 after
the NGO Medecins Sans Frontieres (MSF) deplored "the lack of
reactivity" of organisations like the World Health Organisation to
what it termed an "uncontrollable" epidemic.

The Congo DR is also battling cholera and polio epidemics.

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[According to a UN News Centre press release
(<http://www.un.org/apps/news/story.asp?N ... 9&Cr=&Cr1=>): "A
UN-coordinated campaign has vaccinated 3.1 million children. The USD
1.9 million vaccination drive, which was launched on 10 May 2011,
targeted youngsters in the country's Katanga, Kasai Occidental,
Bas-Congo, Equateur, and Orientale provinces."

Fidele Sarasso, the UN's humanitarian coordinator in the Congo DR,
said in the statement: "We thank our partners and urge them to
continue supporting us, especially now that DRC is facing other
epidemics, including cholera in the west of the country." Some 5407
cases of measles were reported in Congo DR last year [2010], causing
82 deaths, compared to 899 cases, including 26 fatalities, in 2009.

The HealthMap/ProMED-mail interactive map of Congo DR can be accessed
at: <http://healthmap.org/r/01ek>. - Mod.CP]

MEASLES UPDATE 2011 (26)
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[1] Romania
Date: Thu 4 Aug 2011
Source: Eurosurveillance, Volume 16, Issue 31 [abridged & edited]
<http://www.eurosurveillance.org/ViewArt ... leId=19932>


Ongoing measles outbreak in Romania, 2011
---------------------------------
[Citation style for this article: Stanescu A, Janta D, Lupulescu E,
Necula G, Lazar M, Molnar G, Pistol A. Ongoing measles outbreak in
Romania, 2011. Euro Surveill. 2011;16(31)]

Summary:
--------------
Since January 2011 up to June 2011, Romania has been experiencing a
measles outbreak, with 2072 cases notified in 29 of the 42 Romanian
districts. Most cases occurred in the north-western part of the
country among unvaccinated children, with the highest number of cases
(893 cases) registered in children aged one to 4 years. This report
underlines once more the need for additional measures targeting
susceptible populations to achieve high vaccination coverage with 2
doses of measles-mumps-rubella vaccine. No measles-related deaths have
so far been notified in 2011.

Abbreviated text:
---------------------
[Interested readers are referred to the full text at the source URL to
view the data, tables and references cited.]

An outbreak of measles was 1st noticed in late August 2010 in the
north-eastern part of Romania [1], and by the end of the year, 193
cases were registered in the whole country.

Measles is a statutorily notifiable disease since 1978 in Romania, and
medical practitioners have to immediately report all suspected measles
cases to the local public health authorities. At national level, the
National Centre for Communicable Diseases Surveillance and Control in
Bucharest collects and analyses all notifications of measles cases.
National case-based notification was initiated in 1999, and the
European Union (EU) case definition and case classification have been
adopted since 2005 [2].

The monovalent measles-containing vaccine was introduced in 1979 in
the Romanian immunisation schedule for children aged 9-11 months. In
1994, the 2nd measles vaccine dose was introduced for children aged
between 6-7 years (1st school grade). The combined
measles-mumps-rubella (MMR) vaccine replaced the monovalent measles
vaccine in 2004 and was recommended as a 1st dose for children aged
12-15 months. The 2nd MMR vaccine has been recommended for children
aged between 6 and 7 years since October 2005.

Between 2000 and 2008, the national measles vaccination coverage for
children aged between 18 and 24 months with the 1st dose of
measles-containing vaccine was estimated at 97-98 percent, and for
children aged 7 years, the vaccination coverage with the 2nd dose of
measles-containing vaccine was estimated at 96-98 percent [3]. In the
last 2 years, a constant decrease could be noticed in the measles
vaccination coverage for children aged 12 months. According to the
vaccination coverage reports, in 2009, the coverage for the 1st MMR
vaccine dose was 85.1 percent (95 percent CI: 82.4-87.8) at the age of
12 months and reached the target of 95 percent (95 percent CI:
93.4-95.8) coverage for children aged 18 months. A high number of
children remain unvaccinated not only in the hard-to-reach communities
but also in the general population, due to parental refusal and
scepticism regarding the benefits of the vaccination.

