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MEASLES UPDATE (50)
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[1] Turkey
Date: Wed 11 Dec 2013
Source: Daily News [abbreviated & edited]
http://www.hurriyetdailynews.com/measle ... sCatID=341


Health Minister Mehmet Muezzinoglu declared that the numbers of measles cases, which had been reduced down to just 4, had jumped to an annual average of 1040. "In 2001, the number of measles cases was 31 000. Due to the vaccination program carried out between 2003 and 2005, the numbers were reduced down to just 4," he said, also claiming that the current [outbreak] had been brought under control and lowered to fewer than 20 cases per week.

"No matter how you calculate the case numbers -- which the Minister [was unable] to say were per week, per year, or per day -- you can see the level to which the measles risk has risen," an [unidentified] opposition deputy commented.

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[Despite the optimistic statement of the Minister of Health, it is clear that eradication of measles in Turkey has not yet been achieved. - Mod.CP

A ProMED-mail HealthMap can be accessed at http://healthmap.org/r/1Cfs.]

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[2] Pakistan (Punjab)
Date: Tue 10 Dec 2013
Source: The International News [edited]
http://www.thenews.com.pk/Todays-News-5 ... listed-in-


An inquiry committee of the Punjab Home Department has exposed inherent contradictions in the anti-measles immunization campaign resulting in 146 casualties in Punjab this year [2013], as the vulnerable population failed to attain the desired herd immunity despite official claims of achieving 100 per cent coverage against the disease.

Revealing shocking and depressing facts, the inquiry committee identified that the anti-measles campaign was reduced to only 19 out of 36 districts, whereas the claim of optimum utilization of vaccine was belied owing to a huge gap between 14 543 500 dosages (8 017 300 measles vaccine and 6 526 200 TT vaccine) and 5 116 168 syringes (0.5 ml AD) issued against them during the year 2012, showing a gap of nearly 10 million syringes less than the actual vaccine dosages, which led to the measles fiasco in the following year. Similarly, nearly one million syringes were short in a total of 12 463 700 syringes issued against 13 446 430 dosages (8 146 820 measles vaccine and 5 399 430 TT vaccine) in 2011. However, in an attempt to cover up discrepancies between the number of vaccines and syringes, the health authorities issued nearly 3 million extra syringes in a total of 13 258 299 syringes against 10 419 200 (7 759 000 measles vaccine and 2 660 200 TT vaccine) in 2013.

The inquiry committee, headed by Punjab Home Secretary Shahid Khan (Convener) along with 2 members -- KEMU Vice-Chancellor Prof Faisal Masood and Additional Secretary Nasim Sadiq -- presented its fact-finding report on 10 Jun 2013, prima-facie declaring the Provincial Steering Committee as guilty of negligence and dereliction of its duties and fixed the responsibility on the then Health Director General(s) including Dr Muhammad Aslam Ch (presently on leave), who served from 3 Oct 2005, to 23 Jan 2012, and Dr Nisar Ahmed Cheema (retired), who served from 21 Feb 2012 to 31 Mar 2013. Besides, the supervisory tiers in the health administration have also failed to prevent the aforesaid dereliction or initiate corrective measures.

Up till 10 Jun 2013, when the fact-finding report was submitted, a total of 16 620 cases have been reported across the province resulting in 146 deaths. Lahore district, which showed 88 per cent coverage, topped with 80 measles deaths, while 10 deaths were reported in Kasur, 9 in Sheikhupura, 6 in Rajanpur, 5 each in Gujranwala, Jhang, Okara and Rahim Yar Khan, 4 in Faisalabad, 3 in Vehari, 2 each in Bahawalpur and Narowal, and one each in Rawalpindi, Hafizabad, Mandi Bahauddin, Sialkot, Khanewal, Sahiwal, Pakpattan, Toba Tek Singh, Sargodha and Bahawalnagar. Remaining districts showed zero casualties.

Another inquiry report on the epidemic of measles was prepared by Prof Zafar Iqbal, Chairman, Shaikh Zayed Hospital, Lahore, and a summary was also prepared by the then Chief Secretary, Punjab Javaid Aslam to fix the responsibility on the negligent that, surprisingly, omitted one of the guilty mentioned in the 1st report and included 4 other people.

The home department's committee further reported that the Federal Ombudsman had also conducted an inquiry into the measles outbreak, which concluded that the main cause of the epidemic was a deterioration and failure of the routine EPI system in Pakistan.

While noting its findings, the committee identified that 2 mass immunization campaigns had been conducted in years 2007-08 and 2010-11. During the 2007-08 campaign, children from 9 months to 13 years were vaccinated against measles throughout the country. During the 2010-11 campaign, 19 districts of Punjab were covered in 2 phases. In the 1st phase, vaccinations were given in Mianwali, Khushab, Bhakkar, Layyah, DG Khan, Muzaffargarh, Rajanpur and RY Khan, whereas in the 2nd phase, vaccinations were administered in Lahore, Rawalpindi, Multan, Sargodha, Sialkot, Hafizabad, Jhang, Nankana Sahib, Gujrat, Chakwal and Attock. Thereafter, the National Steering Committee did not recommend a mass measles campaign; therefore, measures were taken only to ensure availability of vaccine as per requirement. Measles cases are being reported in districts covered under the 2010-11 mass immunization campaign like Lahore, Sialkot and Jhang.

The reported EPI coverage during the last 5 years starting from 2008 is 87 percent, 88 percent, 92 percent, 95 percent and 100 percent. The survey conducted by the Institute of Public Health (IPH), Lahore narrates the overall coverage of 58 percent against the reported figures of 100 percent in year 2013.

The committee observed that EPI coverage figures for the last 5 years oscillate between 88 to 100 percent, meaning thereby a success rate of 80 percent should have been attained in all districts of the Punjab, although, the DG Health Services contended that the herd immunity for measles took place at 95 percent. Based on the figures provided since the 2010-11 mass immunization campaign in 19 districts of the Punjab, the proportionate reduction in the vaccinated population had taken place; therefore, herd immunity would be hovering between 80 and 90 percent.

The health authorities admitted that the mass immunization programme in the Punjab was restricted to 19 districts only. It also admitted that the regular immunization programme based on the data produced before this committee was unsuccessful. Finally, the monitoring mechanism also rendered the immunization campaign faulty.

The committee concluded that the regular immunization programme, when viewed in the context of its administration, human resource management, distribution, cold chain continuity, and other allied aspects, was not successful. The reporting of vaccine utilization in particular was forged or exaggerated. This is substantiated by the monitoring mechanism put in place, which reduced the coverage of immunization by at least an average of 25-30 per cent. More importantly, the current outbreak of measles with 146 deaths in the province and around 5021 patients in Lahore only manifests an epidemic which has exposed ineffectiveness and insufficient coverage of the earlier campaigns.

The information provided to the committee established that, over the 5 years, the provincial steering committee responsible for evaluating and extending the programme either through the federal government or its own recourses failed on both counts. The minutes of meetings dated 3 Jan 2013 and 21 Jan 2013 identified the need of a high quality measles campaign in all 36 district but the same were in any case either untimely or not adequately pursued for turning such a campaign into reality. It is established that the provincial steering committee did not take up the matter of mass immunization with the federal government. No formal reference to the federal government to extend the mass immunization from 19 to 36 districts has been produced before the committee.

It also didn't launch the programme through provincial resources except for spending a sum of Rs 701 million [USD 6.6 million] for an extended coverage in 12 high risk districts in 2013. Out of this, Rs 243 million [USD 2.2 million] were used on procurement of vaccine through UNICEF in February 2013 for use in the Lahore campaign and mop up operation in April 2013. A total of Rs 458 million [USD 4.3 million] have been deposited with UNICEF for the campaign in 12 high risk districts.

Some other factors also contributed to the recent measles outbreak like malnutrition, poor maternal health, and poor public health facilities (safe water, sewerage disposal and healthy food chain). The health authorities did not undertake a pragmatic assessment of the programme identifying the gaps and proposing measures to overcome pitfalls. It is a fact that the Health Care Management System is sliding on a downward track due to lack of direction, corruption and inefficiency. This situation is further compounded with a general lack of awareness about the importance of immunization to prevent the disease, which has been wiped out not only in developed countries but also in several developing countries. Despite ratification of the UN convention on the Rights of the Child (CRC), which recognizes vulnerability of children to disease and requirements for special care and assistance, the response of the supervisory tiers of the health department is dismal. The loss of precious lives clearly indicates that the health authorities and allied departments have failed to effectively administer the measles immunization campaign.

[Byline: Amer Malik]

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[In view of these administrative inadequacies described above, eradication of measles in Punjab province is a distant prospect. - Mod.CP

A ProMED-mail HealthMap can be accessed at http://healthmap.org/r/1iGJ.]

MEASLES UPDATE (52)
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Congo Republic
Date: Wed 18 Dec 2013
Source: Afriquinfos, Xinhua News Agency report [in French, machine transl., edited]
http://afriquinfos.com/articles/2013/12 ... 240302.asp


The head of the Expanded Programme on Immunization (EPI), Boris Didi Herman Ngossaki, reported Tuesday [17 Dec 2013] in Brazzaville the resurgence of measles, with more than 900 cases detected this year [2013] in Congo Republic. Dr. Didi Ngossaki gave these statistics during the launch by the government of a national vaccination campaign against measles in order to fight this scourge which has resurfaced in the country.

"This endemic reemerged -- 1st in Pointe-Noire in 2010-2011 -- [and] has unfortunately spread to all other departments of the Congo and the new campaign is the only way to fight back against this scourge, he declared. The vaccination campaign for children aged 6 months to 5 years will provide supplementary vaccination, vitamin A, and mebendazole for deworming. Parents are being advised to have children of this age vaccinated at the nearest health centre to their home or in the nearest village's health facility.

Conducted jointly by the Ministry of Health and Population and development partners, including UNICEF and the World Health Organization (WHO), the vaccination campaign will end on [21 Dec 2013].

