Many countries around the world are experiencing measles outbreaks. As of November 2019, there have been 440,263 confirmed cases reported to WHO through official monthly reporting by 187 Member States in 2019. From the start of the year 2019 till November 2019, Pakistan confirmed 1,978 cases.
Measles is a highly contagious viral disease which affects susceptible individuals of all ages and remains one of the leading causes of death among young children globally. It is transmitted via droplets from the nose, mouth, or throat of infected persons. Initial symptoms include high fever, usually accompanied by runny nose, conjunctivitis, cough and tiny white spots on the inside of the mouth. Sometimes later, a rash develops, starting on the face and upper neck. A patient is infectious four days before the start of the rash.
Public health response
WHO has established a measles outbreaks Incident Management Support system to coordinate its support to affected countries. It coordinates with its partners to support for the following activities:
- Enhancing preparedness for measles outbreak response
- Strengthening public trust in vaccines
- Strengthening surveillance, risk assessment and outbreak investigations
- Improving clinical management of measles cases
- Implementing outbreak response immunization activities
- Evaluating outbreak response activities
WHO risk Assessment
Even with implementation of routine immunization, measles continues to circulate globally due to sub-optimal vaccination coverage and population immunity gaps. Any community with less than 95% population immunity is at risk for an outbreak. If an outbreak response is not timely and comprehensive, the virus will find its way into more pockets of vulnerable individuals and potentially spread within and beyond the affected countries.
The impact on public health will persist until the ongoing outbreaks are controlled, routine immunization coverage is continuously high (≥ 95%) and immunity gaps in the population are closed. As long as measles continues to circulate anywhere in the world, no country can be assured to avoid importation. However, countries can protect their populations through high vaccine coverage achieved primarily through routine immunization programmes, and where necessary through supplemental immunization activities designed to assure that susceptible individuals are vaccinated.
Immunization is the most effective preventive measure against measles. Two doses of measles-containing-vaccine are recommended to ensure immunity.
While there is no specific antiviral treatment for measles, prompt provision of vitamin A is recommended by WHO for all children infected with measles. It is critical to quickly recognize and treat complications of measles in order to reduce mortality and severity of disease.
WHO urges to do the following:
- Maintain high measles vaccination coverage (≥ 95%) with two doses of measles-containing-vaccine, in every district;
- Offer vaccination to individuals who do not have proof of vaccination or immunity against measles, and who are at risk of infection and transmission of the virus, such as healthcare workers, people working in tourism and transportation, and international travelers;
- Strengthen epidemiological surveillance for cases of ‘fever with rash’ for timely detection of all suspected cases of measles in public and private healthcare facilities;
- Ensure that collected blood samples from suspect measles cases appropriately tested by laboratories within five days;
- All countries need to provide a rapid response to imported measles cases to prevent the establishment or re-establishment of endemic transmission;
- Recognize complications early and provide comprehensive treatment to reduce the severity of disease and avoid unnecessary deaths.
- Administer vitamin A supplementation to all children diagnosed with measles to reduce the complications and mortality (two doses of 50, 000 IU for a child less than 6 month of age, 1,00, 000 IU for children between 6 and12 months of age or 2, 00, 000 IU for children 12-59 months, immediately upon diagnosis and on the following day.
- Ensure health care workers are vaccinated in order to avoid infections acquired in a health care setting.