Vaccination coverage for the 2nd dose of MMR vaccine is reported every
year by the school medical staff to the local health authorities after
the school vaccination campaign. In 2010, the reported coverage for
the 2nd dose of measles-containing vaccine, calculated using the
number of doses administrated divided by the total number of eligible
children aged 7 years was 93.4 percent (95 percent CI: 90.7-95.0).

Here, we report an ongoing measles outbreak in Romania by analysing
measles data available from 1 Jan to 30 Jun 2011. From the beginning
of 2011 until 30 Jun 2011, a total number of 2072 measles cases were
notified by the local public health authorities. The highest number of
cases was registered among children aged between one and 4 years (893
cases), followed by the 5-9 year-olds (445 cases) and the infants
under one year of age (303 cases). Among the 10-14 year-olds, there
were 189 cases identified, 150 cases in those aged 20 years and above
and 92 cases were registered among adolescents aged between 15 and 19
years.

Among the total number of cases, approximately half occurred in
hard-to-reach communities. The monthly incidence increased from 131
cases registered in January 2011 to a peak of 515 cases in May 2011
and decreased in June 2011, when the number of notified cases was
437.

The laboratory confirmation was performed by detecting measles IgM
antibodies in serum samples. Due to many local outbreaks, the
laboratory confirmation was performed only in some of the 1st cases
identified in a particular area until D4 genotype was confirmed. For
those cases with a clear epidemiological link with the outbreak, the
epidemiological confirmation criteria were used. Of the 2072 notified
measles cases, 898 were laboratory-confirmed; 1161 were probable cases
with documented epidemiological link, and 13 were clinical measles
cases for whom sera could not be obtained due to parental refusal.
RT-PCR techniques to detect measles virus nucleic acid were also used
to confirm the 1st cases from some affected districts. Twelve viruses
were genotyped by a nested RT-PCR reaction which targeted a 450 nt
region at the C-terminus of the N protein (Nc region). All of them
belonged to D4 genotype currently circulating in Europe [4].

Of the total number of 2072 measles cases, 800 (38.6 percent)
presented complications: 582 (72.8 percent) cases developed pneumonia,
203 (25.4 percent) diarrhoea, 8 (one percent) malnutrition, 5 (0.62
percent) convulsions and 2 (0.25 percent) encephalitis.

Most cases occurred among unvaccinated children, representing 72.8
percent from the total number of cases registered during period
mentioned above. Of these, only 19.8 percent were not eligible for MMR
vaccination due to their age (under 12 months).

Several control measures have been implemented by the local health
authorities in their efforts to stop this outbreak. An additional MMR
vaccination campaign started in the affected areas targeting all
children aged between 7 months and 7 years, irrespective of their
measles vaccination status.

Discussion and conclusions
-----------------------
Despite the high national immunisation coverage with MMR vaccine
reported during the last 10 years, this outbreak highlights the
presence of pockets of individuals vulnerable to measles and
particularly those members of hard-to-reach communities, but not only.
We observed that more parents, even among highly educated persons,
lost their confidence in vaccination benefits for their children, and
this became an important problem that needs to be addressed.

The current measles outbreak in Romania and in other European
countries reveal the need for increased awareness on the declining
confidence that people have in vaccination benefits for their children
and for public health intervention focused in hard-to-reach
communities. In addition, after the pandemic influenza A(H1N1) 2009, a
constant scepticism and refusal regarding vaccination in general could
be noticed, not only in hard-to-reach communities, but also in the
general population.

In areas and communities where vaccine coverage remains sub-optimum,
large cohorts of susceptible people accumulate and represent a
potential for large outbreaks. The large proportion of cases observed
in infants suggests an intensely circulating measles virus [7].

--
Communicated by:
ProMED-mail <promed@promdmail.org>

[The continued existence of pockets of individuals vulnerable to
measles virus infection in both hard-to-reach [e.g. Roma] communities
and a declining confidence of the benefits of vaccination in others
are hurdles that will have to be overcome before measles can be
eradicated from Europe.