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[Republic of the Congo (French: Republique du Congo), also referred to as Congo-Brazzaville, is a country located in Central Africa. It is bordered by Gabon, Cameroon, the Central African Republic, the Democratic Republic of the Congo and the Angolan exclave of Cabinda. A HealthMap is available at http://healthmap.org/r/1Ahz. - Mod.CP]

MEASLES UPDATE (05)
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In this update
[1] Guinea
[2] Somalia
[3] & [4] Uganda

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[1] Guinea
Date: Wed 29 Jan 2014
Source: IRIN News [edited]
http://www.irinnews.org/fr/report/99537 ... s-outbreak


Health authorities in Guinea are scrambling to contain a measles outbreak that has killed one child, infected 37 others and spread to half of the country's 33 districts. More than 400 suspected cases, nearly all of them in children under 10 years old, have been registered. A vaccination campaign targeting over 1.6 million children is to be launched in the coming weeks.

"We have moved from 3 affected districts in Conakry before the end of last year [2013] to the whole city now being affected. Five more districts out of Conakry are also affected. It means that it could spread throughout the country," said Felix Ackebo, the UN Children's Fund (UNICEF) deputy representative for Guinea.

"One of the causes is the nature of the disease. The other is the social/political instability. Many bilateral donors stopped support, awaiting the holding of legislative elections. The whole health system has been weakened. The government was restricted on what it could purchase, and this affected [availability of] vaccines and other important drugs. Many of the basic social services have suffered from this pause in investment," Ackebo told IRIN. "In the past, we have been obliged to buy measles vaccines and others because the government could not." Only 37 percent of Guinean children are fully vaccinated, according to the 2012 Demographic Health Survey. The country's last measles epidemic, in 2009, infected 4755 people and killed 10.

Keita Sakoba, head of disease prevention at the Ministry of Health, said that the current stock of measles vaccine, meant for routine immunisation, was insufficient for the vaccination drive. He explained that the outbreak was likely due to the accumulation of unvaccinated children. "We will launch a vaccination campaign in the 15 affected districts and carry out targeted immunizations in districts neighbouring the affected ones," Sakoba said.

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[2] Somalia
Date: Mon 27 Jan 2014
Source: AllAfrica.com [edited]
http://allafrica.com/stories/201401271187.html


Over 100 outbreak alerts, mainly for measles, were reported and investigated in December 2013, according to the World Health Organization (WHO). The majority of the measles cases were reported in central Somalia, where immunization coverage is very low. To accelerate child health and improve immunization coverage, Child Health Days were held across southern and central Somalia in December 2013 with support from pooled funds.

The campaign targeted over one million children with pentavalent vaccine and vaccine against measles and polio. Pentavalent is a vaccine against diphtheria, whooping cough, tetanus, hepatitis B, and haemophilus influenza. About 1.2 million women of childbearing age were targeted with tetanus toxoid vaccination. An increased number of suspected cholera cases were reported in December 2013.

Health partners collected and analysed stool samples, which tested negative for cholera and other diseases like shigella and salmonella. However, about 2/3rds of the cases tested positive for rotavirus. Rotavirus is one of the major causes of acute watery diarrhoea in Somalia, which highlights the importance of hygiene promotion activities to reduce the burden of the disease. The wild polio cases in Somalia stood at 185 as of mid-January 2014, and response activities continue. Incidences of violence have continued in southern Somalia.

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[Measles vaccine is probably one of the most effective and safest of the vaccines listed, although, being heat-sensitive, it is logistically one of the most difficult to administer. - Mod.CP

A ProMED-mail HealthMap is available at http://healthmap.org/r/9-NG.]

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[3] Uganda
Date: Mon 27 Jan 2014
Source: New Vision (Uganda) [edited]
http://www.newvision.co.ug/news/651853- ... dents.html


Four people have died, and 10 others are being closely monitored after a suspected outbreak of measles in Kakindo and Birembo Sub Counties, Kibaale district. The 4 children died on Sunday [26 Jan 2014] after battling the disease within one week. They are aged between 2 to 8 years. Three additional cases have been reported in Buyaga West County.

According to William Mutesa, a member of the Village Health Team-VHT, before their deaths, 2 presented with high fever, general skin rash, and running nose, which are known signs of measles. Last evening [26 Jan 2014], a team of health workers was dispatched to Kakindo Sub Country to collect blood samples from some of the patients for further scrutiny. Sanyu Suleiman, the Kibaale district surveillance officer (DSO), said they will collect body tissue from the deceased.

The village chairperson, Andrew Nibihurira, said the suspected outbreak was due to a poor response to immunization, adding that most of the children aged between 2-5 years are not immunised. Residents were advised to avoid direct body contact with patients as a basic precautionary measure.

[Byline: Shamin Saad]

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[A suspected measles outbreak has been reported in Kakindo and Birembo sub-counties and Buyaga west counties in Kibaale district, where cases have been attributed to low routine measles immunization coverage. The definitive response to the outbreak should be guided by the findings from laboratory testing.

Maps of Uganda can be accessed at http://en.wikipedia.org/wiki/Districts_of_Uganda and
http://healthmap.org/r/5miP. - Mod.JFW]

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[4] Uganda
Date: Thu 30 Jan 2014
Source: Vaccine News [edited]
http://vaccinenewsdaily.com/medical_cou ... in-uganda/


The United Nations Human Rights Agency [UNHRA] started a mass measles immunization campaign on Friday [30 Jan 2014] in northern Uganda to prevent the disease from spreading among South Sudanese refugees. Adrian Edwards, a UNHCR spokesperson, announced the campaign on Friday, which is targeting the more than 59 000 South Sudanese refugees who arrived in the country since clashes began in South Sudan in mid-December 2013. The Ugandan Ministry of Health confirmed the measles outbreak after 5 cases and 3 suspected cases were registered among refugees in the Arua area.

"The immunization campaign will cover all refugee and Ugandan children below 15 years in age in the Arua and Adjumani districts," Edwards said. "We are working on this project with UNICEF, the Ugandan Ministry of Health, Medecins Sans Frontieres-France, and Medical Teams International." Edwards said Uganda is still receiving 250 refugees a day at the Adjumani reception area. He said the UNHCR welcomes the signing of the South Sudan ceasefire agreement and hopes it can be implemented to avoid further displacement.

Since mid-December 2013, more than 100 000 refugees from South Sudan fled to neighboring countries, including Sudan, Kenya, Ethiopia, and Uganda. There are approximately 490 000 individuals who are internally displaced within the country. South Sudan was already host to 230 000 refugees itself, most of whom are from Sudan.

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MEASLES UPDATE (06)
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[1] Review (MMWR)
Date: Fri 7 Feb 2014
Source: Global Control and Regional Elimination of Measles, 2000-2012 Weekly [abridged & edited]
http://www.cdc.gov/mmwr/preview/mmwrhtm ... mm6305a5_e


In 2010, the World Health Assembly established 3 milestones toward global measles eradication to be reached by 2015: 1) increase routine coverage with the 1st dose of measles-containing vaccine (MCV1) for children aged one year to 90 per cent or more nationally and 80 per cent or more in every district, 2) reduce and maintain annual measles incidence at under 5 cases per million, and 3) reduce measles mortality by 95 per cent from the 2000 estimate.

After the adoption by member states of the South East Asia Region (SEAR) of the goal of measles elimination by 2020, elimination goals have been set by member states of all 6 World Health Organization (WHO) regions, and reaching measles elimination in 4 WHO regions by 2015 is an objective of the Global Vaccine Action Plan (GVAP). This report updates the previous report for 2000-2011 (2) and describes progress toward global control and regional elimination of measles during 2000-2012.

During this period, increases in routine MCV coverage, plus supplementary immunization activities (SIAs) reaching 145 million children in 2012, led to a 77 per cent decrease worldwide in reported measles annual incidence, from 146 to 33 per million population, and a 78 per cent decline in estimated annual measles deaths, from 562 400 to 122 000. Compared with a scenario of no vaccination, an estimated 13.8 million deaths were prevented by measles vaccination during 2000-2012. Achieving the 2015 targets and elimination goals will require countries and their partners to raise the visibility of measles elimination and make substantial and sustained additional investments in strengthening health systems.

Immunization activities
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WHO and the United Nations Children's Fund (UNICEF) use data from administrative records and surveys reported annually by member states to estimate MCV1 coverage among children aged one year. Since 2003, member states also have reported the number of districts with greater than or equal to 80 per cent MCV1 coverage. Estimated MCV1 coverage increased globally from 73 per cent to 84 per cent during 2000-2009, then remained at 84 per cent through 2012. The number of member states with greater than or equal to 90 per cent MCV1 coverage increased from 83 (43 per cent) in 2000 to 128 (66 per cent) in 2012. The number of member states with greater than or equal to 90 per cent MCV1 coverage nationally that also had greater than or equal to 80 per cent MCV1 coverage in all districts increased from 40 (38 per cent) of 104 in 2003 to 58 (45 per cent) of 128 in 2012. Of the estimated 21.2 million infants who did not receive MCV1 in 2012, about 13.5 million (64 per cent) were in 6 member states: India (6.4 million), Nigeria (3.8 million), Ethiopia (1.0 million), Indonesia (0.9 million), Pakistan (0.7 million), and the Democratic Republic of the Congo (0.7 million).

During 2000-2012, the number of member states providing the 2nd dose of measles vaccine (MCV2) through routine immunization services increased from 96 (50 per cent) to 145 (75 per cent). During 2012, about 145 million children received MCV during SIAs conducted in 33 member states. MCV coverage greater than or equal to 95 per cent after SIAs was reported by 18 (55 per cent) member states, and 12 (36 per cent) member states conducted coverage surveys to validate coverage. During measles SIAs, 20 (61 per cent) member states included one or more additional child health interventions; 18 (55 per cent) included oral poliovirus vaccination.

Disease incidence
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Effective measles surveillance includes case-based surveillance with laboratory testing to confirm cases. During 2004-2012, the number of member states using case-based surveillance increased from 120 (62 per cent) to 187 (96 per cent). During 2000-2012, the number of member states with access to standardized quality-controlled testing through the WHO Measles and Rubella Laboratory Network increased from 71 (37 per cent) to 191 (98 per cent).

