Attachments
- Introduction
1.1.Worldwide case load and challenges of Measles
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 1. Still this is one of the leading causes of mortality among children under five years of age, particularly in low income countries. In 2008, there were 164 000 measles deaths globally – nearly 450 deaths every day or 18 deaths every hour. This might hamper the efforts to achieve the 4th Millennium Development Goal (MGD) of reduce the under-five mortality by rate by twothirds between 1990 and 2015.
The risk of measles infection is high with high prevalence of malnutrition, poor immunization coverage particularly in complex emergencies and disasters and displacement lead concentration camps. Increasing trend of disasters and complex emergency situations might worsen the global burden of measles.
Effective immunization is the only cost effective preventive measure for Measles control. Cumulatively, approximately 12.7 million measles deaths were averted during 2000–2008 as a result of immunization 2. Concurrently the use of injectable Measles antigen requires standard precautions and trained staff to perform the vaccination and the wide range of vaccination target group also make the vaccination process to be a great challenge, particularly in complex emergencies and developing economic settings.
The sero-conversion rate of measles vaccine is 85%, that means only 85% of vaccinated children shall develop immunity against Measles after the first dose. About 15% of the vaccinated children need a second dose to ensure their lifelong immunity. Therefore it is essential to provide a second dose to all the children vaccinated with the first dose of measles vaccine at appropriate interval (usually 3-9months apart).
One of the advantage of immunization is development of herd immunity this could be achieved in a developed community by >80% coverage of immunization with a very efficient (>95% sero-conversion rate) vaccine. But for measles; the coverage should be >95% of the whole population due to its poor sero-conversion particularly in complex emergency situations where the reproduction rate of measles is high. There for achieving 95% countrywide coverage is being a deceptive target for most of the developing countries in complex emergencies.
Apart from availability of reasonably effective vaccine; poor health system and complex situation in low income countries are continue to be the main obstacle to achieve the coverage of immunization. Better development of health system in those low income countries might guarantee better immunization coverage.
Measles infection could end up with diarrhea, severe malnutrition, Pneumonia, blindness, ear infection and deafness and encephalitis. These complications of measles are very detrimental, costly to treat and need special treatment facilities and the long term effect of the disease might end up with disabilities. Disabilities themselves will reduce the capacity of the affected personal and affect their productivity and ultimately it might affect the productivity of the country and its economy. Therefore strong commitment of all stakeholders and their joint efforts is mandatory to reduce the burden of Measles in countries like Afghanistan.