This problem has been considered in detail in a recent article
entitled: "Addressing the vaccine confidence gap," published in The
Lancet, Volume 378, Issue 9790, Pages 526-535, 6 Aug 2011, by Dr Heidi
J Larson
(<http://www.thelancet.com/journals/lance ... ct?rss=yes>).
Among other things, the authors conclude that: "Although provision of
accurate, scientifically based evidence on the risk-benefit ratios of
vaccines is crucial, it is not enough to redress the gap between
current levels of public confidence in vaccines and levels of trust
needed to ensure adequate and sustained vaccine coverage. More
research is needed not just on individual determinants of public
trust, but on what mix of factors are most likely to sustain public
trust."

The HealthMap/ProMED-mail interactive map of Romania can be accessed
at: <http://healthmap.org/r/172k>. - Mod.CP]

******

[2] Ethiopia
Date: Sat 6 Aug 2011
Source: Radio Netherlands Worldwide, Africa [edited]
<http://www.rnw.nl/africa/bulletin/measl ... arks-alarm>


The UN refugee agency (UNHCR) said Saturday [6 Aug 2011] that it was
alarmed by a suspected measles outbreak in south-east Ethiopia's Dollo
Ado camps, where thousands of famine-hit Somalis have sought refuge in
recent weeks. "UNHCR fears the outbreak could lead to high mortality
and serious illness in an already vulnerable refugee population whose
overall health was already fragile," said the office of the UN High
Commissioner for Refugees in a statement. On 4 Aug 2011, health
workers reported 25 deaths in the Kobe camp, of which half were
suspected to have arisen from measles, said the UNHCR. Other cases
have also been reported in other camps in the surroundings.

Measles rarely kills healthy individuals but can be fatal to
malnourished people. "This situation is alarming, and we cannot afford
to wait," warned Moses Okello, UNHCR Ethiopia representative. "We must
act now, urgently and decisively, to arrest and turn around this
situation," he said, adding that a campaign to vaccinate children was
essential.

A team of experts are expected to arrive in Dollo Ado on Sunday [7 Aug
2011] to support a vaccination campaign which is to begin Tue 9 Aug
2011. The Dollo Ado camps host 118 400 Somali refugees, including 78
000 who arrived this year [2011] after fleeing violence and what the
UN has described as the region's worst drought in decades.

--
Communicated by:
HealthMap alerts via ProMED-mail
<promed@promedmail.org>

[The Dollo Ado refugee camps are located in southern Ethiopia close to
Mandera in Kenya. A map showing the location of the Doilo Ado camps
can be accessed at:
<http://www.unhcr.org/cgi-bin/texis/vtx/ ... =49e483986>. -
Mod.CP]

MEASLES UPDATE 2011 (27)
************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

******

[1] Ethiopia
Date: Sat 6 Aug 2011
Source: AllAfrica.com [edited]
<http://allafrica.com/stories/201108070045.html>


The UN refugee agency (UNHCR) today [6 Aug 2011] expressed growing
alarm over the plight of refugees in the Dollo Ado camps in
south-eastern Ethiopia following an outbreak of suspected measles.
UNHCR fears the outbreak could lead to high mortality and serious
illness in an already vulnerable refugee population whose overall
health is already fragile. An outbreak could also reverse the progress
which has been made over the last several weeks to stabilise Somali
refugees, many of whom arrived in Ethiopia in extremely poor health.

Officially, there have so far been 47 cases and 3 deaths from
suspected measles in the Kobe camp of 25 000 people over the last
week. But on 4 Aug 2011 alone, community health workers reported 25
deaths in the camp, half of which were suspected to be from measles.
Refugee children are the most affected. Other suspected cases have
been reported in the other 2 refugee camps in the area, as well as in
the transit centre where there are just over 15 000 refugees awaiting
relocation to the newly-opened Hilaweyn camp.

According to medical experts, measles in healthy populations does not
kill, but measles complications do. In the context of the refugee
camps in Dollo Ado, the mix of measles and high levels of malnutrition
can be fatal. "This situation is alarming, and we cannot afford to
wait. We must act now, urgently and decisively, to arrest and turn
around this situation," Moses Okello, UNHCR's Representative in
Ethiopia, said after returning from Dollo Ado for a firsthand
assessment of the situation.

Okello who said he was "shaken" by the situation in the Dollo Ado
camps, held an urgent meeting Saturday [6 Aug 2011] with Ethiopian
government officials and UNHCR health partners to agree to a plan of
action. He said the "number one priority is a mass vaccination
campaign," noting that the emergency required "seamless teamwork" for
an effective response.

