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MEASLES UPDATE 2012 (29)
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Nigeria
Date: Thu 19 Jul 2012
Source: Nigeria Centre for Disease Control (NCDC), Federal Ministry of Health - Nigeria, Weekly Epidemiology Report Issue: Volume 2 No. 27 13 Jul 2012 [edited]


Update on suspected cases of Measles in Nigeria as of 13 Jul 2012
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5.1. In the reporting week 27 (2012), 64 suspected cases of measles with 0 deaths were reported from 14 states. Between weeks 1-27 2012, a total of 7371 suspected measles cases, 466 laboratory confirmed and 102 deaths (CFR 1.38 percent) were recorded.

5.2. NPHCDA and partners have launched an outbreak response strategy in 72 LGAs across the country.

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MEASLES UPDATE 2012 (30)
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Pakistan (K-P, FATA)
Date: Sun 29 Jul 2012
Source: The Express Tribune [edited]
http://tribune.com.pk/story/414351/meas ... n-mohmand/

Measles outbreak: Six children die in Mohmand
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PESHAWAR: Locals claim an outbreak of measles in Ambar tehsil of Mohmand Agency has killed six children. Officials confirmed the death of two of the children, but said they died because of an unconfirmed disease. [A tehsil is a city or town that has fiscal and administrative power over the villages and municipalities within its jurisdiction. - Mod.CP]

Local Qari Ali Gul told The Express Tribune on Saturday [28 Jul 2012] that the disease has struck the areas of Gumbati, Shaji Kor, Soor Tangi, Bakhmal Shah, Musa Kor and Khairo Kor, and has affected a large number of tribesmen. Another local, Mushtaq Khan, said that affected children were taken to Khar Hospital in Bajaur Agency. They said that the residents [asked] the agency surgeon to send inoculation teams to control the spread of the disease. They also urged the government to send mobile vaccination teams and said the situation may become uncontrollable if prompt action was not taken.

Mohmand Agency Officer, Dr Shabeer, denied the spread of the disease [had resulted in] the deaths. "Two deaths have been reported in Ambar and Utmanzai but by an unknown disease, we cannot confirm they were caused by measles," he said. He added that the areas further away lack qualified doctors and people depend on unqualified doctors. "The scarcity of proper health facilities worsens the situation in these circumstances," he said.

He claimed the Federally Administered Tribal Areas (FATA) Child Heath Project had worked in three community health centres, one in Daravo, one in Had Kor and one in Shati Meena. Ambar is a tehsil of the agency bordering Bajaur Agency. The area lacks basic amenities regularly, and has only one high and middle school with most residents going to schools in Charsadda.

In June, 211 children with symptoms of measles were brought to the Lady Reading Hospital (LRH) Peshawar from different areas of K-P [Khyber Pakhtunkhwa] and FATA. Hospital data revealed that a total of 989 cases of measles were brought to the LRH over the past six months, of which 884 were discharged and 44 had died. Nine patients left the hospital against doctors' advice.

A study conducted by Dr Majid Khan and Dr Tariq Anwar at LRH from 01 Nov 2011, to 22 May of this year, revealed that the measles outbreak in K-P and FATA was a result of poor vaccination campaigns, military conflict, migration and malnutrition in the area. Talking to The Express Tribune, Dr Khan explained that measles was an infectious viral disease that could easily spread through migrating people, especially if they have a weak immunity due to inadequate food intake. He said the hospital has received children as young as four months suffering from measles. Khan explained that children younger than nine months usually do not get measles as they have antibodies transmitted from their mothers during pregnancy. This shows that the mothers did not receive proper nutrition.

Measles is highly contagious and spread by a virus that is easily prevented by proper immunisation but can be fatal. It caused nearly 140 000 deaths worldwide in 2010, according to the World Health Organisation - 95% in low income countries with poor health infrastructure.

(By Mureeb Mohmand)

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[The Mohmand Agency is a district in the Federally Administered Tribal Areas of Pakistan created in 1951. Before that, the Mohmand Tribes were administered by the Deputy Commissioner based in Peshawar, Khyber-Pakhtunkhwa province of Pakistan. The interactive HealthMap of Pakistan can be accessed at:
http://healthmap.org/r/2s7B. - Mod.CP]

MEASLES UPDATE 2012 (31)
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[1] Nigeria

Date: 27 Jul 2012
Source: Epidemiology Report, Nigeria Centre for Disease Control (NCDC), Federal Ministry of Health, Issue: Volume 2 No. 29

Update on suspected measles cases
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In the reporting week 29 (2012), 89 suspected cases of measles with no deaths were reported from 20 States. Between weeks 1 - 29 2012, a total of 7550 suspected measles cases, 466 laboratory confirmed and 102 deaths (CFR 1.35) was recorded.

Nigeria PHCDA and Partners have launched outbreak response strategy in 72 LGA across the country.

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[A map of the states of Nigeria can be accessed at: http://www.waado.org/nigerdelta/Maps/Ni ... tates.html. - Mod.CP]

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[2] Pakistan (SW)
Date: Fri 3 Aug 2012
Source: Central Asia Online [edited]
http://centralasiaonline.com/en_GB/arti ... wsbrief-13

South Waziristan measles outbreak kills 5 children
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A total of 5 children in South Waziristan have died from measles during the past week, an official said. "Non-availability of measles vaccines has become a big problem and if the desired vaccines were not made available, the situation could slip out of control," Dr. Azmat Hayat Khan, agency surgeon, told Central Asia Online on Fri 3 Aug 2012.

Measles has affected about 400 children, of whom about 100 were hospitalised, he said. He warned of an outbreak throughout the agency if medics failed to immunise children immediately. Letters regarding the unavailability of measles vaccine have gone to the Federally Administered Tribal Areas (FATA) directorate of health, he said, expressing hope the vaccine would become available in a few days.

The Taliban have refused to allow polio vaccination in areas of South Waziristan they control, endangering more than 157 000 children below age 5, he said.

The directorate has received the agency surgeon's letter and is sending vaccines to South Waziristan, FATA Health Director Dr. Fawad Khan said. "We have also started vaccination in Mohmand, Bajaur and Khyber agencies, where measles had killed several children besides sending hundreds to hospitals," he said.

[Byline: Ashfaq Yusufzai]

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[The interactive HealthMap of South Waziristan (FATA) can be accessed at: http://healthmap.org/r/306S. - Mod.CP]

MEASLES UPDATE 2012 (32)
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[1] Nigeria (NCDC)
Date: Thu 9 Aug 2012
Source: Weekly epidemological report, Nigerian Center for Disease Control, Federal Ministry of Health Nigeria. Week 30, as at 3rd August. [edited]

Update on Suspected Measles as at 3 Aug 2012, 2012
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In the reporting week 30 (2012), 93 suspected cases of measles with no deaths
were reported from 23 States. Between weeks 1 and 30 2012, a total of 7648
suspected measles cases, 471 Laboratory confirmed and 102 deaths (CFR 1.35) were recorded.

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[2] Pakistan (K-P)
Date: Thu 9 Aug 2012
Source: The Express Tribune [edited]
http://tribune.com.pk/story/419546/immu ... les-cases/

Khyber-Pakhtunkhwa witnesses sudden upssurge in measles cases
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The number of measles cases in Khyber-Pakhtunkhwa (K-P) is rapidly increasing and posing a threat to its population. However, since a majority of the population has been vaccinated against the fatal disease, questions are being asked as to why there has been a sudden emergence of such a large number of cases.

A total of 4048 cases have been reported in the first five months of this year across the province, with 1276 cases in Peshawar, 642 in DI Khan, 579 in Malakand, 352 in Swat and 180 in Bannu, according to data collected by the expanded programme on immunisation (EPI) in K-P. Appallingly, a majority of patients who tested positive for measles had been vaccinated against the virus for one to five years, leading many to suspect that the routine vaccinations were either ineffective or expired.

Out of 4084 cases in the province, 3029 children were administered vaccinations while the remaining 1019 were either outside vaccination coverage or their parents were not aware of the importance to provide them timely vaccinations. Dir Upper, Dir Lower and Lakki Marwat are the three districts where not a single child was vaccinated while a small number of vaccinations were reported in Bannu, Kohistan and Shangla districts. Officials believe that since the government provided vaccination free of charge, the coverage area in K-P managed to vaccinate most children. The officials claim that the recent emergence of cases was due to a poor diet, lack of awareness, poverty, low immunity levels and non-availability of clean drinking water.

