Attachments
Operation Start Date: 2024-04-20
Operation End Date: 31-08-2024
Targeted Areas: Federacija Bosne i Hercegovine, Republika Srpska
Description of the Event
Date when the trigger was met: 2024-04-09
What happened, where and when?
The outbreak of measles in Bosnia and Herzegovina (BiH) began at the beginning of 2024. Initially, in January and February 2024, the highest number of cases were recorded in Bijeljina, Banja Luka, and the Tuzla Canton, specifically in the cities of Tuzla and Živinice. Subsequently, the number increased in the Sarajevo Canton, especially in mid March, where it is still on the rise. Measles cases have also been reported in the Brčko District of BiH. In addition to measles, cases of pertussis (whooping cough) and varicella (chickenpox) are also being recorded.
According to official data from the Institute of Public Health of the Federation of BiH, in the last three months, from January to April 2024, a total of 1,749 cases of measles have been reported, with the highest number in the Sarajevo Canton (1,243 cases), Tuzla Canton (423 cases), Zenica-Doboj Canton (56) and Central-Bosnia Canton (23). Comparing monthly data, a significant increase can be observed from 76 cases in January 2024 to 289 cases in February and 949 cases in March 2024. 88 cases of pertussis were also reported in the Zenica-Doboj Canton from January to March 2024. Hospital visits have now been prohibited due to this situation.
Following the epidemiological situation in Bosnia and Herzegovina through daily, weekly, and monthly reports from the Institute of Public Health, it was noted that in the last week of March 2024, the number of confirmed measles cases suddenly increased fourfold, especially in Sarajevo. Considering that the peak of the epidemic (late March) recorded 1,017 cases, and with 252 cases reported in just the first week of April, it is presumed that the number of confirmed cases will exceed the total for the previous three months. In the last week of March 2024, a meeting was held with representatives from the World Health Organization (WHO) country office in BiH. In the first week of April, another meeting was held with representatives from the Institute of Public Health. Official information from both the Institute of Public Health and the WHO country office from 9 April confirmed the need for the Red Cross Society of Bosnia and Herzegovina to be involved in supporting efforts to control epidemics and conduct promotional and educational campaigns.
Additionally, a meeting between the Red Cross Society of Bosnia and Herzegovina and the Public Health Institute of the Federation of BiH was held on April 9 regarding the current measles and epidemics in the country. During the meeting with the Public Health Institute, it was agreed to initiate more concrete activities working with local communities and emphasize the importance of additional vaccine promotion. As a result, the meeting served as the trigger to initiate the DREF request.
Scope and Scale
Nationwide data has indicated that there have been 99 cases of measles among children aged 0-1 years old, 731 among children aged 1-4 years old, and 483 cased among children aged 5-9 years old. Additionally, there have been 130 cases of measles reported among individuals aged 30 to 65 years.
By the end of the first week of April, a total of 1,243 cases of measles have been reported in the Sarajevo Canton. The majority of cases were among children aged 1 to 4 years (42.4%), followed by the age group of 5 to 9 years (29%) and the age group of 10 to 14 years (11%). Two deaths from these diseases have been confirmed in Sarajevo.
Due to the high number of cases, a measles epidemic was declared in the Sarajevo Canton on 10 February 2024. In addition to the measles outbreak, Sarajevo Canton has also been burdened with a higher number of pertussis cases. The Ministry of Health of the Sarajevo Canton declared an epidemic of pertussis, also known as whooping cough, on March 12 for the territory of the canton. A total of 112 cases of pertussis were recorded in the Sarajevo Canton from January to March 2024.
A measles epidemic was also declared in Bijeljina in February 2024, followed by one in Banja Luka. According to official data from the Institute of Public Health of Republika Srpska, there have been 40 cases of measles and 125 cases of pertussis reported. The highest number of pertussis cases was recorded in Banja Luka, totaling 105 people. In the Brčko District of BiH, 28 cases of measles have been reported. According to official data, the vaccination rate in this area is only 52 per cent.
Finally, due to the deteriorating epidemiological situation in the Tuzla Canton, the Ministry of Health of the Tuzla Canton issued an order declaring a measles epidemic on 23 February 2024, upon the proposal of the Institute of Public Health of the Tuzla Canton. In addition to measles, 69 cases of pertussis were recorded in the Tuzla Canton from January to March 2024.
Additional complications arose due to high rates of chickenpox infections. During the period from January to March 2024, close to 1,500 cases of chickenpox were recorded in BiH. The highest numbers were reported in the Sarajevo Canton (357), Tuzla Canton (308), Una-Sana Canton (296), and Herzegovina (260). This data represents the situation for January and February 2024.
The measles outbreak is expected to lead to increased cases of severe illness, hospitalizations, and fatalities, especially among unvaccinated or under-vaccinated individuals, infants, children, and those with compromised immune systems, as evidenced by the two fatalities already confirmed.
The national healthcare infrastructure is also experiencing additional strain due to increased demand for medical services, hospital beds, and medications. Public health systems may face challenges in managing the outbreak effectively. People who have not received the recommended measles and pertussis vaccinations are at higher risk of contracting and spreading the diseases, particularly infants who are too young to be fully vaccinated. Young children, especially those under 1 year old, are highly vulnerable to severe complications from measles and pertussis, and they may require intensive medical care and are at risk of long-term health effects.
Furthermore, families may face economic strain due to healthcare costs, missed workdays to care for sick family members, and disruptions in childcare arrangements. The outbreak also impacts people's mental health, causing significant stress, anxiety, and fear among the population, particularly parents worrying about the health of their children and the overall community's health.
According to the national health authorities, less than 60 per cent of the population in BiH is vaccinated against measles and rubella. In 2022, BiH achieved a vaccination rate of 60 per cent with two doses of the measles vaccine, which is significantly below the prescribed level of the World Health Organization. According to the World Health Organization, at least 95 percent of children must be fully vaccinated, meaning they should receive two doses of the MMR (measles, mumps, rubella) vaccine to achieve herd immunity and prevent further spread of the epidemic Historically, prior to the COVID-19 pandemic, vaccination rates were significantly higher, resulting in isolated and very low case numbers of communicable diseases. However, following the pandemic, there has been a decline in trust of vaccines and the public healthcare system due to the mis-and disinformation, including various myths, especially those suggesting vaccines cause autism and various autoimmune diseases. This distrust is evident by the fact that currently, among people infected with measles, the vaccination rate is around 0.5 per cent.