He called on all UNHCR health partners to scale up their capacity to
meet the "extremely serious public health challenges." UNICEF and WHO,
through Ethiopia's Ministry of Health, are providing the needed
vaccines. Vaccination of all children between the ages of 6 months and
15 years was started on Friday [5 Aug 2011] for all refugee children
being transferred from the transit centre to the newly-opened Hilaweyn
camps. Some 300 children were vaccinated before relocation, and 7
cases of suspected measles were isolated for in-patient care at the
transit centre. The relocation is expected to be completed within a
fortnight with daily convoys of 1000 people.

Following Saturday's [6 Aug 2011] meeting, UNHCR and the government
will lead a UN/NGO team of health experts to Dollo Ado on Sun 7 Aug
2011 to support the roll-out of a plan of action, which includes the
preparation of a mass vaccination campaign to begin on Tue 9 Aug 20
for all children aged 6 months to 15 years in Kobe camp, the most
affected camp. The vaccination campaign, which will include
vaccination against polio, will be extended to the other camps as well
as to the hosting communities where deemed necessary by the health
authorities.

Health workers emphasised the importance of proper management of
identified suspected measles, particularly as vaccines provide
protection only 14 days after administration. They also agreed to
strengthen surveillance and case finding using community health
workers, to set up satellite and mobile health clinics to improve
access to health services, and to intensify a mass information
campaign which started Fri 5 Aug 2011. An isolation ward in Kobe camp
is also being set up, and additional health personnel are being
dispatched to help manage this ward as well as additional clinics in
the camps.

Health experts said high rates of acute malnutrition, low vaccination
coverage in Somalia, and overcrowding in the camps are some of the
aggravating factors associated with this outbreak. They also cited
poor hygiene habits and poor health-seeking behaviour as challenges.

As of Fri 5 Aug 2011, the number of Somali refugees in the Dollo Ado
camps had reached 118 400. Nearly 78 000 of them arrived this year
[2011]. This is in addition to more than 41 600 Somali refugees in the
Jijiga area of the Somali region. Ethiopia hosts a total of 237 500
refugees, mainly from Somalia, Eritrea and Sudan.

--
communicated by:
HealthMap alerts via ProMED-mail
<promed@promedmail.org>

[The Dollo Ado refugee camps are located in southern Ethiopia close to
Mandera in Kenya. A map showing the location of the Dollo Ado camps
can be accessed at
<http://www.unhcr.org/cgi-bin/texis/vtx/ ... =49e483986>. -
Mod.CP]

******

[2] India (Karnataka)
Date: Fri 12 Aug 2011
Source: Deccan Herald [edited]
<http://www.deccanherald.com/content/183 ... irmed.html>


A 3.5 year old boy of Manemoole tribal hamlet in H D Kote
[sub-district] who died recently succumbed to measles.

According to a [statement] from district health and family welfare
officer Dr S M Malegowda, the lab reports have confirmed the death of
the boy as due to measles. The boy and 3 other children had been
admitted to the primary health centre in D B Kuppe for viral fever.
However, the baby died on 6 Aug 2011. The blood samples of all the
children had been collected and sent for testing at the National
Institute of Virology in Bangalore. The reports on 10 Aug 2011
confirmed the cause of death as measles. The remaining kids are
undergoing treatment at Vivekananda Hospital and are recuperating.

[Children] with similar symptoms (viral fever with rashes) have not
been reported in other tribal hamlets, but health officers have been
instructed to take precautionary measures, according to Dr S M
Malegowda's statement.

--
communicated by:
HealthMap alerts via ProMED-mail
<promed@promedmail.org>

[Karnataka state is in the south western part of India. It is mainly a
tableland and an extension of the Deccan plateau. Mysore district lies
in the Southern Maidan (Southern Plateau), and it is in the
southernmost part of Karnataka state. A map of the districts of the
Indian state of Karnataka can be accessed at
<http://www.mapsofindia.com/maps/karnataka/karnataka.htm>. - Mod.CP]

MEASLES UPDATE 2011 (28)
************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>


Ethiopia (Dollo Ado)
Date: Tue 16 Aug 2011
Source: Voice of America [edited]
<http://www.voanews.com/english/news/afr ... 79003.html>

Alarming Rise of Measles Deaths in Dollo Ado Refugee Complex
------------------------------------------------------------
The United Nations refugee agency [UNHCR -- United Nations High
Commission for Refugees] reports the death rates in one of 4 refugee
camps at the Dollo Ado complex in Ethiopia have reached alarming
levels. The UNHCR says it suspects a combination of measles and
malnutrition brought on by famine is the major cause of death.