The provincial health department only runs a mass campaign to vaccinate children against measles whenever there is a spike in the number of cases in the province, the official added. While Pakistan's struggle to eradicate polio is well known since authorities launched a major awareness campaign through print and electronic media, billboards, brochures, and sermons in mosques, measles which is also a preventable illness has been given no such coverage in the government's expanded programme on immunisation.

"No child from a rich family has been found positive for measles or polio and other diseases and it only hits poor families, which shows that they are deprived of basic necessities of life including proper food, drinking water, knowledge of cleanliness, and awareness of diseases," an official of the health department said, requesting anonymity.

The official went on to add that vaccination alone could not prevent measles since a poor diet, unclean drinking water and low immunity levels cancel out the effect of vaccinations even if they are administered several times. "Most drinking water pipelines are laid alongside the sewerage system and thus potable drinking water is contaminated which causes many fatal diseases," the official said, adding that the government needed to facilitate less-privileged people to improve living standards. Deputy Director EPI, K-P Dr Jan Baz Afridi told The Express Tribune that the programme would sanction an awareness campaign in their strategy against measles, adding that most cases were due to negligence of parents.

"We have provided injections of all diseases to all major hospitals of the province where the residents can get them without charge, but cases are still reported from many districts which shows that parents are not aware of such a facility," Dr Afridi said.

(Byline: Noorwali Shah)

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[A map showing the locations of the districts of Khyber-Pakhtunkhwa province of Pakistan can be accessed at: http://www.nrdf.org.pk/maps/132-map-of-kpk - Mod.CP]

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[3] Pakistan (K-P)
Date: Sun 12 Aaug 2012
Source: The Express Tribune [edited]
http://tribune.com.pk/story/420891/meas ... worst-hit/

Measles outbreak: Ten UCs declared worst hit
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District government and health department officials declared 10 union councils (UCs) [in Upper Dir] as worst affected by the measles outbreak. Briefing DCO Muhammad Ali Shah during a meeting, Expanded Program on Immunization (EPI) Coordinator Dr Muhammad Gul said that the outbreak started two months ago. Later on, the DCO directed the department to start an anti-measles drive in these UCs and report to the DCO by 01 Sep 2012.

The Emergency [Officer] in charge at District Headquarters Hospital (DHQ) Hospital Dr Sahib Gul told The Express Tribune that more than 2000 patients with measles have been registered in the hospital since June, adding that none of them were vaccinated. However, no casualty [fatality] had yet been confirmed. Dr Gul said that two UCs, Jabar and Palam, were the worst hit areas. He complained that the government had launched a campaign but was not able to complete it.

District Supervisor for Vaccination Behre Karam said that they launched a campaign to provide immunisation against measles before June in which nearly 50% of the population, especially children under seven, were vaccinated.

"We will once again start the vaccination campaign after August 15 in the UCs to eradicate the disease. Before, we were not able to reach all the areas due to shortage of funds," he added. Karam further said that so far two children had died of measles in UC Kotki.

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[Upper Dir is one the 24 districts in the Khyber Pakhtunkhwa Province of Pakistan. The district was formed in 1996, when Dir District was divided into Upper Dir and Lower Dir. Its location can be found in the map at: http://en.wikipedia.org/wiki/Upper_Dir_District. - Mod.CP]

MEASLES UPDATE 2012 (33)
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Pakistan (FATA?KP)
Date: Tue 14 Aug 2012
Source: IPS News Agency [edited]
http://www.ipsnews.net/2012/08/pakistan ... bal-goals/


Pakistan's Measles Deaths Hinder Global Goals
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PESHAWAR: Measles outbreaks, which have killed at least 100 children in Pakistan's militancy-hit border areas since May, have prompted calls by experts for better cooperation in territories adjacent to Afghanistan with international immunisation campaigns. "The latest victims of this paediatric disease are children in the Mohmand Agency of the Federally Administered Tribal Areas (FATA) where nine deaths have been confirmed as a result of non-vaccination," Dr. Anwar Shah, top health officer in the agency, told IPS. Shah blamed unsettled conditions caused by Taliban militancy as well as poor public awareness of the value of vaccination for the outbreak of measles in the seven agencies and six border regions that make up the FATA and in adjacent Khyber Pakhtunkhwa province.

"My eight-year-old son died of measles last month. He hadn't been immunised," a farmer in the Lakaro area of Mohmand Agency, told IPS over telephone. He said he had to take his three surviving children to Charsadda, one of the 25 districts of Khyber Pakhtunkhwa, to have them vaccinated against measles.

In FATA's North Waziristan, where the outlawed Tehreek Taliban Pakistan group banned oral polio vaccination (OPV) in June, an estimated 163,000 children are said to be exposed to poliomyelitis. The result of the ban on OPV is that the FATA is now the only polio-endemic region in the world that harbours two strains of poliovirus, posing a threat to countries certified polio-free, according to the World Health Organisation (WHO) officials. According to Asghar Ali, a WHO doctor, most of the FATA's seven agencies have less than 45 percent vaccination coverage against the national target of 95 percent set by the 'Prime Minister's Emergency Polio Eradication Plan 2012'.

The situation is worst in the South Waziristan agency where the Taliban has ordered a ban on all vaccinations, leaving the children vulnerable not only to polio but also to measles and other infectious diseases. On Jul. 31, South Waziristan's chief surgeon Azmat Hayat Khan issued a warning that the Taliban's blanket ban could result in a measles outbreak and more deaths. "The problem is complex because apart from the ban on vaccination there is a shortage of vaccines," Khan told IPS. "Measles-affected children need to be admitted to hospital within 24 hours and this is not possible in the tribal areas where people lack transport or resources to move their children to facilities in KP," Khan said.

Khan said that besides the 100-odd children known to have died of measles since May about 3,000 have been treated in hospitals. "When unvaccinated children get measles, they need to be rushed to hospitals if they are to survive," Muhammad Aman, a pediatrician at the Khyber Teaching Hospital in Peshawar, told IPS. Dr. Jan Baz Afridi, top immunisation officer in KP, told IPS that additional vaccinators were being deployed in KP districts. "Our staff now visits villages and makes announcements from mosques over loudspeakers to encourage people to get all children up to 15 years of age immunised," he said.

Fawad Khan, FATA's chief health director, said: "Law and order is another problem hampering the government's effort to promote vaccination. We are looking to the government to ensure security of the health workers to carry out immunisation activities." "Vaccine-preventable ailments do not discriminate between cultures, religions, borders or language," Michael Coleman, communications specialist with the United Nations Children's Fund (UNICEF), told IPS. "A small number of unvaccinated children could put at the razor's edge the lives of thousands of children."

In April, UNICEF joined WHO and the Centres for Disease Control and Prevention of the United States in launching a global strategy to reduce measles deaths to zero by 2015. But the new strategy relies on high vaccination coverage and close monitoring of the spread of measles as well as rubella, using laboratory-backed surveillance and effective communication - grossly lacking in the FATA. Studies by the WHO, published in April, showed that accelerated efforts to reduce measles deaths had resulted in a 74 percent reduction in global measles mortality, from an estimated 535,300 deaths in 2000 to 139,300 in 2010. The WHO study estimated that during the 2000-2010 period, measles vaccine had saved over 9.6 million children.

"Since April, we have immunised 8,000 children against measles in the Jalozai refugee camp (outside Peshawar), where people displaced by military action against the Taliban in FATA are lodged," WHO's Dr. Junaid Shah told IPS. "It is much harder to immunise children in the FATA." Shah said that propaganda by the Taliban against oral polio vaccine had not only harmed the immunisation efforts in the FATA but was now proving to be a setback to global efforts to reduce deaths from measles.

[Byline: Ashfaq Yusufzai]

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Nepal (Doti)
Date: Wed 22 Apr 2012
Source: The Himalyan Times, Himalayan New Service [edited]
http://www.thehimalayantimes.com/fullNe ... sID=344520

Measles vaccines could have caused infants' deaths in Doti, says DPHO
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DIPAYAL: The Doti District Public Health Office today said primary investigations pointed at measles vaccines for the deaths of four infants in Kadamandau of Doti. Four infants between nine and 14 months had died in the remote village in Doti 24 hours after inoculation with measles and DPT (diphtheria, pertussis and tetanus) vaccines on Sunday. The two other infants who were also vaccinated on the same day at Deukanda vaccine centre at Kadamandau are undergoing treatment at Doti District Hospital.

