UNICEF, WHO warn of larger measles outbreaks across the globe.

Updated by Faith Barbara Namagembe at 0849 EAT on Friday 29 April 2022.

An increase in measles cases in January and February 2022 is a worrying sign of a heightened risk for the spread of vaccine-preventable diseases and could trigger further larger outbreaks, particularly measles among children in 2022, according to the World Health Organisation and UNICEF.

The risk for large outbreaks has increased as communities relax social distancing practices and other preventive measures implemented during the height of the COVID-19 pandemic. The increase of such vaccine-preventable disease outbreaks has also been facilitated by displacements due to conflicts, lack of clean water and sanitation, overcrowding and disruptions in routine immunization.

The two UN agencies have stated that such pandemic-related disruptions, increasing inequalities in access to vaccines, and the diversion of resources from routine immunization are leaving too many children without protection against measles and other vaccine-preventable diseases.

Almost 17,338 measles cases were reported worldwide in January and February 2022, compared to 9,665 during the first two months of 2021. As measles is very contagious, cases tend to show up quickly when vaccination levels decline and the agencies are concerned that outbreaks of measles could also forewarn outbreaks of other diseases that do not spread as rapidly. 

Apart from its direct effect on the body, which can be lethal, the measles virus also weakens the immune system and makes a child more vulnerable to other infectious diseases like pneumonia and diarrhoea, including after the infection itself among those who survive.  Most cases occur in settings that have faced social and economic hardships due to COVID-19, conflict, or other crises, and have chronically weak health system infrastructure and insecurity.

“Measles is more than a dangerous and potentially deadly disease. It is also an early indication that there are gaps in our global immunization coverage, gaps vulnerable children cannot afford,” said Catherine Russell, UNICEF executive director.

“It is encouraging that people in many communities are beginning to feel protected enough from COVID-19 to return to more social activities. But doing so in places where children are not receiving routine vaccination creates the perfect storm for the spread of a disease like measles.”  

In 2020, 23 million children missed out on basic childhood vaccines through routine health services, the highest number since 2009 and 3.7 million more than in 2019.  As of April 2022, the agencies reported 21 large and disruptive measles outbreaks around the world in the last 12 months. Most of the measles cases were reported in Africa and the East Mediterranean region.

The figures are likely higher as the pandemic has disrupted surveillance systems globally, with potential under-reporting, the organization notes. Countries with the largest measles outbreaks in the past year include Somalia, Yemen, Nigeria, Afghanistan, and Ethiopia. Insufficient measles vaccine coverage is the major reason for outbreaks, wherever they occur.

“The COVID-19 pandemic has interrupted immunization services, health systems have been overwhelmed, and we are now seeing a resurgence of deadly diseases including measles. For many other diseases, the impact of these disruptions to immunization services will be felt for decades to come,” said Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organization.

The UN bodies have recommended the launch of catch up immunization campaigns whereby on April 1, 57 campaigns in 43 countries had been scheduled place 43 countries at the start of the pandemic in 2020 are still postponed.

Of these, 19 are measles campaigns, which put 73 million children at risk of measles due to missed vaccinations. In Ukraine, the measles catch-up campaign of 2019 was interrupted due to the COVID-19 pandemic and thereafter due to the war.

However, experts say coverage at or above 95 per cent with two doses of the safe and effective measles vaccine can protect children against measles.

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