More than 118 000 Somalis live at the Dollo Ado refugee complex in
Ethiopia. More than 78 000 of these refugees, fleeing drought and
famine, have arrived in Dollo Ado this year. U.N. refugee spokesman,
Adrian Edwards, says an assessment of mortality finds a sharp rise in
death rates in one of the four camps at Dollo Ado.

“Since the Kobe refugee camp opened in June [2011], an average of 10
children under the age of 5 have been dying each day. An outbreak of
suspected measles, combined with high rates of acute malnutrition is
thought to be the major cause of death. Across all Dollo Ado sites,
148 cases and 11 deaths due to suspected measles have been reported.
This deadly combination has historically caused similar death rates in
previous famine crises in this region,” Edwards stated. Children who
are healthy generally do not die of measles. But, for those who are
malnourished, this preventable disease can be fatal. And, so it is
proving to be for many of the acutely malnourished Somali children,
whose health has been severely weakened due to drought and famine.

Kobe houses 25 000 Somali refugees. The UNHCR and its partners on
Monday [15 Aug 2011] completed a mass vaccination campaign against
measles. All children between the ages of 6 months and 15 years were
immunized against this killer disease.

Edwards says vaccination campaigns will begin in other camps in the
coming days. “There is a need to encourage parents to return with
their children to health centers for continued treatment for
malnutrition, and to actively identify children who are sick to ensure
they receive immediate help. UNHCR is already working with refugee
leaders and outreach workers to raise awareness of measles symptoms
and hygiene promotion,” he said.

Most of the refugees arriving from Somalia are from rural areas.
UNHCR spokesman Edwards says the camps in Ethiopia may be the first
time the Somalis have ever gone to a health care facility. He says it
is crucial to make the refugees aware of the health and nutrition
programs that are available to them. He says the UNHCR, together with
the Ethiopian government and other partners, are working to improve
nutrition, water supply and sanitation in the camps. He says this can
help bring down the high mortality rate.

Measles is a highly contagious disease. The UNHCR says action to
prevent people from dying of this disease is the number one priority
facing aid agencies.

[Byline: Lisa Schlein]

--
Communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org>

[A map showing the location of the Dollo Ado refugee complex can be
accessed at:
<http://www.unhcr.org/cgi-bin/texis/vtx/ ... =49e483986>. -
Mod.CP]

MEASLES UPDATE 2011 (29)
************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

*****
[1] Angola (Cuando Cubango)
Date: Tue 23 Aug 2011
Source: Angop Salud [In Spanish, machine trans., edited]
<http://www.portalangop.co.ao/motix/es_e ... 96903.html>


An outbreak of measles raging in recent days the municipality of Cuito
Cuanavale, Cuando Cubango province, is causing the local authority
great concern. According to an ANGOP [news agency] report of Tue 23
Aug 2011 the outbreak has been responsible for the deaths of 4
children.

According to Joaquim Kantema, the city manager, after the onset of the
measles outbreak the local authorities implemented a routine
vaccination campaign. The campaign will be extended to cover 3
communities -- Lupiri, Longa, and Baixo-Longa -- with a view to
stalling the spread of the disease.

In the last few days, 3 deaths have been reported in the Dumba
neighbourhood and 16 cases in the Longa commune resulted in the deaths
of 5 children.

--
communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org>

[A HealthMap/ProMED-mail interactive map of Angola can be seen at
<http://healthmap.org/r/1b6Q>. Cuando Cubango is a province in the
south of Angola with a population of about 140 000. Menongue is the
capital of the province. Municipalities in this province include
Cuchi, Cuangar, Cuito Cuanavale, Rivungo , Mavinga, Calai, Dirico, and
Longa. The location of the province can be seen in the map of Angola
at <http://en.wikipedia.org/wiki/Cuando_Cubango_Province>. - Mod.CP]

******
[2] Somalia (South & Central)
Date: Thu 24 Aug 2011
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA),
ReliefWeb [edited]
<http://reliefweb.int/node/442840>


In July 2011 alone, 1019 suspected measles cases and 31 related deaths
have been reported in South and Central Somalia, representing almost
20 per cent of all cases for this year. Compared with the same period
in 2010, the number of suspected measles cases has increased by 666
per cent 4 [sic]. Since January 2011, 5176 suspected measles cases
were reported in South and Central Somalia alone.