Mahendra Dhwoj Adhikary of Doti DPHO said the infants who were administered with other than measles vaccines have not developed any life-threateningsigns. Dr Phanindra Baral at Doti hospital said they could, at this point of time, only surmise that there was something wrong with the vaccines. Few hours after the vaccination, the infants had started vomiting profusely and developed a deathly pallor. The vaccines that were administered to infants were not expired though, said DPHO, adding that the vials of measles vaccines had labels showing expiry date of September 2013. The vaccines were brought to the hospital from Dhangadhi 10 days ago.

Adhikary said with the deaths of four infants, he is in a dilemma whether to continue the vaccination campaign. Condition of those undergoing treatment is improving. Kadamandau locals today staged a sit-in in front of the hospital demanding a thorough investigation and punishment to the guilty. Doti-based human rights organisations also demanded that a probe be launched immediately. Experts to submit report by Sunday

The Child Health Division under the Ministry of Health and Population in Katmandu has formed a committee to investigate into the deaths of four infants in Kadamandau of Doti. CHD Director Dr Taranath Pokhrel said a team will reach Doti by Thursday to find out what went wrong. "An emergency meeting of adverse events following immunisation monitoring committee was held today and it has decided to send a team to Doti," said Dr Pokhrel. "The team comprising representatives from CHD and World Health Organisation and two child specialists will submit its final report by Sunday."

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[Death within hours of vaccination suggests gross contamination of the vaccine or during the process of administration of the vaccine, and cannot be accounted for by exposure of the vaccine to extremes of temperature. Further information is awaited.

Doti District is one of the 75 districts of Nepal. The Doti district, with Dipayal as its district headquarters, covers an area of 2,025 km² and has a population (2001) of 207,066. Its location is shown in the map at: http://en.wikipedia.org/wiki/Doti_District. - Mod.CP]

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[1] Horn of Africa (Ethiopia, Kenya & Somalia)
Date: Fri 31 Aug 2012
Source: Morbidity and Mortality Weekly Report (MMWR) 61(34); 678-684 [edited]
http://www.cdc.gov/mmwr/preview/mmwrhtm ... mm6134a4_e

Measles -- Horn of Africa, 2010-2011
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Member states of the World Health Organization (WHO) African (AFR) and Eastern Mediterranean (EMR) regions have set goals for measles elimination by 2020 and 2015, respectively. The two WHO regions include AFR member states Ethiopia and Kenya, and EMR member state Somalia. All three countries are in the Horn of Africa, where measles remains endemic, with periodic outbreaks despite efforts to achieve elimination goals (1). This report describes outbreaks that occurred in the Horn of Africa during 2010-2011. The outbreaks were exacerbated by a complex humanitarian emergency in Somalia, with an influx of an estimated 600 000 refugees into camps in Kenya and Ethiopia near the borders with Somalia. During 2010-2011, a total of 9756 measles cases were reported in Ethiopia and 2566 in Kenya, with wide age distributions, and 16 135 were reported in Somalia, with 78% occurring among children aged <5 years. Cases occurred predominantly in unvaccinated persons. Outbreak response immunization (ORI) strategies were implemented; however, outbreaks continued. To reach AFR and EMR measles elimination targets, uniform high coverage with 2 doses of measles-containing vaccine (MCV) must be achieved and maintained in Horn of Africa countries, including in refugee camps.

In 2010, the World Health Assembly endorsed targets to be met by 2015 as milestones toward eventual global measles eradication. These included 1) increasing first dose coverage with MCV (MCV1) to ≥90% nationally and ≥80% in every district, 2) reducing to and maintaining an annual measles incidence of <5 cases per million population, and 3) reducing estimated measles mortality by ≥95% in comparison with 2000 estimates (2). WHO recommends 2 MCV doses for all children and emphasizes on-time delivery of the first dose at age 9 months in countries with ongoing measles virus transmission (3). In Ethiopia, Kenya, and Somalia, MCV1 is provided in the routine childhood vaccination schedule at age 9 months, and a second dose of MCV is provided through periodic supplemental immunization activities (SIAs). In Somalia, MCV also is provided to children aged 9-59 months during child health days or SIAs. In refugee settings, Sphere standards for humanitarian response* recommend providing MCV to ≥95% of new arrivals aged 6 months-15 years and SIAs to prevent outbreaks (4). Infants that receive MCV1 at age <9 months should receive 2 additional doses at least 1 month apart and according to the national immunization schedule (3).

WHO and the United Nations Children's Fund (UNICEF) annually estimate MCV1 coverage administered through routine immunization services among children aged 1 year. Countries annually report the number of districts with ≥80% MCV1 coverage (5). In refugee camps, MCV coverage is monitored by the United Nations High Commissioner for Refugees using administrative records and nutrition surveys (6). Countries report annual measles surveillance data to WHO and UNICEF (7). In Kenya and Ethiopia, measles surveillance is case-based with laboratory confirmation of suspected measles (8). In Somalia, case-based surveillance with laboratory testing is limited to sentinel sites; an integrated disease surveillance system collects aggregated case counts of clinically confirmed measles cases nationally.

Ethiopia
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Estimated MCV1 coverage in Ethiopia was 56% in 2010 and 57% in 2011; the percentage of districts reporting ≥80% MCV1 coverage was 45% in 2010 and 43% in 2011. A nationwide measles SIA targeting approximately 9.1 million children aged 9-47 months was conducted in two phases; seven regions were targeted in October 2010 and the four remaining regions in February 2011 (Figure 1). Administrative coverage† was 106%, and coverage based on a population-based survey was 88.2% (95% confidence interval [CI] = 85.1%-90.6%); 87 (91%) districts reported >95% administrative coverage. During 2010-2011, annual reported measles incidence decreased from 75 to 42 per 1 million population; the percentage of reported cases among children aged <5 years decreased from 45% to 31% [Data tabulated in the original text].

Kenya
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Estimated MCV1 coverage in Kenya was 86% in 2010 and 87% in 2011. The percentage of districts reporting ≥80% MCV1 coverage was 66% in 2010 and 65% in 2011. The most recent nationwide measles SIA in 2009 reached approximately 82% of an estimated 5.5 million children aged 9-59 months. During 2010, 105 measles cases were reported, primarily in the northeast during the first half of the year. Starting in January 2011, measles cases increased throughout the country, first occurring in the Northeast Province and among the Somali community in Nairobi. National reported measles incidence increased from 3 per 1 million population in 2010 to 59 per 1 million population in 2011. During July-August 2011, ORIs were conducted in five districts in the Northeast Province; however, cases coinciding with outbreaks in Dadaab refugee camps and in southern Somalia continued to occur.

Somalia
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Estimated MCV1 coverage in Somalia was 46% in both 2010 and 2011. The percentage of districts reporting ≥80% MCV1 coverage was 20% in 2010 and 35% in 2011. During three rounds of child health days conducted during May 2010-January 2011, southern and central regions were inaccessible because of armed conflict, and national administrative coverage was 39%-62%. During 2010-2011, reported measles incidence increased from 145 to 1,542 cases per 1 million population [Data tabulated in the original text]. ORIs were implemented, but cases continued to occur in 2011.

Refugee Camps
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In 1991, the Hagadera, Ifo, and Dagahaley camps were established in the Dadaab refugee complex in northeastern Kenya to house Somali refugees fleeing civil war. During 2005-2011, the estimated refugee population increased from 127 387 to 443 974 in Dadaab. To accommodate approximately 75 000 refugees in unplanned settlements, Ifo-extension and Kambioos camps were added in August 2011. In the Dollo Ado region of southern Ethiopia, Bokolmanyo and Malkadida refugee camps were established in response to refugees arriving from Somalia during 2009-2010. In 2011, the estimated population of the Dollo Ado camps increased from 46 000 to 142 233, and Kobe, Hilaweyn, and Bur-Amino camps were opened to accommodate the influx of refugees.

In the Dadaab refugee camps, sporadic measles cases occurred during January-June 2011. In July 2011, an outbreak began, coinciding with a large influx of refugees and the measles outbreak in Somalia; 59% of cases were among refugees aged ≥15 years. During 2011, ORIs were conducted during March 28-April 7, targeting children aged 9 months-14 years; during August 1-5, targeting children aged 6 months-5 years; and during September 12-17, targeting adults aged 15-29 years. In addition, in August 2011, measles vaccination was provided to new arrivals aged 6 months-29 years, all hospitalized pediatric patients, and unvaccinated household contacts aged 6 months-14 years. Beginning in October, reported cases decreased as the numbers of newly arriving refugees also decreased. During March-April 2011, a cluster of measles cases occurred in the Dollo Ado refugee camps, followed by an outbreak involving 436 cases during July-October; 44% of cases were among refugees aged ≥15 years. In September 2011, routine measles vaccination was expanded to include new arrivals aged 6 months-29 years. Beginning in September, the number of new arrivals and reported cases decreased.