During 2000-2012, the number of measles cases reported worldwide each year decreased 73 per cent, from 853 480 to a historic low of 226 722, and measles incidence decreased 77 per cent, from 146 to 33 cases per million population per year. The decrease in 2012 occurred in all regions and followed 3 years of increasing numbers of cases. During 2000-2012, the Region of the Americas (AMR) maintained measles incidence at under 5 cases/million; in 2012, reported incidence in the Western Pacific Region (WPR) was 6 cases/million, a historic low. The percentage of reporting member states with under 5 cases/million increased from 55 per cent (104 of 188) in 2011 to 64 per cent (119 of 187) in 2012. During 2012, large measles outbreaks were reported by the Democratic Republic of the Congo (72 029 cases), India (18 668), Indonesia (15 489), Ukraine (12 746), Somalia (9983), Sudan (8523), Pakistan (8046), and Romania (7450). China reported 6183 cases, a historic low after a steady annual decrease from 3159 cases in 2010.

Genotyping results from isolates from persons with measles were reported from 49 (39 per cent) of the 125 member states reporting measles cases in 2012. Six measles genotypes were identified; the predominant genotypes were B3 in the African Region (AFR) and the Eastern Mediterranean Region (EMR); D4 in the European Region (EUR); H1, D8, and D9 in SEAR and WPR; with one G3 reported from one outbreak in WPR.

Mortality estimates
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In response to the lack of reliable data on the number of measles deaths from many member states, WHO has developed a model to estimate mortality using numbers and age distribution of reported cases, routine and SIA MCV coverage, and age-specific, country-specific case fatality ratios. The model was refined in 2013 to reflect the impact of different SIA target age ranges and the population targeted in subnational SIAs. These refinements, together with new 2012 measles vaccination coverage and case data for all member states, updated data for the period before 2012 for some member states, and updated population estimates, led to new mortality estimates for 2000-2012. During this period, estimated measles deaths decreased 78 per cent, from 562 400 to 122 000; all regions had substantial reductions in estimated measles mortality, ranging from 52 per cent in EMR to 88 per cent in AFR. Compared with a scenario of no vaccination against measles, an estimated 13.8 million deaths were prevented by measles vaccination during 2000-2012.

Regional verification of measles elimination
-------------------------------------
By 2012, regional verification commissions were established in AMR, EUR, and WPR, and frameworks for documenting elimination were developed in AMR and EUR. While verifying elimination, member states in AMR uncovered weaknesses in surveillance and routine immunization programs, leading to a regional emergency plan of action to strengthen these programs.

MMWR editorial note
----------------------
During 2000-2012, increasing routine MCV coverage worldwide and regular SIAs in member states lacking high coverage with 2 doses of MCV contributed to a 77 per cent decrease in reported measles incidence and a 78 per cent reduction in estimated measles mortality, reaching historic lows. During this period, measles vaccination prevented an estimated 13.8 million deaths. Measles elimination continues to be maintained in AMR, and WPR is approaching measles elimination. However, based on current trends and performance, the WHO Strategic Advisory Group of Experts (SAGE) concluded that the 2015 global targets and regional elimination targets in EUR, EMR, and AFR will not be achieved on time.

AFR, EMR, and SEAR, the regions with the largest number of infants not receiving MCV1 through routine immunization services in 2012, had large measles outbreaks during 2012 and had 98 per cent of the estimated global measles mortality burden, highlighting the need to strengthen immunization systems. Globally, 2012 might represent a temporary low in the normal cycle of measles incidence. Preventing a resurgence will require progress in reaching greater than or equal to 95 percent of children with 2 MCV doses through routine immunization services and high-quality SIAs.

The findings in this report are subject to at least 3 limitations. 1st, MCV coverage estimates likely included errors resulting from inaccurate estimates of the size of target populations, inaccurate reporting of doses delivered, and inclusion of SIA doses given to children outside the target age group. 2nd, underestimation in surveillance data can occur because not all patients with measles seek care, and not all of those who seek care are reported. These errors in coverage and surveillance data in turn affect the accuracy of the measles mortality model results. Finally, some member states also maintain multiple reporting systems for measles and might, like India, report aggregate, unconfirmed cases rather than case-based data.

To achieve measles elimination, member states should aim to fully implement measles control and elimination strategies described in GVAP and the 2012-2020 Global Measles and Rubella Strategic Plan of the Measles and Rubella Initiative, which include achieving vaccination coverage greater than or equal to 95 per cent with 2 doses of MCV administered through routine immunization or SIAs and maintaining this coverage uniformly across all districts. For many member states now at under 90 per cent coverage nationally, reaching greater than or equal to 95 per cent coverage will require substantial and sustained additional investments of financial and human resources to strengthen health systems and achieve equitable access to immunization services. Further progress toward achieving the 2015 global measles control targets and regional measles elimination targets will also require member states and partners to increase the visibility of measles elimination activities and make the needed investments.

Summary
--------
During 2000-2011, global vaccination coverage with the 1st dose of measles-containing vaccine increased from 72 per cent to 84 per cent, about 225 million children received a 2nd opportunity for measles immunization during measles supplemental immunization activities in 2011, and global reported measles cases decreased until 2008, then increased in 2010 and 2011. By 2011, about 45 per cent of countries had not met the incidence target of under 5 cases/million. As milestones toward eventual global measles eradication, the 2010 World Health Assembly endorsed a series of targets to be met by 2015.

In 2012, the estimated global coverage with the 1st dose of measles-containing vaccine remained at the 2011 level of 84 per cent, but the number of countries providing a 2nd dose of measles-containing vaccine through routine immunization services increased from 96 (50 per cent) in 2000 to 145 (75 per cent) in 2012, and 144 million children were vaccinated against measles during vaccination campaigns. In 2012, annual reported measles incidence was 33 reported cases/million population, a decline of 77 per cent from 146 cases/million in 2000, and estimated measles deaths decreased 78 per cent, from 562 400 to 122 000. An estimated 13.8 million deaths were prevented by measles vaccination during 2000-2012.

Although measles incidence decreased during 2011-2012, WHO's African, Eastern Mediterranean, and European regions are not on track to achieving their elimination targets. To accelerate progress toward achieving these regional measles elimination targets, national governments and partners are urged to give these efforts high priority and adequate resources to achieve their commonly agreed upon goals, and in so doing reach the targets set by the Global Vaccine Action Plan.

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[Interested readers should consult the original text via the source URL to view the tables, diagrams, and illustrations. - Mod.CP]

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[2] Syria
Date: Fri 7 Feb 2024
Source: Expatica [abbreviated & edited]
http://www.expatica.com/ch/news/swiss-n ... 84662.html


The number of people dying from measles has fallen to a record low, driven down by mass vaccination campaigns, but outbreaks in crisis zones such as Syria remain a threat, the UN said on Thursday [6 Feb 2014]. "We have reached a record low in measles cases, with a 77 percent decline from 2000 to 2012, which has led to a record drop in the number of estimated deaths, by 78 per cent," said Robert Perry of WHO's immunisation department.

Measles, which is highly contagious and particularly deadly for children, claimed some 122 000 lives in 2012, WHO said. This is the most recent year for which global figures are available. Back in 2000, the toll was a stark 562 000. Over the same period of time, the annual number of cases has been driven down from more than 853 000 to close to 227 000.

"Despite these gains, the progress is still fragile," Perry told reporters. "In nations where the disease had been close to eradication, war has set back efforts. Syria had a very good programme, and very high coverage, with 2 doses of vaccine through routine coverage. It very rarely did specific measles campaigns, and was well on the way to measles elimination up until 2012," said Perry. Perry said that the number of measles cases recorded in Syria was 13 in 2012, but that the figure last year [2013] was thought to be over 700. "You really see that tracking to kids not having access to health services, including measles vaccination," he added.

With the 3-year civil war having driven millions of Syrians from their homes, the disease has reared its head in neighbouring Lebanon, Jordan, Iraq, and Turkey. There have been similar concerns about a revival of polio in Syria. Measles hotbeds have persisted, notably in African countries facing a mix of shaky health systems and conflict; an outbreak in the Democratic Republic of Congo infected 72 000 in 2012.

Rich countries have not been unaffected either, for different reasons. In Britain, the number of reported cases in 2012 was close to 2100. Perry said that that was the result of parents' wariness due to the alleged links between measles vaccines and autism. "That has since been found not to be true, but those fears still bounce around the blogosphere and Internet and have led to a drop of coverage in Britain, and now those children are the ones being affected," he said.

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[3] Ghana
Date: Fri 7 Feb 2014
Source: Ghana News Agency [edited]
http://www.ghananewsagency.org/print/70478


New mortality estimates from WHO show that annual measles deaths have reached historic lows, dropping 78 per cent from more than 562 000 in 2000 to 122 000 in 2012. During this time, an estimated 13.8 million deaths had been prevented by measles vaccination, and surveillance data showed that reported cases declined 77 per cent from 853 480 to 226 722.

The report, which was made available to the Ghana News Agency on Thursday [6 Feb 2014] by Fadela Chaib, WHO Communications Officer, noted that these gains are a result of global routine measles immunization coverage holding steady at 84 per cent and 145 countries having introduced a routine 2nd dose of measles vaccine to ensure immunity and prevent outbreaks. It said in addition to routine immunization, countries vaccinated 145 million children during mass campaigns against measles in 2012 and reached more than one billion since 2000, with the support of the Measles and Rubella Initiative. It noted that despite the impressive gains made, progress towards measles elimination remains uneven with some populations still unprotected. It said measles continues to be a global threat, with 5 of 6 WHO regions still experiencing large outbreaks and with the Region of the Americas responding to many importations of measles cases.

The report said the African, Eastern Mediterranean and European regions are not likely to meet their measles elimination targets on time. It said the Region of the Americas has achieved measles elimination and continues to maintain this status while the Western Pacific region is approaching its target. It said routine measles vaccination coverage is an important progress indicator towards meeting Millennium Development Goal 4 because of its potential to reduce child mortality and widely recognized as a marker of access to children's health services. It said without improved immunization coverage both through routine services and mass campaigns, outbreaks will continue to occur, hampering efforts to meet global elimination targets and prevent additional deaths. It said the ability to contain outbreaks by improving routine coverage and, when necessary, implementing high quality vaccination campaigns requires countries to place a high priority on elimination goals and to invest heavily in health systems improvements.