Measles is a highly contagious viral disease, which affects mostly
children. It is transmitted via droplets from the nose, mouth, or
throat of infected persons. Initial symptoms, which usually appear
10-12 days after infection, include high fever, runny nose, bloodshot
eyes, and tiny white spots on the inside of the mouth. Several days
later, a rash develops, starting on the face and upper neck and
gradually spreading downwards.

There is no specific treatment for measles and most people recover
within 2-3 weeks. However, particularly in malnourished children and
people with reduced immunity, measles can cause serious complications,
including blindness, encephalitis, severe diarrhoea, ear infection,
and pneumonia.

The major factors for a measles outbreak in Somalia are low [vaccine]
coverage, malnutrition, population movements, and overcrowded
internally displaced (IDP) camps. WHO fears that the measles outbreak
could lead to serious illness and a high number of deaths, especially
among the vulnerable IDPs whose overall health is already fragile.

Measles can be prevented by vaccination. The routine immunization
against measles in Somalia is 29 per cent. As response to the
suspected measles outbreak, WHO, UNICEF, health partners, and health
authorities kicked off an emergency measles vaccination campaign in
all accessible areas of South and Central Somalia. About 2.3 million
children aged between 6 and 15 years in 10 regions of South and
Central Somalia, including 745 000 children in Mogadishu, will be
targeted during this campaign.

--
communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org>

[A HealthMap/ProMED-mail interactive map of Somalia can be seen at
<http://healthmap.org/r/00aM>. - Sr.Tech.Ed.MJ]

******
[3] Tanzania (Zanzibar)
Date: Fri 26 Aug 2011
Source: UN Integrated Regional Information Networks (IRIN) News
[edited]
<http://www.irinnews.org/report.aspx?reportid=93598>


The 1st measles outbreak in 5 years on Zanzibar's main island has
prompted health officials to mount a 2-day emergency immunization of
10 000 children under 5.

Most of the 76 cases recorded occurred over the past 2 weeks, said
health minister Malik Abdallah Juma. "We have had no deaths so far,
and we managed to treat 62 children; the remaining 14 are still in
hospital under close [observation] by doctors," he said.

Abdulhamid Ameir Salum, the manager of Zanzibar's Expanded Programme
on Immunization, said the outbreak was partly due to delays in vaccine
delivery caused by high global demand as well as to parents'
reluctance to bring their children to health centres for
immunization.

--
communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org>

[Zanzibar is a semi-autonomous part of the United Republic of
Tanzania. The HealthMap/ProMED-mail interactive map of Zanzibar can be
accessed at <http://healthmap.org/r/01cO>. - Mod.CP]

Tansania - Masern
28.08.2011

Ein Ausbruch hat bislang zu über 1.500 Erkrankten (überwiegend nicht geimpfte Kinder unter 5 Jahren) und 18 Todesfällen geführt. 6 Regionen des Landes sind betroffen: Arusha, Dar es Salaam, Iringa, Pwani, Morogoro und Tanga. Seit Mitte August gibt es einen Ausbruch auf Sansibar mit über 70 Erkrankten, die Insel war 5 Jahre lang frei von Masern. Impfschutz beachten. Fehlende Impfungen sollten gemäß den aktuellen STIKO-Empfehlungen nachgeholt werden. / Quelle: crm

MEASLES UPDATE 2011 (30)
************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
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<http://www.isid.org>

******
[1] Angola (BA)
Date: Mon 29 Aug 2011
Source: Angop Health [edited]


16 new cases of measles were recorded this month [August 2011], in
Balombo Municipality, central Benguela Province, two of which were
fatal, ANGOP has learned. According to the head of the health sector,
Adriano Cachiembe, the cases were recorded in Hoji-ya-Henda,
Chindumbo, and Kavitinga wards.