MMWR Editorial Note
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Severe drought, famine, war, large-scale population movements, and overcrowded refugee camps led to a complex emergency in the Horn of Africa during 2010-2011. In Somalia, low MCV coverage in areas where immunization services could not be provided for nearly 2 years led to a massive measles outbreak, primarily among children aged <5 years. Population movements, including large influxes of refugees from southern and central areas of Somalia into camps in Kenya and Ethiopia near the Somalia borders led to measles virus transmission among refugees and to outbreaks in Ethiopia and Kenya. After ORIs, the number of cases decreased in the refugee camps; the decrease coincided with a decrease in the number of arriving refugees. However, large outbreaks continued in Kenya and Somalia.

In Somalia, a decades-long civil war and the absence of a centralized government crippled efforts to provide basic public health services, including delivering vaccinations to children. Strategies to achieve high vaccination coverage in such settings should use "days of tranquility" to implement vaccination and child health days (9), and should be designed to ensure that every child receives 2 MCV doses, in accordance with WHO recommendations (3). In 2012, the measles outbreak has continued, and additional vaccination activites should be implemented.

In Kenya, 41% of cases nationally occurred among children aged <5 years, indicating that substantial numbers of children were missed by ORIs and SIAs during the past 4 years. In 2011, an ORI was implemented 6 months after the start of the outbreak, targeting a narrow age group in a limited geographic area, but cases continued to occur. A nationwide follow-up measles SIA is planned for 2012, and efforts are needed to ensure a high-quality campaign.

In Ethiopia, although estimated MCV1 coverage nationally was ≤50% before 2009, measles incidence decreased from 2010 to 2011, which might be related to achieving high coverage in the nationwide SIA targeting children aged 9-47 months during 2010-2011. A comprehensive review of surveillance data and SIA implementation conducted in March 2010 led to the development of SIA "best practices," which were implemented during the 2010-2011 SIA, including involving local leaders in microplanning and social mobilization, focusing on hard-to-reach areas, improving training, and house-to-house canvassing during the SIA.

To prevent large measles outbreaks and ultimately reach measles elimination goals in EMR by 2015 and in AFR by 2020, vaccination strategies must be implemented to achieve and maintain uniformly high 2-dose MCV coverage to reach the 93%-95% population immunity threshold that can provide herd immunity in all countries. In refugee settings, Sphere minimum standards for humanitarian response should highlight the need to provide 1) 2 MCV doses to every child, 2) close monitoring of 2-dose MCV coverage, and 3) inclusion of informal settlements and host communities in vaccination plans. Outbreak preparedness should be maintained to ensure high-quality surveillance for measles cases, appropriate case management, and rapid ORI strategies that reach susceptible populations, based on the age distribution of infected persons in a particular outbreak (10).

Notes and Summary
-----------------
The member states of the World Health Organization's African Region (AFR) and Eastern Mediterranean Region (EMR) have set goals for measles elimination by 2020 and 2015, respectively. After implementation of measles vaccination strategies, estimated coverage with the first dose of measles-containing vaccine (MCV1) in 2010 was 76% in AFR and 85% in EMR. However, reported measles cases in AFR increased from 37,012 to 199,174 during 2008-2010. Reported measles cases in EMR increased from 12,120 to 36,605 during 2008-2009 but declined to 10,072 in 2010. During 2010, reported measles incidence per 1 million population was 238 in AFR and 17 in EMR.

Estimated MCV1 coverage for Ethiopia, Kenya, and Somalia in the Horn of Africa was 56%, 86%, and 46% in 2010, and 57%, 87%, and 46% in 2011, respectively. Measles outbreaks occurred in the region and were exacerbated by a complex humanitarian emergency in Somalia. During 2010-2011, annual reported measles incidence in Somalia increased from 145 to 1,542 cases per 1 million, and an influx of refugees from Somalia into border camps in Kenya and Ethiopia resulted in outbreaks in the camps. Outbreak response immunization campaigns were implemented but with limited effect.

To reach AFR and EMR measles elimination targets, uniform high coverage with 2 doses of measles-containing vaccine (MCV) must be achieved and maintained in Horn of Africa countries, including in refugee camps where Sphere standards for humanitarian response should be fully implemented. To reach global measles reduction targets, strengthened vaccination strategies including supplemental immunization activity "best practices," uniform 2-dose MCV coverage, and improved outbreak preparedness and response among displaced populations are necessary to achieve immunity to measles in 93%-95% of the population.

[Interested readers should access the original text at the source URL to view the figures, references and tabulated data accompanying the text. - Mod.CP]

*****

[2] Kenya (Bungoma)
Date: Fri 31 Aug 2012
Source: The Star [edited]
http://www.the-star.co.ke/local/western ... ldren-dead

Fears over measles outbreak
------------------------
Health experts in Kimilili [Bungoma district] have raised an alarm over a measles outbreak. This follows the death of three children from the disease in Kambini. Twenty people are feared to have contracted the disease. Kimilili district medical officer Mutoro Wambasi yesterday told the Star that the patient's blood samples have been sent to KEMRI [Kenya Medical Research Institute]in Nairobi for further tests and analysis.

He said they are working with experts from the World Health Organisation, who have come in handy in providing technical advice on the reported cases. "I call upon other NGOs to show up and assist in the efforts to curb this outbreak to avert more deaths," he said. Wambasi attributed the outbreak to ignorance as parents do not take their children for immunisation. He however requested the residents to take children with measles symptoms to the nearest health facility to prevent the spread of the disease. "We are liaising with the Ministry of Public Health to carry out emergency vaccination to contain the disease," he said.

(By John Nalianya)

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[Kimilili is a town and area in Kenya's Bungoma District. Its is located near Mount Elgon, on the Kenya-Uganda border.
Bungoma District can be located in the map of the districts of Kenya at: http://www.machakos.org/maps_photos.htm. - Mod.CP]

*****

[3]Pakistan (NW)
Date: Thu 30 Aug 2012
Source: The Express Tribue [edited]
http://tribune.com.pk/story/428117/fata ... aziristan/

Fatal outbreak: Measles kills 2 infants in North Waziristan
------------------------------------------------
MIRANSHAH: Measles claimed the lives of two more infants in North Waziristan on Tuesday [28 Aug 2012] , increasing the number of people killed by the disease to 18 since April. An 18-month-old girl and one-year-old boy died of measles pneumonitis in Darpa Khel area of tehsil Miranshah, said Agency Headquarters Hospital Miranshah MS Dr Muhammad Sadiq, adding that 25 more people are admitted at the hospital.

The outbreak of measles started in April across the Agency. Sadiq said that in the past week many patients have come from Darpa Khel and Madakhel because the localities have major sanitation problems. "We started vaccinating children but the disease resurfaced after a gap of one month," he said, adding that most of the vaccines provided by the government have expired because of high temperatures and prolonged power outages.

"Most of the children in Darpa Khel are suffering from the disease," said Dr Muhammad Ali, a paediatrician at the hospital, adding that three of the 25 patients admitted have measles pneumonitis. "We discharged 70 patients on Tuesday after giving them medication," he added. He said that treatment cannot be provided for measles pneumonitis because the patient's body stops responding to medicines and people die within three days. The pediatrician said that most of the patients at the hospital were shifted from Khost, Afghanistan. "The Pakistani government could not vaccinate children from Afghanistan and when the epidemic broke [out] there, patients came to Pakistan for treatment, infecting children here."

Ali added that more vaccines are needed. "If we are not given enough vaccines we will not be able to control the situation," he said, adding that they have asked authorities in Peshawar to assist them. He said that deaths have been reported in Shawal, Datta Khel Birmal and Miranshah.

(By Nasruminallah)

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[1] Kenya (Pokot)
Date: Thu 20 Sep 2012
Source: The Standard [edited]
http://www.standardmedia.co.ke/?article ... n-in-Pokot


Measles outbreak claims 3 children in Pokot
-------------------------------------------
A total of 3 children have died and over 500 others infected following a measles outbreak in West Pokot County. Health officials said the disease was spreading fast and feared the death toll could rise unless urgent measures are taken. Pokot North District Health Officer [MoH] Obadiah Singoei confirmed the 3 deaths. Dr Singoei said blood samples have been taken to Kenya Medical Research Institute for analysis.