According to the report, measles outbreaks in 2012 by WHO Africa region include Democratic Republic of Congo - 72 029, Burkina Faso - 7362, Nigeria - 6447, Angola - 4458, Ethiopia - 4347, Uganda - 2027, South Sudan - 1952, United Republic of Tanzania - 1668, Ghana - 1613, and Equatorial Guinea - 1190. It said worse cases were recorded in Somalia - 9983 and Sudan - 8523.

The Measles and Rubella Initiative, which was 1st launched in 2001, is a global partnership led by the American Red Cross, United Nations Foundation, United States CDC, UNICEF, and WHO. The Measles and Rubella Initiative is committed to ensuring that no child dies from measles or is born with congenital rubella syndrome, reducing measles deaths by 95 per cent by 2015, and achieving measles and rubella elimination in at least 5 regions by 2020.

--
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[A ProMED-mail HealthMap is available at http://healthmap.org/r/1jUt.]

******
[4] Guinea
Date: Sat 1 Feb 2014
Source: Afriquinfos.com [in French, machine trans. abbreviated, edited]
http://afriquinfos.com/articles/2014/2/ ... 243348.asp


More than 1000 measles cases, including one death, were reported in Guinea since the onset of the epidemic on Friday [31 Jan 2014] said the Ministry of Health and Public Hygiene for the 33 prefecture.

The epidemic of measles was reported in 24 prefectures and 5 towns of Conakry, where security measures have been taken to identify the disease of children in order to minimize the distress. In the capital region, more than 2/3rds of the cases were recorded in the 5 towns of the governorate of Conakry.

Dr Sakoba Keita, responsible for the prevention and fight against the disease and the health minister, said a major campaign of vaccination will be launched next week in order to make the necessary vaccine available to protect children from 6 months to 10 years. A large batch of vaccine from Senegal is currently expected by the Guinean authorities, he said.

According to him, the disease spreads very rapidly in children, especially during the period from March to May, which is an appropriate time for combating the disease. The Red Cross is working hard to establish the necessary facilities for protection of vulnerable children.

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

[The situation is worsening in Guinea with new localities affected. The time is right for the occurrence and spread of the disease. Measles vaccine is very effective, well tolerated and available; one wonders why measles continues to be a major public health problem in this country. - Mod.BM

A ProMED-mail HealthMap is available at http://healthmap.org/r/1tx-.]

MEASLES UPDATE (08)
*******************
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******
[1] Guinea
Date: 12 Feb 2014
Source: VOA News [edited]
http://www.voanews.com/content/guinea-a ... 49940.html


Mass emergency vaccination campaigns are now underway in Guinea to control a spreading outbreak of measles. The World Health Organization warns that measles is one of the most highly contagious diseases, and is a leading cause of death among children.

Doctors Without Borders and UNICEF said they were working with Guinea's Ministry of Health to vaccinate more than 2 million children between the ages of 6 months and 10 years against measles.

Guinea's measles outbreak began in December 2013, and the government declared it had reached epidemic proportions.

The head of UNICEF's health program in Guinea, Dr. Salvator Nibitanga, spoke to VOA from the capital, Conakry.

"In the whole country, up to now, we have 1590 cases. This is suspected cases. And among them, unfortunately, 6 deaths have been recorded. And this has covered around 23 districts out of 38. You can imagine that the situation is [quite bad] at the moment. And we also know that other districts will be affected in the coming days," he said.

The last outbreak of measles in Guinea, in 2009, affected more than 4000 children and caused 10 deaths.

Most cases of measles are curable, but health experts say immunization is the best way to keep the death toll down.

WHO reported that vaccinations reduced the number of measles deaths globally by nearly 80 percent between 2000 and 2012.

But in Guinea, Doctors Without Borders said that less than 80 percent of children living in Conakry have received routine vaccinations that include protection against measles, and nationwide, only 37 percent of children have been received the specific anti-measles vaccine.

Dr. Renaldo Ortunio, a medical coordinator for Doctors Without Borders in Guinea, said even one case of measles was too much.

"Measles is a preventable disease by vaccine, so you shouldn't have an epidemic, an outbreak in this country. But unfortunately, there are some weaknesses in the Ministry of Health in the regular vaccinations. And with this lack of vaccination among children, we see an outbreak every 3 to 4 years, which is currently the case in Conakry," he said.

Ortunio said large scale immunization programs targeting measles were difficult because the vaccine must be kept well-refrigerated, and much of Guinea still did not have access to electricity.

To help children who already have contracted the measles virus, UNICEF is supplying the Ministry of Health with antibiotics and vitamin A.

Doctors Without Borders is offering free measles diagnoses and follow-up medical care for cases in which there are complications. Teams of doctors are also training local health center staff to deal with measles cases.

Health officials in Guinea are now urging parents to seek medical care for their children at the 1st sign of measles. Symptoms include a high fever, bloodshot eyes, white spots on the mouth, and a rash on the face and neck.

The vaccination campaigns will continue free of charge for at least 2 weeks.

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

[Guinea can be seen on a HealthMap at http://healthmap.org/r/1tx-. - Mod.LM]

******
[2] Pakistan
Date: 20 Feb 2014
Source: The Express Tribune [edited]
http://tribune.com.pk/story/673875/infe ... -outbreak/


Residents of Bangesh, Madyan fear that an outbreak of measles in the area is causing children to fall ill. Several minors have been found infected with a mysterious illness in the area for the past one week.

Residents complained of no action on the part of the authorities to control the outbreak of said illness. The father of an infected child revealed locals had informed the government of the outbreak and urged them to arrange a medical camp for the treatment of their children. Meanwhile, he said, they had been taking their children to local medics. Residents claimed dozens of children are infected with measles.

Bahrain Assistant Commissioner Mohammad Arif said they have enough medicines, vaccines and staff in hospitals, and soon the epidemic will be controlled. "I have already directed the hospital administration to send an EPI team to the area," he said.

--
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[A ProMED-mail HealthMap is available at http://healthmap.org/r/1iGJ.]

******
[3] India
Date: 20 Feb 2014
From: Husain Poonawala <husain.poonawala@gmail.com> [edited]


I'm a 3rd year medicine resident at UMass in Worcester [MA, USA]. I am currently on an away rotation at Jan Swasthya Sahyog, a non-profit hospital working out of Ganiyari village in Bilaspur district, Chhatisgarh state in India [http://jssbilaspur.org].

We saw a 4-year-old child yesterday [19 Feb 2014] with measles in the outpatient clinic. The diagnosis was made on the basis of clinical features of fever, cough and rash. Unfortunately, the child left to go back to the village before I could get pictures. A team from JSS went to the village today [20 Feb 2014], but the photos are not great. The child is from the village Naktabandha, Karkha panchayat, Kota tehsil and Bilaspur district. The child belongs to the Baiga tribe. Panchayat and Tehsil are administrative units of the government.

We heard of 2 other cases of measles in the district, one in Dari village, Masturi tehsil and mini-basti slum in Bilaspur (where an 11-month-old child is confirmed to have died).

There is also a large outbreak of pertussis in the district that private practitioners have been seeing. I will let you know if we see any here.

--
Husain Poonawala, MD
<husain.poonawala@gmail.com>

[ProMED thanks Dr Poonawala for this firsthand report. Photos sent separately are consistent with measles. - Mod.LM

[A ProMED-mail HealthMap is available at http://healthmap.org/r/1pSH.]

MEASLES UPDATE (10)
*******************
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ProMED-mail is a program of the
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*****
[1] Congo DR (East)
Date: 27 Feb 2014
Source: Radio Okapi [in French, trans. Mod.LM, edited]
http://radiookapi.net/en-bref/2014/02/2 ... s-lusangi/


Two children died of measles of the 76 cases registered since January 2014 in the area of Lusangi in Kabambare territory (Maniema).

The Provincial Office for the Coordination of Humanitarian Affairs (OCHA) in Maniema delivered these numbers in its weekly report published Wednesday [26 Feb 2014] in Kindu. According to the report, the disease affects mainly children aged 1-5 years. 54 of the 76 reported cases of measles are in this age group. In many areas of the hinterland, many parents refuse to vaccinate their children because of their religious beliefs or superstition.

--
Communicated by:
ProMED-FRA
<promed-fra@promedmail.org>

[Measles is a major public health problem. It is a viral disease affecting mainly children and those who are unvaccinated. The paradox is that it is an infectious disease against which there is an effective vaccine available. Traditional beliefs hinder healthcare utilization and, therefore, vaccination against the disease.

Extensive awareness campaigns should be undertaken to encourage coverage in general and against measles specifically.

An interactive HealthMap/ProMED-mail map of Congo DR is available at: http://healthmap.org/r/1Ahy. - Mod.BM]

******
[2] Congo DR (South)
Date: 27 Feb 2014
Source: Radio Okapi [in French, trans. Mod.LM, edited]
http://radiookapi.net/actualite/2014/02 ... le-likasi/


204 measles cases with 2 deaths have been recorded since the beginning of the year [2014] in Likasi.

Medical inspector of health district Likasi released these figures after the weekly meeting of epidemiological surveillance on Wed 26 Feb 2014. Dr. Gaspard Ilunga Dipata announced a vaccination campaign against measles [to begin] by 11 Mar 2014.

The vaccination campaign, lasting 5 days and organized by the health district, will target children aged 6 months to 10 years, said the medical inspector of health district Likasi. He also discussed strengthening epidemiological surveillance as one of the measures to be taken against measles: "We want to hear [about] all cases in order to organize support. We also asked health zones to raise awareness outside communities, churches and schools," he said.

The health areas most affected are Kikula and Kapolowe, according to Dr. Gaspard Ilunga Dipata.