The municipal administrator, Julio da Silva Kwanza Santos, said
vaccination campaigns will be held during the period 9-13 Sep 2011.

--
communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org>

[Benguela is a province of Angola. Its capital is Benguela.
Municipalities in the province include Lobito, Bocoio, Balombo, Ganda,
Cubal, Caimbambo, Baia-Farta, and Chongor. It can be located in the
map of the provinces of Angola at
<http://en.wikipedia.org/wiki/Benguela_Province>. - Mod.CP]

******
[2] Congo DR (ER)
Date: Fri 2 Sep 2011
Source: ElmercurioDigital [in Spanish, machine trans. edited]
<http://www.elmercuriodigital.net/2011/0 ... ar-la.html>


The medical humanitarian organization Medecins san Frontieres (MSF)
has called the executive and their Congolese counterparts to initiate
immediate measles vaccination campaigns in Ecuador [Equateur] and
eastern [Orientale] provinces to stop the spread of the disease in the
country.

Since late 2010, the Democratic Republic of Congo (Congo DR) has
experienced an epidemic of measles that has affected more than 106 000
people and caused about 1100 deaths, mostly children. The disease is
said to be spreading to the provinces of Katanga, Kasai Oriental,
Occidentale, Maniema and South Kivu, because the vaccination campaign
planned for 2010 has not been carried out.

When the authorities declared a measles epidemic in April 2011,
emergency vaccination of children under 5 years was carried out, as
well as an additional campaign in July 2011. So far, more than 11
million children, 3 million of whom are under 15 years, have been
vaccinated with the support of MSF. However, these efforts have failed
to control the epidemic, which is now affecting Ecuador [Equateur] and
several eastern provinces, where vaccination coverage is very poor.

"Vaccination campaigns are planned for September 2011 in the provinces
of Ecuador [Equateur] and eastern [Orientale], but the decision to
implement them has still to be confirmed," warns Dr North Hurtado,
immunization coordinator for MSF. "Measles is a highly contagious
disease and its complications can be fatal. You can still save many
lives by vaccinating all children under age 5 who have not already
been vaccinated."

The 2 main partners of the Congolese Ministry of Health, the World
Health Organization and UNICEF, have been mobilized, and vaccines have
arrived in Kinshasa, the capital. The decision to initiate the
campaign now depends solely on the government and especially on their
economic cooperation.

"If the campaign begins in September [2011], it could be interrupted
when the rainy season begins. And with the start of the school year,
we face a greater risk of infection among children," said Dr Laurence
Sailly, medical coordinator for MSF in Congo DR.

MSF believes that the epidemic may spread to the eastern provinces
[from] Ecuador [Equateur] and is asking the government to ensure the
start of vaccination in September 2011 to stop the epidemic.

--
communicated by:
ProMED-mail from Health Map alerts
<promed@promedmail.org>

[A map showing the location of the provinces of the Democratic
Republic of Congo can be accessed at
<http://www.mapsofworld.com/democratic-r ... l-map.html>.
- Mod.CP]

******
[3] Somalia
Date: Fri 2 Sep 2011
Source: United Nations Children's Fund (UNICEF) [abbreviated &
edited]
<http://www.unicef.org/infobycountry/somalia_59699.html>


About 9000 cases of measles have been reported in Somalia since
January [2011]. In the capital Mogadishu, tens of thousands of
families displaced by drought and conflict are living in camps around
the city. Quarters are tight, making the conditions ripe for an
infectious disease like measles.

With tens of thousands of people crowded into displaced persons camps
in Mogadishu, Somalia, UNICEF and its partners are vaccinating
children against measles. "This is an airborne disease," explained Dr
Yasin Mohamed Nur of the World Health Organization (WHO). "It is
spread by coughing and sneezing, and imagine the risk when there are
so many people living in such a congested area."

Malnutrition makes the situation even worse. In south-central Somalia,
a region where some 40 per cent of children under the age of 5 are
acutely malnourished, the effects are disastrous. "When a person
becomes malnourished, their immunity drops, so he is prone to
everything," says WHO's Mohamed Shire. "When the child cannot get the
basic necessities," notes Mr Shire, "his body will utilize all the
nutrients that were stored in the body, and that will lead to a
reduction in immunity. If the child is already malnourished, he can
easily be infected by measles, and this can often lead to death."