"Hundreds of children have been infected and the disease is spreading at an alarming rate in remote villages bordering Pokot-Turkana counties and Kenya-Uganda border," said the MoH. He said hardest hit areas in the district are not accessible due to rough terrain and lack of roads. The MoH identified the most affected areas as Konyao, Alale, Kasei, Kanyerus and Ombolion location along Pokot-Turkana border. Singoei said lack of funding has hindered vaccination campaigns against the epidemic that is threatening the lives of pastoralist children.

The disease, he said, broke out in villages in Alale Division before spreading to the neighbouring locations. Singoei said no vaccination has been conducted due to lack of funds. He said the Government provided the vaccines but lacked money to mobilise health workers and transport to conduct the exercise in the vast district. "We expected to conduct a mop up against the disease but we lack funds for logistics and we are appealing for financial support from humanitarian agencies such as Action Aid, World Vision and Unicef," he said. Information and Communication minister Samuel Poghisio urged the Government to speed up vaccination to save lives.

The West Pokot immunisation coverage stands at 60 per cent while the national coverage is at 92.

[Byline: Osinde Obare]

---
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["A vacation campaign has stalled because the Government provided the vaccines but lacked money to mobilise health workers and transport to conduct the exercise in the vast district. We expected to conduct a mop up against the disease but we lack funds for logistics and we are appealing for financial support from humanitarian agencies."

West Pokot District is an administrative district in the Rift Valley Province of Kenya. It can bee located in the interactive HealthMap of Kenya at: http://healthmap.org/r/01fN. - Mod.CP]

****

[2] Kenya (Nandi
Date: Fri 14 Sep 2012
Source: The Star, Nairobi [edited]
http://allafrica.com/stories/201209140157.html


Kenya: Doctors warn against measles outbreak
---------------------------------------
Doctors in Nandi North district yesterday [13 Sep 2012] started immunising hundreds of children against measles following an outbreak of the disease in the area. The area Medical Officer of Health, Erik Terer, said children of followers of a religious sect in Kabiyet division have opposed the immunisation of their children.

"Members of the church have resisted efforts by the Ministry of Public Health to immunise their children and protect them from disease because they believe in the healing by the Holy Ghost," he said. Terer said more blood samples of the victims had been taken to the Kenya Medical Research Institute for analysis.

He said 5 children who have been admitted to the Kabiyet Health Centre were in a stable condition while several others have been treated and discharged. The church doctrines prohibit childhood immunisation and do not believe in modern western medicine [with the result that] parents keep their children at home [avoiding] compulsory immunization for all infants, Dr Terer revealed.

He said he had instructed public health officers in the district to ensure that all sick children of the members of the cult were taken for medications while those not immunised should be inoculated as required by law [because] their resistance is unacceptable and contravened children's rights. He commended members of the provincial administration for the support that enabled the revelation and the disease outbreak.

Areas seriously hit include Cheptuiyet location in Mosop where the religious sect has its big following and [accordingly] the Ministry of Public Health plan to conduct [a] massive campaign to vaccinate children. Paul Cheruiyot, a child Rights activist, called for the prosecution of parents and members of Dini ya Roho [sect] for violating the children rights.

[Byline: Barry Salil]

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[In this district of Kenya measles vaccination is being impeded by members of a religious sect who refuse to allow their children to be vaccinated. Compulsion is being considered. Nandi north District can be found in the interactive HealthMap at: http://healthmap.org/r/3uhVhttp://healthmap.org/r/3uhV. - Mod.CP]

MEASLES UPDATE 2012 (36)
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[1] Republic of Congo (Likouala)
Date: Sat 22 Sep 2012
Source: Actualite information Afrique - Afriquejet [edited]
http://www.afriquejet.com/health-2012092245640.html


Measles epidemic kills 22 in Republic of Congo
---------------------------------------
An outbreak of measles, which has been raging in Likouala, North-eastern Republic of Congo, since April has already killed 22 people, the state-run radio said Friday [21 Sep 2012]. The epidemic, which initially hit Liranga and Betou, has now reached Impfondo and Epena.

Following the outbreak, the Ministry of Health on Thursday [27 Sep 2012] launched a 5-day vaccination campaign against measles in the district. Vaccination teams will travel throughout the localities of the Republic of the Congo, which since 2009 has sheltered more than 100 000 refugees from the Democratic Republic of Congo (DRC), who are fleeing inter-ethnic violence in the Equateur province.

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[Haemorrhagic fevers are only one of the types of infection prevalent in the Congo geographic region of Africa.

Likouala, Republic of Congo, can be located in the interactive HealthMap at: http://healthmap.org/r/1RZy. - Mod.CP]

******
[2] Namibia (Ohangwena), Angola
Date: 27 Sep 2012
Source: The Namibian [edited]
http://www.namibian.com.na/news/full-st ... ohangwena/


Measles outbreak in Ohangwena
-----------------------------
The Ministry of Health and Social Services started a measles vaccination campaign on Monday [24 Sep 2012] in areas of the Ohangwena Region bordering Angola to contain a measles outbreak there. The measles outbreak was confirmed by the acting health director in the region, Dr Odon Nkongolo, who said that most of the cases originated in Angola. Dr Nkongolo said the region experienced a smaller measles outbreak in the Engela Health District in January this year [2012].

The numbers of cases reported in the district in the last 2 months have shown a sharp increase. So far 68 suspected cases have been reported, of which 10 have been confirmed. Those confirmed to have contracted measles were treated at the Engela District Hospital. No deaths have been reported.

60 percent of the cases diagnosed were in children younger than 5 years, but children between 6 and 7 years, and adults, have also been diagnosed with measles. A number of people have been treated and discharged from the Engela hospital and by Tuesday [25 Sep 2012] only 5 children were still in hospital.

According to Dr Nkongolo, the latest measles outbreak has mostly affected villages or areas such as Oshikango, Onamhinda, Eeshoke, Okahadulu, Omafo and Oimbandalunga. "So far the situation is under control and measures have been put in place to vaccinate all children between 9 months and 5 years. This started already on Monday this week [24 Sep 2012] and we are still busy in those villages," Dr Nkongolo said.

They are also monitoring the situation in nearby villages in the Engela Health District. He said the Angolan health authorities have been contacted through the World Health Organisation.

[Byline: Oswald Shivute]

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["60 percent of the cases diagnosed were in children younger than 5 years, but children between 6 and 7 years, and adults, have also been diagnosed with measles."

Ohangwena is one of the 13 regions of Namibia. The northern and western parts of the region are the most densely populated of this essentially subsistence agricultural region in which small scale mahangu cultivation and the keeping of cattle form the predominant activities. Ohangwena is located in the north of Namibia, and can be located in the interactive ProMED/HealthMap at http://healthmap.org/r/3zGD. - Mod.CP]

******

[3] Pakistan (Swat)
Date: Mon 24 Sep 2012
Source: The Express Tribune [edited]
http://tribune.com.pk/story/441344/meas ... -in-kalam/


Measles outbreak: Children infected in Kalam
--------------------------------------------
Over 100 children have been infected with measles during the last 2 days in Kalam Tehsil, it has been learnt. The disease is spreading fast as there are not enough health facilities or doctors in the area, Ahmadin Siddiqui, a local journalist and social activist, told The Express Tribune. Dozens of children are being brought to local hospitals daily and dispensers are performing the duties of doctors as an emergency measure, said Siddiqui. He said the reason for the outbreak, according to health experts, is that the children had not been administered the required vaccines to protect them against measles.

Locals have demanded of the government to provide better health facilities in the area and appoint a permanent doctor at Kalam's central hospital. Dr Mohammad Imran, who runs a private clinic in Kalam, said that vaccination campaigns by the government are "weak" in the area and parents don't bother to get their children vaccinated against the disease. He said the best way to protect children against measles is to administer the MMR (measles, mumps and rubella) vaccine after the age of one. Given the present outbreak, he urged local parents to get their children between the ages of 4 to 6 vaccinated against the disease.