--
Communicated by:
ProMED-FRA
<promed-fra@promedmail.org>

[An interactive HealthMap of Congo DR is available at: http://healthmap.org/r/1Ahy. - Mod.BM]

MEASLES UPDATE (11)
*******************
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ProMED-mail is a program of the
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http://www.isid.org

******
[1] Ethiopia (national)
Date: Mon 3 Mar 2014
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA), ReliefWeb [edited]
http://reliefweb.int/sites/reliefweb.in ... 202014.pdf


During the past week [24 Feb-2 Mar 2014], 601 suspected measles cases were reported, primarily from 23 woredas [districts] in North and South Gonder, East and West Gojam, and North Wello in Amhara (446 cases). The remaining cases were reported from SNNP [Southern Nations, Nationalities, and People's Regions] (67) Oromia (56) and Tigray (6) regions, and Addis Ababa (16) and Harar (6). In light of the continuing increase of measles cases in Amhara and newly reported measles cases among the refugee and host populations in Gambella, partners are reviewing the national response plan to widen the target population for measles vaccinations. In Gambella, a mass measles vaccination campaign started on 27 Feb 2014. WHO continues to mobilize funds for the measles vaccination campaign targeting 6.8 million children under-15 in Oromia, SNNP, and Somali regions. The campaign was initially planned for 11 Jan 2014. For more information, contact <who-wro@et.afro.who.int>.

--
Communicated by:
Dr Ota Masaki, MD, PhD
Chief Adviser
JICA Amhara Regional Infectious Disease Surveillance Project (AmRids)
<otam@jata.or.jp>

[Thanks to Dr Masaki for finding this report.

Maps of Ethiopia can be seen at http://www.geographicguide.net/africa/i ... ia-map.gif and http://healthmap.org/promed/p/95. - Mod.LM]

******
[2] Somalia (Galguduud)
Date: Thu 13 Mar 2014
Source: RBC Radio [edited]
http://www.raxanreeb.com/2014/03/somali ... ud-region/


Measles breaks out in Xerale, Galgadud [Galguduud] Region confirmed by the area heads.

Xerale governor, Bashir Dahir Yusuf, said that one death case and 30 more ill of measles are so far seen in Xerale.

The governor stated that it was a couple of days ago when measles cases were observed after children and adults are reported to have become ill of the disease, adding that there are no medications or [vaccines] available to respond to the outbreak.

He finally urged the region administration, Health Organization, and business community to deliver aid for measles suffering Xerale local residents.

--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>

[This event warrants an epidemiological investigation, but in the meantime adequate and appropriate treatment and care should be accorded to all the cases to prevent further deaths. Skilled clinical and nursing care along with the recommended medicines for providing supportive care are therefore a priority in the immediate term.

Maps of Somalia can be seen at http://www.un.org/Depts/Cartographic/ma ... omalia.pdf and http://healthmap.org/promed/p/35291.- Mod.JFW]

MEASLES UPDATE (12)
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******
[1] Uganda
Date: 21 Mar 2014
Source: Uganda MOH weekly bulletin [edited]
http://health.go.ug/mohweb/?page_id=1294


This week [3-9 Mar 2014], a total of 44 suspected measles cases were reported from 23 districts. The top 10 districts included (Hoima, Buikwe, Ntungamo, Wakiso, Luweero, Masaka, Mubende, Kyenjojo, Mbarara, Kampala), which reported 2-5 cases each.

Measles outbreaks have been confirmed in Adjumani, Arua, Hoima, Kibaale and Ntungamo. The cases in Ntungamo have been reported from Nyakyera, Itojo, and Kahunga sub counties from where a total of 6 cases were confirmed to have measles following tests conducted in the measles laboratory at UVRI on 11 Mar 2014.

The outbreaks in Ajumani and Arua have been reported in camps hosting refugees from South Sudan, while the cases in Hoima originated from Kyangwali sub county IDP camp and then spread to the neighboring sub counties. Measles vaccinations have been undertaken in the affected refugee populations targeting children less than 5 years of age, while accelerated routine immunization has been implemented in the other affected areas.

At the close of 2013, a total of 101 (90.18 percent) districts had investigated at least one suspected measles case. Consequently, the annualized rate for suspected measles cases investigated was 3.22/100 000 (national target 2/100 000). Also, 8 percent of investigated suspected measles cases had tested measles IgM positive [measles cases have been confirmed from 27 districts]. The current trends are generally far below the cases reported for the corresponding period of 2012 and 2013.

--
Communicated by:
Sarah Achen for ESD-MoH Team, Uganda
<esduganda@yahoo.co.uk>

[An interactive ProMED/HealthMap can be seen at: http://healthmap.org/promed/p/97. - Mod.LM]

******
[2] Pakistan (Khyber Pakhtunkhwa)
Date: 22 Mar 2014
Source: Dawn [edited]
http://www.dawn.com/news/1094744/medica ... s-outbreak


The health department has sent its teams to the mountainous villages of the Gadoon Amazai belt to tackle a measles outbreak after reports that the disease claimed the life of a girl there.

According to reports, the measles-hit areas include Sokeelye, Sandwa, and Talaye. When contacted, people of these villages said that their children had been vaccinated regularly against various diseases, including measles, but despite that, several of them had been affected by the disease.

"We don't know about the treatment. The health officials should come and educate people on preventive measures," said Salam Pur of Sandwa village.

Zahir Shah of the same village told this correspondent by phone that an 8-year-old girl had died due to measles on Wednesday [19 Mar 2014]. However, district head of EPI Dr Yaqub said that the girl had recovered from measles and that she died due to extensive vomiting.

Answering a question, Mr Zahir said that some health officials visited the area, gave medicines to the children, and advised people to adopt precautionary measures. He said that there were about 70 measles-hit children only in Sandawa village and that more teams of doctors should be sent to the area on a emergency basis.

However, the EPI head brushed aside such assertions and said that health department teams had vaccinated 250 children and recorded that 23 of them were suffering from measles. He said that people of the area were reluctant to bring out their children for vaccination and that they were tight-lipped about the disease of their children. He also suggested that health officials should set up camps there to provide treatment to the affected children and create awareness among people about preventive measures.

This correspondent repeatedly tried to contact district health officer Dr Ihsan Akbar, but his mobile phone number was off due to unknown reasons.

Meanwhile, MPA Shiraz Khan said that he would meet with the DHO and ask him to send more medical teams to the area to treat the children.

--
Communicated by:
ProMED-mail from HealthMap Alerts
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[An interactive ProMED/HealthMap can be seen at: http://healthmap.org/promed/p/19537. - Mod.LM]

MEASLES UPDATE (14)
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******
[1] Angola (Kwanza North)
Date: 5 Apr 2014
Source: Prensa Latina [in Spanish, machine trans. edited]


At least 66 cases of measles were recorded between January and March 2014 in the city of Quiculungo, in the Angolan province of Kwanza Norte, the interim director of the municipal hospital, Kifinamena I Luzolo, confirmed today [5 Apr 2014]. "Of these, 63 children from 0-5 years old were diagnosed with the condition, whereas there are 3 adults affected," Luzolo revealed to ANGOP news agency.

He explained that patients received clinical and drug treatments dependent on symptoms. "Medical care focused on antibiotics, and serum vitamin A," he said [There are no antimicrobials known to be effective against measles, but vitamin A will benefit those who are deficient and has been shown to reduce morbidity and mortality. - Mod.LM]. The official said that in the same period, 5 patients were hospitalized in serious condition, and cases were reported affecting 3 children under 9 months.

To prevent spread, health services Quiculungo, 138 km north east of the provincial capital Delantando, conducted a vaccination campaign.

Recent estimates by the World Health Organization show that annual numbers of deaths worldwide from measles broke record lows and went from more than 562 000 in 2000 to 122 000 in 2012, representing a reduction of 78 per cent.

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

[Kwanza Norte province in Angola can be accessed on the ProMED/HealthMap at http://healthmap.org/promed/p/12166. - Mod.LM]

******
[2] Chad (N'djamena)
Date: 1 Apr 2014
Source: Medecins sans Frontieres [edited]
http://www.msf.org/article/chad-despite ... decreasing


Efforts to contain an ongoing measles epidemic affecting the Chadian capital of N'djamena must be immediately stepped up, said the international medical-humanitarian organisation, Medecins Sans Frontieres (MSF).

Despite a recent vaccination campaign carried out by the Ministry of Health, patients continue to flow into MSF-supported hospitals and health centres, with 2511 cases of the disease reported in the capital since the beginning of January 2014. MSF is urging Chadian health authorities to rapidly increase their response to the epidemic by re-launching vaccination, improving treatment of the disease in hospitals, and ensuring that existing drug supplies reach health centres.

"Without a more appropriate response to the epidemic, many more patients risk dying from this preventable disease," said Jerome Alin, MSF's head of mission in Chad. "Typically, following a mass vaccination campaign, we should see the number of measles cases decline. However, we are still seeing a significant number of patients, even though the campaign finished 4 weeks ago."

Medical data from the isolation wards in the hospitals show that the majority of the patients have not actually been vaccinated. Last week alone, 80 per cent of MSF's patients reported that they were not immunised. MSF has launched short-term support to the Ministry of Health in N'djamena in the Liberty and Union Hospitals and in 7 health centres. So far, teams have treated more than 1765 patients with measles. MSF planned its support until the end of the 1st week of April 2014 due to the number of severe cases still being admitted in the hospital. MSF will extend its support to the Ministry of Health in Hopital la Liberte up to the end of April 2014.

MSF is increasingly concerned about the disease spreading further, with a growing number of patients coming from some areas on the outskirts of the capital. "Ideally, a new vaccination campaign should be launched, targeting these affected areas," continued Alin. In addition, the lack of drugs reaching health centres is alarming. Despite the availability of medicines in N'Djamena to treat measles, supplies are not being dispatched to reach the affected population, and MSF is currently the sole provider of medications. "It is an absolute priority that drugs and medical equipment are immediately provided to the health centres," said Alin. "When we complete our support to the centres in a few days' time, the health authorities must step up their capacity to provide this essential, free of charge treatment."

North east of N'djamena, MSF is also responding to the measles epidemic in the Massakory district in Hadjer Lamis. The organisation is carrying out a one-month-long vaccination campaign for 42 000 children aged between 6 and 59 months. Between the end of January 2014 and now, 193 cases have been recorded, and MSF has treated 112 of these at Massakory Hospital.

[byline: Florence Fermon/MSF]

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[This outbreak is in the capital city. It can be found on the ProMED/HealthMap at http://healthmap.org/promed/p/38335. - Mod.LM]

******
[3] Ethiopia
Date: 31 Mar 2014
Source: The Humanitarian Bulletin, UNOCHA's official bulletin [edited]
http://reliefweb.int/sites/reliefweb.in ... 202014.pdf


Since the number of reported measles cases surged in mid-January 2014, more than 5000 suspected cases have been reported from Amhara, Gambella, Oromia, SNNP [Southern Nations, Nationalities, and People's] and Tigray regions, 975 of which have been confirmed.