The Horn of Africa is facing what has been described as the worst
drought in over half a century, and the UN has declared a famine
emergency in some regions. In Somalia, where the drought is compounded
by conflict, hundreds of thousands of people have fled to urban
centres and neighbouring countries. National malnutrition rates are
soaring. Combined with low immunization rates, they raise serious
concerns about large scale outbreaks of vaccine-preventable diseases.

Even before the current crisis, Somalia had low vaccine coverage
compared to most other nations, with routine immunization rates
stagnating between 30 and 40 per cent. The combined effects of
poverty, civil unrest and poor health care have negatively impacted
Somali communities even further. Modest gains made in immunization
over the last few years are now at risk, particularly with respect to
measles elimination and polio eradication.

Due to the crisis, a large number of children from Lower Shabelle,
Middle Shabelle, Bay, the Jubas and other regions have settled in
Mogadishu. Immunization activity in these regions stopped for nearly 2
years amidst conflict, leaving many of these children unprotected.
Over the last several weeks, UNICEF, WHO, and other partners have been
conducting emergency vaccination campaigns in parts of Mogadishu. A
plan is also in place to vaccinate all children in south-central
Somalia, where the famine is at its peak, over the next few months.

Despite hopes for the mass campaign, which is targeting 750 000
children in all, many concerns remain. "Insecurity remains one of our
biggest obstacles," says Dr Nur. "It is important to get full access
to everyone. Our concern now is for the [displaced persons] who will
arrive in Mogadishu after we have completed the campaign here."

[byline: Eva Gilliam]

--
communicated by:
ProMED-mail from HealthMap alerts
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[A map showing the location of Mogadishu and the administrative
divisions of Somalia can be accessed at
<http://en.wikipedia.org/wiki/File:Somal ... tricts.png>.
- Mod.CP]

MEASLES UPDATE 2011 (31)
************************
A ProMED-mail post
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*****
Tanzania (Zanzibar)
Date: Sat 10 Sep 2011
Source: The Daily News [edited]
<http://www.dailynews.co.tz/home/?n=23536&cat=home>


Health authorities here on Friday [9 Sep 2011] confirmed increasing
cases of measles in Zanzibar islands, prompting a daily 2-week
[duration] immunization campaign starting next Monday [12 Sep 2011].

"Measles is now a serious problem. We have so far recorded 262 cases
[up from 70 last month (August 2011) - Mod.CP] in both Unguja and
Pemba islands. 40 children are now in hospital," Mr Juma Duni Haji,
Minister of Health, said in a press conference held at the Ministry's
conference hall.

The minister said villages of Pangawe, Kianga, Mtofaani, Magogoni,
Welezo, and Kinuni on Unguja Island [the main island] were most
affected as he appealed to leaders at all levels, religious clerics,
and parents to join in the campaign by promoting awareness.

"In Pemba island, the problem has been recorded in all districts
including Micheweni, Wete, Mkoani, and Chakechake. We need to work
together," he said, adding: "We are working diligently to contain the
measles outbreak and to minimize the outbreak's impact on our
community. We are asking parents to make sure they respond well to the
immunization exercise."

Accompanied at the press conference by officials from WHO, UNICEF, and
from the ministry, the minister attributed the outbreak stubbornness
to low awareness about the importance of measles vaccine, and
negligence by parents. "In our efforts to control the diseases, we
have formed a task force; we have been active on surveillance; we have
opted for daily vaccination, and fortunately, we are working closely
with our development partners WHO and UNICEF," said the minister.

According to the ministry's Principal Secretary (PS), Dr Mohamed Saleh
Dahoma, a nationwide vaccination [campaign] against measles is planned
for November this year [2011]. The PS said measles causes a fever,
runny nose, cough and a rash over the body. The virus [is present] in
the mucus in the nose and throat; when the infected person sneezes or
coughs, the droplets spray into the air and can infect other
individuals. According to the health official, measles is so
contagious that if one person has it, 90 per cent of the people close
to the infected person and not immune from the disease will contract
it.

[Byline: Issa Yussuf]

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Communicated by:
ProMED-mail from HealthMap alerts
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[A map of the Zanzibar islands can be accessed at:
<http://www.shoortravel.com/zanzibarmap.html>.