The central hospital in Kalam lacks the required health facilities and it is next to impossible for a majority of locals to go to hospitals in Mingora for vaccination, said Nazir Ahmad, a university student. He stressed that the health department should establish permanent vaccination centres in Kalam and send mobile teams to remote villages to prevent further outbreaks. Executive District Officer (EDO) Health Dr Khurshid said that medical teams have been dispatched to the affected areas which have so far administered vaccines to 88 children. He said that after clubbing [sic] details of the vaccination drive being conducted in Kalam and Matiltan, where 2 children recently died of measles, the teams have so far visited 700 houses and vaccinated 273 children. Dr Khurshid said that locals are also being informed about preventive measures they should take to avoid spread of the disease.

The EDO said that a qualified doctor has been appointed in Kalam's central hospital, adding that he will be taking charge of his duties soon.

[Byline: Fazal Khaliq]

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["Over 100 children have been infected with measles during the last 2 days in Kalam Tehsil, it has been learnt. The disease is spreading fast as there are not enough health facilities or doctors in the area,"

Kalam is a community along the upper reaches of the Swat River in Swat Valley, in the Khyber Pakhtunkhwa province of Pakistan. A map of the Swat Valley can be accessed at: http://www.bing.com/maps/?cp=35.383333~ ... 072.183333. - Mod.CP]

MEASLES UPDATE 2012 (37)
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*****

[1] Angola ( Kuando Kubango)
Date: Fri 12 Oct 2012
Source: Angop Health [edited]
http://www.portalangop.co.ao/motix/en_u ... 81c75.html


Ten people died of measles virus infection from 17 Sep 2012 to the present date in Menongue City, capital of the south eastern Kuando Kubango province, a fact that is worrying the local health authorities. ANGOP [Angola News Agency] has learnt that most of the deceased are children below the age of 2, but there is also the record of a 35 year old adult.

According to the head of the Menongue Municipality Health Department, Carlos Jonas, who gave this information to ANGOP on Thursday [11 Oct 2012], the authorities have reinforced routine vaccination activities. From Thu 17 Sep 2012 up to the present date, the authorities recorded 320 cases of measles in Menongue City, a number that is deemed very high considering the period of the outbreak.

According to official sources, 10 people are currently inpatients in the central hospital for medical assistance, while others are getting ambulatory treatment.

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[The death toll of 10 individuals (all but one less than 2 years old) among 320 cases within a period of 25 days is an example of the devastating impact of measles virus infection in the absence of comprehensive immunisation.

A map of the provinces of Angola showing the location of Menongue City in Kuando Kubano province can be seen at http://www.mapsofworld.com/angola/angol ... l-map.html. - Mod.CP

A ProMED-mail HealthMap for Angola can be found at http://healthmap.org/r/1iGj.]

******
[2] Kenya (Narok North)
Date: Mon 8 Oct 2012
Source: AllAfrica, ex The Star (Nairobi) [edited]
http://allafrica.com/stories/201210090123.html


Measles cases in Narok North district have been reduced drastically, according to district medical officer of health Dr David Kuria. Addressing reporters in his office yesterday [7 Oct 2012], Kuria said 346 cases of measles have been reported since January [2012]. He attributed the drop to the stringent measures which were put in place by the Department of Public Health.

Kuria thanked parents for ensuring that children below 5 years old are immunised. The medical officer said the sustainable campaigns against the disease carried out in Olokurto, Mao and Central divisions helped in achieving 60 per cent coverage in the fight against the disease. However, Kuria accused some parents of failing to take their children for immunisation. "These parents do not take their children to be immunised during clinical check-ups. This has led to the outbreak of the disease in some places," he said.

[byline: Kiplang'at Kirui]

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

["Kuria thanked parents for ensuring that children below 5 years old are immunised. The medical officer said the sustainable campaigns against the disease carried out in Olokurto, Mao and Central divisions helped in achieving 60 per cent coverage in the fight against the disease."

A map of the districts of Kenya showing the location of Narok district in the south west of the country can be accessed at http://www.machakos.org/maps_photos.htm. - Mod.CP

A ProMED-mail HealthMap for Kenya can be found at http://healthmap.org/r/1zkN.]

MEASLES UPDATE 2012 (38)
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*****

Angola (Huila)
Date: Fri 19 Oct 2012
Source: ANGOP Health [edited]
http://www.portalangop.co.ao/motix/en_u ... 33eaf.html


According to the Angop news agency, 5 children died of measles this month [October 2012] in Chibia municipality, southern Huila province as a result of 35 cases recorded in the region. A local health source said that despite the deaths, the outbreak is under control as a vaccination campaign has been in progress since September 2012.

The campaign is taking place in the localities of Jau, Capunda, Cavilongo, Quihita and at the municipal headquarters. The local health authorities are calling on parents to rush to a health centre if they suspect their child has measles.

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[Five deaths of children among 35 cases is an extraordinarily high case/fatality ratio. It suggests deficiencies in surveillance.

Chibia is a town and municipality in Huila province in Angola. A map of Angola showing the location of Huila can be accessed at: http://www.mapsofworld.com/angola/angol ... l-map.html. - Mod.CP

A ProMED HealthMap for Angola can be found at http://healthmap.org/r/1iGj.]

MEASLES UPDATE 2012 (39)
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*****

Zambia (Kitwe)

Date: Tue 23 Oct 2012
Source: The Times of Zambia [edited]
http://www.times.co.zm/?p=16701


Mpelembe records new measles cases
-------------------------------
Mpelembe Secondary School in Kitwe has recorded 3 more suspected measles cases. This brings the number of cases [reported] on Wed 17 Oct 2012 to 53. School principal Margaret Chilando and clinic sister-in-charge Dorothy Bolla confirmed this development yesterday [Mon 22 Oct 2012] in separate interviews. 2 pupils have since been quarantined. Ms Bolla said 2 grade 9 pupils and a girl from the school township were cases recorded yesterday. She said the district health management team had collected samples and taken them to Lusaka [the capital city] for examination. "However, the situation is under control and those isolated are in stable condition," Ms Bolla said.

The school recorded 49 cases of measles on Wednesday last week [17 Oct 2012] thus compelling management to prematurely close non-examination classes.

[Byline: Stanslous Hgosa]

--
Communicated by:
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[Kitwe is the 2nd largest city in terms of size and population in Zambia. With a population of 504 194 (2010 census provisional). Kitwe is one of the most developed commercial and industrial areas in the nation, alongside Ndola and Lusaka. It is located on the border with the Democratic Republic of Congo and can be found in the map of Zambia at: http://geology.com/world/zambia-satellite-image.shtml. - Mod.CP]

MEASLES UPDATE 2012 (40)
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*****

[1] Angola (Cunene)
Date: Mon 5 Nov 2012
Source: Agence Angola Press [in French, trans. Mod.CP, edited]
http://www.portalangop.co.ao/motix/fr_f ... fea01.html


19 new cases of measles have been diagnosed in the last 48 hours at the Onahumba Health Centre in Ondjiva, Cunene province, an increase of 5 cases with respect to the previous 48 hours. The data are contained in the report of the health unit, which indicated that these cases of measles have been reported in children aged 15 months to 14 years resident in rural areas. According to this report, 8 of these children have been admitted to the Pediatric Ward, and 7 are hospitalised in the Internal Medicine Department.

--
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[Measles remains widespread in Angola despite continuing vaccination campaigns. Earlier this year (2012), a similar outbreak was reported in Huila province (Measles update 2012 (38) 20121021.1356456).

The province of Cunenen is located in the southwest of Angola. A map showing the locations of the provinces of Angola can be accessed at: http://www.atozmapsdata.com/zoomify.asp ... ngola_Pol2. - Mod.CP

A ProMED HealthMap is available at http://healthmap.org/r/1iGj.]

******
[2] Nigeria (FCT)
Date: Wed 7 Nov 2012
Source: Leadership [edited]
http://leadership.ng/nga/articles/39406 ... ncils.html


The Federal Capital Territory (FCT) Administration said it has recorded cases of measles virus in 3 of the 6 area councils in the territory. Secretary of the FCT Primary Health Care Development Board, Dr. Rilwan Mohammed, who disclosed this yesterday [6 Nov 2012], said that the listed councils include Gwagwalada, Kuje and Bwari.

Mohammed, who was speaking on the sidelines at a state level training during Maternal, Neonatal and Child Health Week (MNCHW) organized for senior health officials in the FCT, said the board was already working to contain the disease and prevent a recurrence. "The affected areas have come to collect more vaccines from us, and even though we don't have the actual number of people affected, we have started massive vaccination and have given out over 1000 vaccines," he said.