Close to 2 million children under 15 years of age in Sidama, Silte and Wolayita zones of SNNPR, and some 250 000 children under 15 in selected kebeles [villages] of Amhara region were vaccinated. The government and health partners prepared a national measles outbreak response plan for a measles vaccination campaign targeting 6.7 million children under 15 in 125 woredas [districts].

--
communicated by:
Ota Masaki MD, PhD
<otam@jata.or.jp>

[A ProMED-mail HealthMap for Ethiopia can be found at http://healthmap.org/promed/p/95.]

******
[4] Pakistan (Sindh)
Date: 4 Apr 2014
Source: The Express Tribune [edited]
http://tribune.com.pk/story/691200/poss ... -of-sindh/


"Two deaths [from measles] have been reported from Thatta," confirmed the provincial health secretary. The outbreak of measles in different villages of Thatta and Sajawal district has presented another challenge for the provincial health authorities after the Tharparkar crisis. At least 2 children have died in Thatta district, and several others have reportedly been diagnosed with the viral disease over the last few days.

"Two deaths have been reported from Thatta," confirmed the provincial health secretary, Iqbal Hussain Durrani. He said that the situation was under control and that all children of the province would be vaccinated soon. Durrani told the Express Tribune that the affected areas of Thatta district were a priority and that his department would act promptly as 200 children had died last year [2013].

Though health officials are still not sure whether both the boys from UC Sonda died because of measles, they believe the symptoms were indicative of the viral disease and that it could affect other healthy children. The 1st child was reported to be affected by the virus on 7 Mar 2014 and to have died on the way to the district hospital. The 2nd child was referred from the district hospital to Karachi but died at the National Institute of Child Health last week.

"Laboratory tests will confirm the cause of death," said the district health officer, Dr Zahoor Ahmed Memon. "Unusual cases could be reported anywhere. There is no measles outbreak in my district," he said.

A majority of pregnant women are anaemic in coastal areas, including Thatta, Sajawal and Badin districts, because of poverty. Their children, meanwhile, are severely malnourished. Health officials say that resistance to the viral disease among children is weak due to malnourishment.

Vaccinations are being started from Monday [7 Apr 2014] in Thatta and Sajawal districts. The 1st phase, which will run from 7-13 Apr 2014, will target children of 3 talukas, including Thatta, Sajawal and Jati. The 2nd phase will run from 14-20 Apr 2014 in the remaining parts of Thatta and Sajawal districts.

The government will aim to vaccinate 414 545 children in both districts. Dr Memon said that out of 55 UCs, 7 have already been covered. Children above 9 months and below 11 years of age will be targeted.

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

[Sindh province is in southeastern Pakistan adjacent to the Indian states of Gujarat and Rajasthan. An interactive ProMED/HealthMap is available at http://healthmap.org/promed/p/707. - Mod.LM]

MEASLES UPDATE (15)
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******
Pakistan (Sindh)
Date: Tue 15 Apr 2014
Source: The Nation [edited]
http://www.nation.com.pk/karachi/15-Apr ... s-outbreak


At least 7 children have been killed while 185 others hospitalised due to the recent outbreak of measles in a village near Keenjhar Lake, Thatta [District, Sindh province].

Representative of various leading humanitarian organisations linked the outbreak of measles to the use of contaminated water of Keenjhar Lake. The death of 7 children took place in Sonehri village, located close to Keenjhar Lake. The village has 550 families, mostly depending on fishing and cultivation for their livelihoods.

The villagers said that only 50 per cent population has access to get water from the filter plant installed by a non-governmental organisation, while the remaining population has no other option but to use water from the government's water supply line, which is said to be smelly and contaminated. The villagers accused the government authorities of ignoring them.

The releasing of industrial chemicals into Keenjhar Lake ignited the measles outbreak, killing 7 children and inflicting around 185 others in Sonahri Village and its neighbourhoods. The fishermen said that neither they have job to feed their children properly nor health facilities in the area to get treatment in emergency.

The government's apathy could be gauged from the fact that some of the medical practitioners, who were deputed at major government hospitals, are running their private clinics in the scattered villages and are reluctant to provide help to the ailing children.

"When we took our 3-year-old child to a nearby private clinic in Sonda Village, the doctor didn't even come out to suggest us what to do. We stayed outside the clinic for 2 hours, crying for help but returned home hopelessly. Again we hired a vehicle on Rs 8000 [about USD 83] to take the child to Makli Hospital. However, the child expired at hospital before reaching any medical aid," the father of the victim narrates the tale of apathy. He has lost his 2 children, a boy and girl, in the same disease one after the other. A 4-member team of Pakistan Fisher-folk Forum (PFF) after visiting the affected area quoted the parents, saying despite getting their children vaccinated they are facing horrible situation. According to the villagers, so far, they have buried 7 dead children who became victims of the measles.

It is for the 1st time the people are experiencing disastrous situation, but the government officials are reluctant to declare emergency to avoid further loss.

They said that doctors are still unable to share cause of the outbreak that is said to be similar to the one which killed a large number of children in Shikarpur district after the 2010 flooding. It was the contaminated water there which caused deaths of several children.

The team collected information of about 185 children affected by the diseases (measles and pneumonia), where 7 children [2-11 years old] reportedly have died.

The villagers said that the failure of health services is also aggravating the problem. No health facilities are functional properly to benefit the people.

The parents are facing difficulties to take their children to major hospitals in Thatta and other cities for treatment because of poverty. Many times they starve hunger; they have empty pockets; they even cannot afford to visit private clinics, said [a parent]. There is dispensary in village Sonehri, which remained closed most of the time. After this phenomenon, the dispensary has been made functional for the sub immunisation activity of the affected children. Moreover, the dispensary only provides medicines for fever, cough and other ailments as 1st aid. After receiving a measles or pneumonia patient, the staffers refer the patient to Makli Hospital, Thatta Civil Hospital, Jinnah Hospital Karachi and other private clinics for getting better treatment.

PFF chairperson Mohammed Ali Shah said the efforts against hunger and poverty could be fruitless without protecting natural resources. Fresh water lakes are the natural assets and degradation of such resources due to flawed policy and carelessness resulted in such outbreaks of diseases.

He also appealed to the authorities concerned to take precautionary measures as Keenjhar Lake is the main source of supplying water to Karachi. "When we can reach here to help the people, why the government is reluctant to visit the affected areas and declare emergency to help the people," he criticised the officials. He said the people, who are facing malnutrition, joblessness and acute poverty, are unable to take their loved ones to the hospitals.

Thatta Medical Officer Hassan Gandro said that the recently launched vaccination covered more than 5000 children in Sonda Union Council. The measles outbreak was reported at the end of March and now it has panicked the wide area. The PPP-led Sindh government is seemingly silent as it could not initiate any move to extend helping hand to save the lives of children.

[Byline: Ramzan Chadio]

--
Communicated by:
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[While the report above does not clearly distinguish the diseases causing childhood morbidity and mortality, measles is not difficult to recognize and may be complicated by pneumonia in some children. Therefore, there is most certainly a measles outbreak in progress. Clearly, contaminated water is not at fault, but the lack of infrastructure might be expected to accompany an inadequate vaccination program.

Maps of Pakistan can be seen at http://www.ezilon.com/maps/images/asia/ ... kistan.gif and http://healthmap.org/promed/p/2677. - Mod.LM]

MEASLES UPDATE (17)
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*****

India (Bangalore, Karnataka)
Date: Thu 24 Apr 2014
Source: Times News Network (TNN) [edited]
http://timesofindia.indiatimes.com/city ... 132640.cms


This isn't the season for measles yet 40 cases in the city have flummoxed doctors. Nearly 70 percent of the afflicted are children below 14 years. "Measles usually occurs in winter, not summer. But we are attending to such cases now," say doctors. Though reasons for the outbreak are yet to be traced, doctors attribute it to irregular vaccination.

"This is true of the migrant population, specially the labour class. If one child in the group who is not immunized gets the virus, the disease can spread to other children," say doctors.

"The measles virus spreads very fast through aerosol and parents of the affected children must quarantine them. This is the season of summer camps and there are possibilities of affected children in their initial stages spreading the same to others," says pediatrician Karthik Nagesh.

Not surprisingly, the state health department is yet to gear up to control the outbreak. "Those who have missed the routine immunization are the affected group. We will be conducting field visits and focus on slums where children might have missed the routine immunization programme to prevent measles," said Dr Geetha Nyamegowda, director, health and family welfare department.

According to pediatrician Dr Jagadish Chinnappa, the outbreak is an indication of immunity level declining among children. "What was largely seen among toddlers is now seen among children aged 6-7 years. In over a month, I have seen 4 cases of measles among children," he adds.

Byappanahalli [Karnataka], the epicentre: the state health and family welfare department mapping the affected geographical area was shocked to find the large spread of the virus in Byappanahalli, Bangalore East, which is home to thousands of migrant families working in construction sites.

An apartment complex in Indiranagar [neighborhood] had multiple cases of measles that affected both adults and children.

"We don't know the source of infection. My husband and other neighbours in the apartment complex were down with measles. We could avoid the spread by quarantining them," said an apartment dweller on condition of anonymity.

The possible reason for the spike in measles cases is that children of migrant labourers who probably missed the vaccination got the virus and spread it.

"The outbreak has also been seen in North and central part of Karnataka. When we see more than 5 cases in one week in a taluk [administrative division], we term it as an outbreak. There could be unreported cases where the affected children are taken to temples, traditional healers and not to the hospital. Superstition and negligence are the biggest hurdles in measles elimination drive," said Dr BP Subramanya, surveillance medical officer World Health Organization, who is working with state government in measles elimination. He insists government conduct immunization programmes in construction sites to ensure labourers' children do not miss it.

The city has also seen a spike in cases of mumps. "I have seen about 4 cases in the past one week. Most of the kids are in the age group of 5-7 weeks or in pre-school. The 1st vaccine of mumps is given when baby attains 15 months. The 2nd vaccination is given when the baby is 4-5 years old. Many educated parents miss out on the 2nd vaccination due to lack of awareness," said Dr PS Raghavan pediatrician from Apollo Hospital.

