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Fighting Measles Endemic in Ethiopia amid Global Health Crisis

Measles is a highly contagious, serious disease caused by a virus. In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year.

The disease is one of the leading causes of death among young children, even though a safe and cost-effective vaccine is available.

Measles is common in many low- income countries, but there is limited information on confirming the outbreak, describing the outbreak in terms of person, place and time, and identifying determinants of the outbreak. It can occur in areas with high vaccination coverage. An estimated 52 600 people died from measles in 2018 in the African Region, mostly children under the age of five.

The measles outbreaks remain a risk in all African countries where the routine immunization coverage remains below 95% and where periodic supplemental immunization campaigns have been delayed or do not achieve 95% coverage in all districts.

According to WHO and UNICEF national immunization coverage estimate, Ethiopia is the fifth country in the world with a large number of immunized children. In 2018, 872,828 children were not immunized for the third dose of pentavalent vaccine and 1,215,724 children were not immunized with the first dose of measles vaccines.

Measles is a highly infectious vaccine-preventable disease. While children that are not immunized are at risk, those that are also malnourished or are already affected by other diseases are especially susceptible to it.

The East African country of the Federal Democratic Republic of Ethiopia is confronted with several disease outbreaks in 2019. Measles is endemic in Ethiopia with outbreaks reported annually. Improved outbreak preparedness and response efforts of the Government, as well as measles supplementary immunisation activities (SIAs), have helped to significantly reduce measles cases and increase coverage with one dose to 65%.

Since the beginning of the year 2020, health officials have 1,873 measles cases in Ethiopia and since an outbreak was declared on Jan. 24, 700 cases were reported. The outbreak was declared in  the East Wollega, Oromia region, with the first case dating back to early December 2019.

The continued measles outbreaks were most likely a result of low routine vaccination coverage: 69 per cent of the cases reported not having received a single dose of measles vaccine before the infection, while 12 per cent could not recall encountering such a service.

Experts have warned that interruptions to vaccination programmes caused by the COVID-19 pandemic may result in new waves of measles outbreaks. A growing number of one-off immunisation campaigns and national routine vaccine introductions are being delayed amid social distancing and other measures to curb the spread of COVID-19, leaving millions unprotected.

Nearly 15 million children were vaccinated despite COVID-19 challenges- WHO

However, a new report by WHO indicates that almost 15 million children have been vaccinated against measles in Ethiopia in an effort by the health authorities to maintain essential health services, even as they battle to contain the COVID-19 pandemic.

Ahead of the immunization drive targeting children aged 9–59 months, vaccinators were trained on the COVID-19 prevention measures, communities informed of the campaign and encouraged to turn up, and vaccination supplies as well as personal protective equipment and sanitizers were shipped.

The campaign’s target was 15 million children and it attained 96% coverage (14.4 million), showing that even with an ongoing COVID-19 pandemic, countries can continue to carry out life-saving mass vaccinations.

“By taking the appropriate measures, we can continue to provide essential services while striving to end this pandemic. Millions of children are at risk of vaccine-preventable diseases and waiting for the end of COVID-19 to restart immunization campaigns is a gamble we cannot afford,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

The nationwide campaign which wrapped up this weekend was conducted under the leadership of the Ethiopian Ministry of Health with support from World Health Organization (WHO), UNICEF, Gavi, the Vaccine Alliance and the United States Centers for Disease Control and Prevention. The vaccination campaign was initially scheduled for April but was suspended due to the pandemic and resumed in July.

The campaign ran for 10 days, which is longer than similar past campaigns to limit crowding and risks of COVID-19 infections. Health workers wearing face masks delivered the measles vaccine in open and well-ventilated areas. Other measures such as physical distancing, handwashing and temperature checks were also implemented in compliance with COVID-19 prevention guidelines.

Fewer than 10 of the 47 countries in the WHO African Region are on track to achieve the 2020 measles elimination target of cutting new infections to fewer than one per 1 million population. The COVID-19 pandemic threatens to set the region back even further. Initial data from the first quarter of 2020 indicates that 1.5 million more African children missed the first dose of measles vaccine compared with the same period last year.

In 2019, 4.5 million children were unvaccinated against measles. Unless vaccination services manage to reach these children in the coming months, the decline adds a significant number of susceptible infants and young children to the existing pool of unvaccinated children across the region, posing huge risks for measles outbreaks.

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