Speaking in an earlier address to declare the training workshop open, he said the MNCHW was one of the key interventions of the board in area councils, with focused awareness and service delivery on maternal, newborn and child health care.

Mohammed recalled that the last MNCHW held in June 2012 recorded 61 per cent vitamin A coverage, 64 per cent Albendazole, and 42 per cent iron folate coverage and urged the trainees to work hard during the MNCHW, scheduled to commence on 17 Nov 2012, to surpass the record.

He also urged them to transmit what they would be taught during the training to health workers in all the health care facilities in the territory and to also mobilise eligible women and newborn children to avail themselves of the services to be offered during the weeklong programme. Some of the trainees were optimistic that the training would enable them shift to a more integrated approach towards offering qualitative primary health care service delivery.

[Byline: Catherine Agbo]

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[The Federal Capital Territory (FCT) is the area that surrounds Abuja the capital city of Nigeria. It was carved out in 1976 from parts of Nasarawa, Niger, and Kogi states in the central part of Nigeria. An administrative map of Nigeria showing the location of FCT can be accessed at: http://www.glpinc.org/Graphics/Project_ ... states.jpg. - Mod.CP

A ProMED HealthMap is available at http://healthmap.org/r/1qGF.]

******
[3] Darfur (North)
Date: Tue 6 Nov 2012
Source: All Africa, Radio Dabanga (Hilversum) [edited]
http://allafrica.com/stories/201211060061.html


The incidence of measles cases in different areas of North Darfur has increased to 77, as compared to the 52 cases registered before [the Festival of Eid al-Adha, the Ministry of Health of North Darfur announced on Mon 5 Nov 2012. According to the ministry, the affected areas are El-Sref Beni Hussein, Kabkabiya, and Saraf Omra. In the latter, 15 new cases have been reported in addition to the 10 cases already registered, it was pointed out.

The Director of the Ministry of Health in North Darfur, Dr. Munir Mohammed Mattar, attributed the increase of measles cases to the densely populated gold mining area of Jebel 'Amer, which employs 60 000 workers. Mattar announced the formation of a joint initiative between the states of Central, West, and South Darfur aimed at quickly intervening and reducing the spread of the disease. In addition, the director denied that people infected with measles are dying, and he denied the existence of yellow fever in North Darfur [but see comment below]. Lastly, Mattar asserted that there is no link between cases of yellow fever and of measles in North Darfur.

--
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[Regarding the occurrence of yellow fever, in fact Sudan's Federal Health Ministry announced that the number of yellow fever cases in Darfur has increased to more than 143, including 63 deaths, according to Radio Dabanga on Sun 4 Nov 2011. The Ministry confirmed the emergence of new cases among the population in the southern regions of El-Geneina in West Darfur and the adjacent areas in Central Darfur, see ProMED-mail post: Yellow fever - Africa (10): Sudan (Darfur) 20121106.1395260.

According to Wilkipedia, Darfur is a region in western Sudan. An independent sultanate for several hundred years, it was incorporated into Sudan by Anglo-Egyptian forces in 1916. The region is divided into three federal states: North Darfur, South Darfur and West Darfur. Because of the war in Darfur between Sudanese government forces and the non-Arab indigenous population, the region was in a state of humanitarian emergency between 2003 and 2011.

For a map of Sudan, see the March 2012 map of Sudan available on Relief Web at http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf. For the HealthMap/ProMED map of Sudan, see http://healthmap.org/r/1A1E. - Mod.CP]

******
[4] Zambia (Kitwe)
Date: Tue 23 Oct 2012
Source: The Times of Zambia [edited]
http://www.times.co.zm/?p=16701


Mpelembe Secondary School in Kitwe has recorded 3 more suspected measles cases. This brings the number of cases [reported] on Wed 17 Oct 2012 to 53. School principal Margaret Chilando and clinic sister-in-charge Dorothy Bolla confirmed this development yesterday [Mon 22 Oct 2012] in separate interviews. Two pupils have since been quarantined. Ms Bolla said 2 grade 9 pupils and a girl from the school township were cases recorded yesterday [22 Oct 2012]. She said the district health management team had collected samples and taken them to Lusaka [the capital city] for examination. "However, the situation is under control, and those isolated are in stable condition," Ms Bolla said.

The school recorded 49 cases of measles on Wednesday last week [17 Oct 2012], thus compelling management to prematurely close non-examination classes.

[Byline: Stanslous Hgosa]

--
Communicated by:
ProMED-mail from HealthMap alerts


[Kitwe is the 2nd largest city in terms of size and population in Zambia. With a population of 504 194 (2010 census provisional). Kitwe is one of the most developed commercial and industrial areas in the nation, alongside Ndola and Lusaka. It is located on the border with the Democratic Republic of Congo and can be found in the map of Zambia at: http://geology.com/world/zambia-satellite-image.shtml. - Mod.CP

A ProMED HealthMap is available at http://healthmap.org/r/1Dk_.]

MEASLES UPDATE 2012 (41)
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*****

[1] Angola (Ondjiva)

Date: Tue 13 Nov 2012
Source: allAfrica, AngolaPress [edited]
http://allafrica.com/stories/201211140241.html


Measles kills 19 oeople in Ondjiva
----------------------------------
Angop (AngolaPress) has learned that at least 19 people died of measles in Ondjiva municipal hospital, southern Cunene province, between August and 13 Nov 2012, out of the 247 cases recorded there. The head of statistics of the hospital, Hilario Ndeudalela, said that the cases of measles affected mostly children.

In 2011, the hospital did not record any case of measles.

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[No cases of measles were recorded in Cunene province in 2008, whereas 99 cases were reported in 2009 [ProMED-mail Measles - Angola (CU) 20090827.3023]. In the previous update [Measles update 2012: (40)] it was reported that 19 new cases of measles had been diagnosed at the Onahumba Health Centre in Ondjiva, Cunene province, an increase of 5 cases in 48 hours. The total number of cases has reached 247 now and there have been 19 deaths.

It is apparent that measles remains widespread in Cunene province despite continuing vaccination campaigns. Earlier this year a similar outbreak was reported in Huila province (Measles update 2012 (38) 20121021.1356456).

The province of Cunenen is located in the south-west of Angola. A map showing the locations of the provinces of Angola can be accessed at http://www.atozmapsdata.com/zoomify.asp ... ngola_Pol2 - Mod.CP]

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[2] Pakistan (Swat Valley)
--------------------------
Date: Thu 16 Nov 2012
Source: The Express Tribune [edited]
http://tribune.com.pk/story/465819/outb ... -symptoms/


Outbreak: child dies of measles, 14 others show symptoms
--------------------------------------------------------
Measles claimed the life of a 3 year old boy in a remote village of upper Swat, where 14 others were brought in with similar symptoms on Wednesday [14 Nov 2012]. The child was a resident of Shahoo village of Kalam. Locals have blamed lack of doctors and unavailability of vaccines at local hospitals for the outbreak. A local resident of Kalam complained that there is no mechanism to conduct vaccination drives in the area. Moreover, he said that due to lack of doctors and medicines at local hospitals, people are denied medical treatment, adding that serious patients have to cover a long distance to [reach] to hospitals in Mingora for treatment.

Meanwhile, Expanded Programme for Immunisation (EPI) coordinator Dr Anwar Jamal refuted these claims. He said that EPI teams routinely conduct door-to-door vaccination drives in all areas of upper Swat. "If a case of measles surfaces in the area, special vaccination campaigns are conducted there," he added. He dismissed claims that there is a shortage of measles vaccine, adding that the EPI teams have stocked measles vaccines for over 2 months. When contacted, executive district officer health Dr Khurshid said he has directed the EPI coordinator to take immediate steps to control the situation. He said that in addition to regular teams, emergency teams have been dispatched to conduct vaccination drives in the area. So far, 350 children in the area have been vaccinated, he added.

Just 2 months back, a more pronounced outbreak of measles was reported in Kalam in which more than 100 children were affected. Locals had blamed the lack of doctors and "weak" immunisation campaigns for the outbreak. They maintained that the Central Hospital in Kalam lacks the required health facilities. They had asked the health department to establish permanent vaccination centres in Kalam -- a demand that remains to be fulfilled.

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[Swat is the name of a river valley and an administrative district in the Khyber Pakhtunkhwa province of Pakistan, near that Afghanistan-Pakistan border. It has recently been a conflict zone and it is not surprising that there have been difficulties in conducting vaccination campaigns and surveillance. Under the prevailing circumstances the number of cases of measles is surprisingly low.