[Byline: Sunitha Rao, Sruthy Susan Ullas]

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[A ProMED/HealthMap is accessible at http://healthmap.org/promed/p/817. - Mod.LM]

MEASLES UPDATE (19)
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*****

[1] Nigeria (Katsina)
Date: Thu 15 May 2014
Source: Daily Times NG [edited]
http://www.dailytimes.com.ng/article/me ... en-katsina


The Katsina State Government on Monday [12 May 2014] confirmed the death of 9 children following the outbreak of measles in some areas of the state. The state Commissioner for Health, Alhaji Hussani Yammama, told newsmen in Katsina that the outbreak had affected all the 34 local government areas in the state with 1260 children so far infected.

The commissioner said that the refusal of parents to take their children to the healthcare centres for routine immunisation had caused it. He, however, said the government had already taken measures to curb the spread of the disease. According to him, the measures include procurement of enough vaccines and other medications for the treatment of infected children. He, therefore, urged parents to present children for routine immunisation against the 6 child killer diseases.

The commissioner also urged them to report cases of disease outbreak to the nearest healthcare facility for urgent medical attention.

[Byline: Lara Adejo]

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[So far, a total of 1260 children have been diagnosed with measles virus infection in Katsina state. 90 children have died as a consequence. - Mod.CP]

[A ProMED-mail HealthMap is available at http://healthmap.org/promed/p/62.]

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[2] Pakistan (Sindh)
Date: Tue 13 May 2014
Source: Samaa TV [edited]
http://www.samaa.tv/health/13-May-2014/ ... s-outbreak


Chief Justice (CJ) of the Sindh High Court (SHC) has taken suo motu notice of over a dozen measles-related deaths of children in Sujawal and Thatta districts of Sindh, SAMAA reported [Suo motu, meaning "on its own motion," is a Latin legal term approximately equivalent to the term sua sponte. For example, it is used where a government agency acts on its own. - Mod.CP].

The CJ issued notices to the Secretary of Health, Chief Secretary and officials of Thatta district administration to appear in the court on Wednesday [14 May 2014] and file their responses over the matter.

Officials said over 12 children have died so far in measles outbreaks in Sujawal and Thatta, with hundreds of measles cases reported in villages of the 2 worst-hit districts.

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[A ProMED-mail HealthMap is available at http://healthmap.org/promed/p/707.]

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[3] Pakistan (Sindh)
Date: 14 May 2014
Source: Dawn.com [edited]
http://www.dawn.com/news/1106022/shc-ta ... nd-sajawal


The Sindh High Court on Tuesday [13 May 2014], taking notice of the reported deaths of 48 children in the provinces of Thatta and Sujawal due to a mysterious disease, sought answers from the provincial government, its health department, and other concerned parties before 14 May 2014, according to a Dawn report.

A citizen had written to the court asking it to take notice of hundreds of children affected by a disease known as rubella [rubeoa?] in Thatta and Sujawal areas of Sindh. He also requested vaccinations against the disease to contain it, warning that failure to do so would enable the disease to spread across the country.

Chief Justice of Pakistan Tassaduq Hussain Jillani had earlier, on 7 Mar 2014, taken suo motu [see [11] above] notice over the deaths of children due to famine and outbreak of epidemics in Tharparkar district, one of the drought-hit parts of Sindh.

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[The identity of the disease -- rubella or rubeola (measles) -- is unclear, but it is likely to be measles on the basis of the previous report. However, clarification of the situation would be appreciated. - Mod.CP]

[A ProMED-mail HealthMap is available at http://healthmap.org/promed/p/707.]

MEASLES UPDATE (20)
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*****

[1] India (Gujarat)
Date: Fri 23 May 2014
Source: Times of India, Times News Network (TNN) [edited]
http://timesofindia.indiatimes.com/city ... 510350.cms


The Health Department of Rajkot Municipal Corporation (RMC) [Gujarat] has been jolted by 11 cases of measles being reported from Lohanagar area in ward number 9 of the city in the last one week. Health teams are now camping in the slums of Lohanagar and taking steps to prevent further outbreak of the disease.

RMC officials said this is for the 1st time that such a large number measles cases have been reported from a single area in the recent years. "A local doctor treating the children first spotted the symptoms of measles and immediately informed us to look into the matter. We have deployed eight medical teams and carried out surveillance. A mobile dispensary has been deployed to reach out to all the families likely to be affected. Although 11 cases have been reported so far, but none of them are serious. We are keeping a vigil in the area to prevent its spread," deputy municipal commissioner PP Vyas said.

All the children found showing symptoms of measles are below the age of 5. Sources said complications are more common in children under the age of 5 and unvaccinated young children are at highest risk of measles. RMC officials said they are finding it difficult to convince people in these slums to get their children vaccinated. Most of the people are poor with low levels of awareness. "We have surveyed 654 houses in this area with 3764 people and vaccinated 24 children,'' deputy health officer Dr PP Rathod said. "Our medical teams with pediatricians will remain in this area and will vaccinate all the children and take preventive measures,'' Vyas added.

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[Rajkot is the 4th largest city in the state of Gujarat, India, Rajkot is the 35th-largest urban agglomeration in India, with a population more than 1.28 million. Rajkot is also the 22nd-fastest-growing city in the world. The city contains the administrative headquarters of the Rajkot District, 245 km (152 mi) from the state capital Gandhinagar, and is located on the banks of the Aji and Nyari Rivers. Its location is shown on the map at http://en.wikipedia.org/wiki/Rajkot. - Mod.CP]

[A HealthMap/ProMED-mail map can be accessed at http://healthmap.org/promed/p/142. - Sr.Tech.Ed.MJ]

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[2] India (Madhya Pradesh)
Date: Fri 23 May 2014
Source: The Free Press Journal (FPJ) [summ., edited]
http://freepressjournal.in/suspected-de ... autopsies/


Bodies were exhumed from Kakanwani police station area in Meghnagar on [Wed 21 May 2014]. The bodies of 2 children, which were exhumed by the police in Meghnwere agar in Jhabua district, were taken to MY Hospital for autopsy on [Thu 22 May 2014]. On the directions of Jhabua district administration and police, the hospital administration conducted post-mortem of the bodies under the super vision of a committee.

It is to be noted that the bodies were exhumed and sent for autopsy to know the exact reasons of the death of the children. It was believed that they died due to the contagious measles. As per information, bodies of an 18 month old child and a 3 year old child were exhumed for autopsy and a report was submitted to the police. "We will present the report to Jhabua police as soon as possible," the superintendent of MY Hospital Dr PS Thakur said.

A FIR against 5 employees of the Jhiasbu Health Department, Jhabua was also lodged in Meghnagar and their arrest would take place in a couple of days.

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[It is unclear why the 2 children were buried without diagnosis of their illness. It appears that hospital staff are implicated and the likely subjects of an FIR, a 1st information report, prepared by police about commission of a cognizable offence.

Meghnagar is a census town in Jhabua district in the Indian state of Madhya Pradesh. Meghnagar has an average literacy rate of 62 per cent, higher than the national average of 59.5 per cent: male literacy is 69 per cent, and female literacy is 54 per cent. In Meghnagar, 18 per cent of the population is under 6 years of age. Its location can be found via on the map at http://en.wikipedia.org/wiki/Meghnagar. - Mod.CP]

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[3] Pakistan (national)
Date: Mon 19 May 2014
Source: SOS Children's Villages [edited]
http://www.soschildrensvillages.org.uk/ ... n-pakistan


Recurring measles outbreaks in Pakistan are a sign of a health system that is struggling more broadly to cope.

With more than 25 000 cases and 321 deaths last year [2013] in Pakistan, measles infections are becoming a growing concern for doctors and citizens alike. This was an increase on previous years and, worryingly, 1329 new cases have already been confirmed this year [2014]. These repeated outbreaks not only raise concerns about measles, but also that the government is not doing enough to combat preventable diseases in general.

Measles is included in the Expanded Programme of Immunisation (EPI), which has been running since 1978 and which also vaccinates against polio, tetanus, and meningitis. This programme should ensure that all children are immune to the most common preventable diseases, but it is failing to reach many. Ishaq Panezai, provincial deputy coordinator for the EPI, tells IRIN news [UN Integrated Regional Information Networks] that in Kalat district, where the 6 people recently died of measles, they are being told by local authorities that it is too dangerous to work there.

The unstable security situation certainly hampers efforts to vaccinate the population, as does the severe flooding caused by monsoon rains. However, many people believe that corruption is at the heart of the problem and this is borne out by a number of studies. Chief amongst them is a recent piece of research done by Quaid-e-Azam University in Islamabad, which cited corruption as the main cause of the high rates of measles infections.

The Lancet, a British medical journal, agrees, calling the Pakistani vaccination programmes "poor quality and ailing". According to a health employee in Quetta, medicines from government clinics are often stolen by employees and then sold to private clinics or shops, damaging the overall EPI mission. As Sikander Lodhi, a Pakistani economist, tells IRIN, this corruption extends to every sector in society, so tackling it will present a major challenge for those hoping to improve public health.

The national government has already moved to free up additional funds for the EPI and they are carrying out a Vaccine Management Assessment. This step has been welcomed by experts, but they remain cautious about the true impact it will have, given the scale of the problems faced. Not least amongst them are the generally low immunisation rates. At the moment 53 per cent of children are not vaccinated against anything, a shockingly high number.

There is some concern that the current approach is not broad enough and that the focus on polio is obscuring the challenges presented by other diseases, including measles. Most suggest that a holistic approach, similar to the original mission of the EPI, is the only way to safe guard Pakistan's children. However, to achieve this people will need to educated on the benefits of immunisations, since misconceptions are currently hampering vaccination programmes. Overcoming these challenges will be important for combating all disease, not just measles or polio.

[The SOS Children [Organisation] carries provides healthcare to vulnerable children in [only] 12 locations across Pakistan.

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[According tor research carried out by Quaid-e-Azam University in Islamabad, the main cause of the high rates of measles infections is corruption in the administration. At the moment 53 per cent of children are not vaccinated against anything. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at http://healthmap.org/promed/p/140. - Sr.Tech.Ed.MJ]

MEASLES UPDATE (21)
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*****

[1]Somalia (Afmadow)
Date: Tue 27 May 2014
Source: AllAfrica [edited]
http://allafrica.com/stories/201405280212.html


A measles outbreak has been reported in Afmadow affecting 72 people, 50 of them children under the age of 5, Somalia's Radio Bar-Kulan reported o Mon 26 May 2014.

Hassan Mursal, director general of Afmadow Hospital, attributed the rise in measles cases to the absence of available vaccinations in the area over the last 2 years.

The World Health Organisation (WHO) estimates that measles vaccine coverage in Somalia is less than 30 percent, according to RBC Radio.

Measles outbreaks have been confirmed in Benadir, Lower Jubba, Mudug, Nugal and Galbeed regions since February 2014, and the number of cases reported in the country has jumped from 1200 in the 1st months of 2013 to 2300 in the 1st months of 2014.

"To mitigate outbreak risks, mass measles vaccination campaigns need to be urgently conducted in the entire country," the WHO said.

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[Afmadow is a city in southern Somalia, located in the middle of the Juba region and bordered by Kenya, Badhadhe, Kismayo, Jamame, Jilib, Hagar, Bardhere, and Elwaq in Somalia, 401 km southwest of the capital Mogadishu. It is home to a wide variety of wild animals, including the Big 5 game animals. The vegetation in Afmadow consists of rich grassland bounded by semi-desert. Its location can be seen at: http://en.wikipedia.org/wiki/Afmadow. - Mod.CP

A ProMED-mail HealthMap is available at http://healthmap.org/promed/p/125.]

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[2] India (Delhi)
Date: Mon 26 May 2014
Source: CITIES [edited]
http://indianexpress.com/article/cities ... es-to-who/


Delhi has witnessed a spike in measles cases over the last 3 months, with this seen as the 1st such jump in a decade. The spike has prompted the Delhi Health department and civic agencies to conduct the 1st ground survey in slum areas to test both children and adults. With another 10 days to go for the survey, over 4500 suspected measles cases have been found. So far, 450 people have been admitted to the Maharishi Valmiki Infectious Diseases Hospital (MVID) under the North Municipal Corporation in the last 3 weeks.

A total of 800 cases of measles have been reported this year [2014], with 363 being reported from MVID hospital between January and March 2014, an official said. Authorities at Delhi's Department of Family Welfare said a preliminary report of the survey has been sent to WHO India experts. From 5-21 May 2014, 90 lakh [a lakh equals 100 000, so 9 million] people have been screened for measles, mostly in congested areas and slums. Half of these are children. According to the report, 4500 suspected cases have been identified, of which 1120 were referred to hospitals and around 450 admitted immediately to MVID as confirmed measles cases. The report stated that 3300 cases were treated at home for complications such as respiratory infections and pneumonia, conditions suspected to be a result of measles.

Dr D K Dewan, director of the Department of Family Welfare, said: "Diagnosed cases of measles are treated only at MVID hospital, since it can spread to other children in routine hospitals. Figures from January to March 2014 at this hospital point to an unusual and unexplained spike in cases this year [2014]. So, we got our field staff to start conducting house-to-house visits, starting with the areas where the initial cases were reported." Dr Dewan said that 90 per cent of high-risk areas -- Sangam Vihar, Mandawali, Mukundpur, Mustafabad and Karawal Nagar -- have been covered. According to health department figures, the capital has recorded 202, 217 and 173 diagnosed cases of measles from January to March in the last 3 years, respectively.

Authorities have started identifying trends from the diagnosed cases this year [2014] to ascertain the possible causes of the sudden spurt. "Most of the children we have confirmed with measles were between 6 and 8 years of age and migrated to Delhi from other states when they were about 2 years old. The measles vaccine has 2 shots, one that is administered after the 9th-12th month after birth, and the 2nd after the 16th month. So, effectively they had missed the immunisation cycle," Dr Dewan said. What is worrying health experts more is the "significant number" of children who were detected with measles despite having been vaccinated. "We have sent blood samples to the National Centre for Disease Control to see if there is any mutation in the virus, which is not being controlled with the vaccine. While every virus has a spurt, the spurt in measles cases this year [2014] has come after 10 years. Routine cycles repeat every 2-3 years. We have also sent a report to the WHO about this," Dr Dewan said.

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[A ProMED-mail HealthMap is available at http://healthmap.org/promed/p/35219.]

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[3] India (Madhya Pradesh)
Date: Tue 27 May 2014
Source: The Free Press Journal News Service [edited]
http://freepressjournal.in/measles-outb ... se-stress/


After children's deaths caused by measles due to incomplete and irregular immunization in the affected villages, the collector directed to lodge FIRs [First Information Reports] against the employees concerned. This action of administration has caused fear and stress among the employees and officers of the district health department.

They also explained in the memorandum that the geographical condition of Jhabua district is very different from the other districts. The villages in which the measles claimed lives of children are on the Gujraat border, and most of the villagers used to go on short-term migration in Gujarat. Due to this, many children used to be left out of immunization.

They further asserted that one ANM [Auxiliary Nurse Midwife] in the health department had to work for 6 to 7 villages, and she has to work according to her available time. According to rule, with a population of 3000, one ANM and one MPW [Male Health Worker] should be posted; but presently in this block, only one ANM is posted for a population of 7-8000. The area-wide situation is more serious, as only one health worker is available to look after an area of 10-15 km in diameter.

Thus, in these circumstances, the action of filing an FIR against the employees is highly unjust, and it has caused widespread anguish among the employees. Therefore, the Medical Officers and Health Workers Union demanded the cancellation.

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[Meghnagar is a census town in Jhabua district in the Indian state of Madhya Pradesh. It can be located in the map at http://en.wikipedia.org/wiki/Meghnagar. - Mod.CP

A ProMED-mail HealthMap is available at http://healthmap.org/promed/p/309.]

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[4] Pakistan (Khyber Pakhtunkhwa)
Date 30 May 2014
Source: Dawn [edited]
http://www.dawn.com/news/1109721/report ... c-minister


Khyber Pakhtunkhwa Senior Minister for Health Shahram Khan Tarakai has directed thorough, transparent, and fair investigation into the deaths of 3 children during the ongoing anti-measles campaign in the province. This he said while chairing a meeting of the fact finding committee of technical experts formed to probe the measles vaccine issue here on Friday [30 May 2014], according to a handout. He also directed the officials to furnish a factual and accurate report in the shortest possible time so that the actual causes behind the deaths of the children could be ascertained.

The minister also directed the committee to thoroughly look into different aspects, including the pre-campaign preparations of the health department, the vaccine being used in the campaign, human and technical errors in administering the vaccine, and the medical treatment provided to the children after reaction to the vaccine, and thus come up with a solid and comprehensive report based on actual findings.

Mr Tarakai said that it was of prime importance not only for him but also for his government to ascertain the root causes behind the loss of 3 innocent lives because, if the children had died due to a reaction to the measles vaccine, then those responsible for it would be taken to task.
Mr Tarakai said findings of the committee would be made public through media and nothing would be concealed in that regard. The committee apprised the minister of the progress made so far in the case. Besides secretary health Ghulam Qadir, chairman of the committee Professor Amin Jan, EPI provincial chief and member of the committee Dr Janbaz Afridi, its other members, and WHO representatives attended the meeting.

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MEASLES UPDATE (22)
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*****

[1] India (Delhi)
Date: Mon 2 Jun 20114
Source: The Indian Express [summ., edited]
http://indianexpress.com/article/cities ... es-to-who/


Delhi has witnessed a spike in measles cases over the last 3 months, the 1st such jump in a decade. The spike has prompted the Delhi Health department and civic agencies to conduct the 1st ground survey in slum areas to test both children and adults. With another 10 days to go for the survey, over 4500 suspected measles cases have been found. So far, 450 people have been admitted to the Maharishi Valmiki Infectious Diseases Hospital (MVID) under the North Municipal Corporation in the last 3 weeks.

A total of 800 cases of measles has been reported this year [2014], with 363 being reported from MVID hospital between January and March, an official said. Authorities at Delhi's Department of Family Welfare said a preliminary report of the survey has been sent to WHO India experts. From [5 to 21 May 2014], 90 lakh [9 million] people have been screened for measles, mostly in congested areas and slums. Dr Dewan said that 90 per cent of high-risk areas -- Sangam Vihar, Mandawali, Mukundpur, Mustafabad, and Karawal Nagar -- have been covered. According to Health department figures, the capital has recorded 202, 217, and 173 diagnosed cases of measles from January to March in the last 3 years.

What is worrying health experts is the "significant number" of children who were detected with measles despite having been vaccinated.

[Byline: Pritha Chatterjee]

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[A HealthMap/ProMED-mail map can be accessed at http://healthmap.org/promed/p/35219. - Sr.Tech.Ed.MJ]

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[2] Pakistan (Charsadda District, Khyber-Pakhtunkhwa) vaccine related
Date: Sun 1 Jun 2014
Source: Pakistan Today, Independent News Pakistan (INP) report [summ., edited]
http://www.pakistantoday.com.pk/2014/06 ... charsadda/


Two more children died on Sunday [1 Jun 2014] after being injected with anti-measles vaccine, taking the death toll from related incidents to 4. A few days ago 2 4-year-old children from the Shabra and Amirabad areas of Charsadda district were injected with the vaccine during an anti-measles campaign. Both expired on Sun 1 Jun 2014. The deaths of 2 more children due to the administration of anti-measles vaccine during the recent campaign has raised the death toll to 4, creating panic locally.

The parents have questioned the quality of the vaccine being used in the anti-measles campaign and condemned the provincial government for continuing the campaign despite the adverse effects of the vaccine on children. Official sources were of the opinion that the major cause of the deaths is untrained staff members providing services in the campaign but the victims' relatives questioned the government's viewpoint and asked why untrained staff was allowed to play with lives of their children.

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[Maps of Pakistan can be seen at http://www.mapsofworld.com/pakistan/map ... al-map.jpg and http://healthmap.org/promed/p/13777. Sr.Tech.Ed.MJ]