The interactive ProMED-mail/HealthMap of Pakistan can be accessed at http://healthmap.org/r/1iGJ. - Mod.CP]

MEASLES UPDATE 2012 (42)
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[1] DRC (Kasai & Orientale)
Date: Thu 17 Nov 2012
Source: allAfrica [In French, transl., edited - Mod.CP]
http://fr.allafrica.com/stories/201211180014.html


Measles epidemic declared in Equateur and Orientale Provinces of Congo-Kinshasa
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A measles epidemic has been declared in Congo-Kinshasa [the Democratic Republic of Congo], affecting Kasai Orientale Province and Equateur province, according to the Secretary General at the Ministry of Health, Pierre Lokadi. He has stated that this is due to several factors, including the lack of vaccines.

The Secretary General promises that the Ministry and its [international] partners, will respond with a through a country-wide campaign to control the outbreak. "It is planned to organize follow-up campaigns to prevent the recurrence of measles. But this has not been achieved yet because of an inadequate supply of vaccine. Pierre Lokadi stated that there will soon be sufficient vaccine to enable us to deal with these epidemics.

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[A map of the locations of the provinces of the DRC can be accessed at:
http://en.wikipedia.org/wiki/File:DCongoNumbered.png. Mod.CP]

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[2] Pakistan (Karachi)
Date: Fri 23 Nov 2012
Source: Pakistan Observer [edited]
http://pakobserver.net/detailnews.asp?id=183779


GPs advised to be aware of possible measles outbreak
-------------------------------------------------
Parents and family physicians in the city have been warned to remain aware of a possible increase in measles cases during the current winter onset phase. Prof. Ayesha Mehnaz, Chairperson, Paediatrics Department, Civil Hospital, Karachi talking to APP [Associated Press of Pakistan] on Thu 22 Nov 2012 stated that the province went through an outbreak of measles last year [2011] and it would be appropriate that relevant care-providers are fully conscious of the possibility of this occurring this year also. Rashes, red marks, possibly fever and viral flu-like symptoms such as running nose, sore throat and cough are some of the manifestations of measles that must not be ignored under any situation, she said.

In answer to another question, Prof. Ayesha Mehnaz said sporadic cases of measles have been reported already to her hospital from different parts of the city.

Delay in referral and inability of patients to receive timely care can lead to complication that may include empylitis [encephalitis ?], aggravated malnutrition, gastroenteritis and even death, she said.

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[Karachi is the largest city, main seaport and financial centre of Pakistan, as well as being the capital of the province of Sindh. The city has an estimated population of 21 million people as of April 2012. Karachi is the most populous city in the country, and one the world's largest city in terms of population. Abolition of measles virus infection will be costly and administratively challenging. - Mod.CP]

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[3] Pakistan (Khyber Pakhtunkhwa)
Date: Mon 19 Nov 2012
Source: The Express Tribune [edited]
http://tribune.com.pk/story/467778/infe ... shabqadar/


Children die of measles in Shabqadar
----------------------------------
A total of 3 children died due to measles in Shabqadar, Charsadda district, on Sunday [18 Nov 2012]. A resident of Shabqadar Kifayatullah, said the deceased were 2 2-year old children and one 3-year old child. "Many children have been affected by the measles outbreak, but the Khyber-Pakhtunkhwa Health Department is not even aware of it," the resident said, adding that the infected children have been moved to the Khyber Teaching Hospital in Peshawar.

EDO [?] Health Dr Fazal Akbar, however, said that the deaths of the minors had not been confirmed. "Health officials have informed us about the epidemic, but we are not sure about the death toll," he said. Meanwhile, an administrative official at Tehsil Headquarters Hospital said that due to lack of medical facilities and doctors, the disease was spreading out of control.

Residents of Shabqadar told The Express Tribune that few people had immunised their children against measles. Some parents also complained that their children caught the infectious disease despite being vaccinated. One villager alleged that the Health Department had neglected their area in the vaccination drive, adding that an immunisation drive is necessary. The government will be responsible if precious lives are lost, he said.

On Wednesday [14 Nov 2012], a 3-year-old boy infected with the disease died in a village in Upper Swat, where 14 others were brought in with similar symptoms. The child was identified as a resident of Shahoo village of Kalam. 2 months before, more than 100 children were reported with measles in Kalam. In North Waziristan, and at least 18 children lost their lives due to a measles outbreak in April [2012].

In all these incidents, the local population has claimed that a lack of vaccine, doctors and medicines have worsened the situation, while health departments have denied these claims and are assuring the people that immediate steps will be taken to ensure that every child is immunised against the disease.

[Byline: Mureeb Mohmand]

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[Charsadda is a district in the Khyber Pakhtunkhwa province of Pakistan that includes the town of Charsadda. The town was part of the Peshawar ex-metropolitan region. Pashtuns make up majority of the population of the district.

The ProMED/HealthMap interactive map of the Khyber-Pakhtunkhwa province of Pakistan can be accessed at: http://healthmap.org/r/3yzA. - Mod.CP]

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[4] Pakistan (Swat Valley)
Date: Thu 22 Nov 2012
Source: The Express Tribune [edited]
http://tribune.com.pk/story/469539/outb ... o-measles/


Another toddler falls prey to measles
-------------------------------
A child died on Wednesday [21 Nov 2010] after contracting measles in Kalam's Gul Abad village in Upper Swat. The 3-year-old child was the 2nd child who died because of the recent outbreak of measles in which more than 100 children were affected, according to official sources. The disease also claimed the lives of 5 more children in Kalam and Matiltan areas 4 months back (See also: ProMED-mail Measles update 2012 (41) part [2]).

The death occurred at a time when the District Health Department said it was sending fresh teams to inoculate children in the area. Locals, however, claim that only those areas where deaths occurred are being covered and the rest are being left out. According to the Health EDO [?], the Expanded Programme for Immunisation (EPI) has been started in upper Swat, where more than 300 children were recently inoculated.

"The increase in measles and other viral disease cases in the area has been caused by treatment from unqualified medical practitioners. Parents also don't pay heed to their children's initial treatment. Then only when their condition worsens, they go to quacks instead of qualified doctors, and substandard treatment by the quacks leaves children in critical condition," said an official at Kalam Tehsil Hospital (KTH).

On the other hand, locals say that there are no facilities at the KTH, so people are compelled to look elsewhere for treatment. They demanded that the government take steps to facilitate the area's only hospital by installing all necessary health facilities and hiring doctors with the required qualifications.

[Byline: Fazal Khaliq]

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[The Swat is a valley and an administrative district in Khyber Pakhtunkhwa province near that Afghanistan-Pakistan border. It is the upper valley of the Swat River, which rises in the Hindu Kush range. The capital of Swat is Saidu Sharif, but the main town in the Swat valley is Mingora. A map showing the location of Swat District can be accessed at:
http://en.wikipedia.org/wiki/Swat_District.

Recurrent civil strife and disastrous flooding have impeded any sustained attempt to control measles virus infection. - Mod.CP]

MEASLES UPDATE 2012 (44)
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Nigeria (Kebbi)
Date: Thu 6 Dec 2012
Source: The Daily Times [edited]
http://dailytimes.com.ng/article/measles-kills-5-kebbi


An outbreak of measles in the Ambursa/Kardi Development Area in Kebbi State has caused the deaths of 5 children and isolation of 187 others. An official of the Primary Health Care (PHC) in the area, Isa Abubakar, told journalists in Ambursa on Thu 6 Dec 2012 that, initially, 192 children were afflicted by the disease. He said that state, federal, and international agencies had intervened to curtail the spread of the disease and provide drugs to victims.

The Chairman of Birnin Kebbi Local Government Area, Musa Dan-Illelah, who inspected the isolation camp and victims in Ambursa, lamented the deaths of the children because of the scourge. He said that efforts would be intensified to ensure the prevention of the spread of the disease to other communities in the state, especially immunisation of children against the 6 killer diseases[?]. He said that drugs and medical facilities would be provided at the designated place of isolation for the victims.

[Byline: Chidi Okoye]

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[A map showing the location of Kebbi state in the northwest of the country can be accessed at: http://www.waado.org/nigerdelta/maps/Ni ... tates.html. - Mod.CP]

[A ProMED-mail HealthMap of Nigeria can be found at http://healthmap.org/r/1qGF.]