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What happened, where and when?
According to the Republican Center for Immunoprophylaxis of the Ministry of Health of the Kyrgyz Republic, since the beginning of 2023, the epidemiological situation in the country on measles and rubella has worsened. Registration of measles cases is observed in all regions. As of December 5, Kyrgyzstan has detected 5,162 cases of measles since the start of 2023, as reported by the Republican Center for Immunoprophylaxis. From these 1,627 cases were laboratory-confirmed, 1,231 were clinically confirmed, and 2,304 cases were epidemiologically related.
In terms of regional distribution, Bishkek recorded 1,517 cases, Osh city 356, Osh region 744, Batken region 116, Chui region 723, Jalal-Abad region 1,467, Talas region 97, Issyk-Kul region 81, and Naryn region 61. 43.6% of cases fall in the 1–4 years age group, 26.5% under 1 year, 17.8% from 5 to 9 years, 4.0% from 10 to 14 years, 0.9% from 15 to 19 years, 4% from 20 to 29 years, and 30 years and older constitute 142 cases.
On November 2, the Ministry of Health of the Kyrgyz Republic reported that a total of three people have died from complications of measles since the beginning of the outbreak (https://ru.sputnik.kg/20231102/kyrgyzstan-kor-deti-smert-1080137174.html). One case was reported in Bishkek (a three-year-old child) and two (2) cases in Chui oblast (a one-year-old child and a thirteen-year-old child). All three children were not vaccinated according to the National Vaccination Calendar.
The main reason for the increase in incidence is a decrease in vaccination coverage for both children and adults as part of routine immunization. Declining childhood vaccination coverage during the COVID-19 pandemic played a key role in the current increase in measles incidence. In 2022, coverage for the first dose of MMR in the country was 94.4% and 94.5% for the second dose.
This increase is also attributed to an increase in vaccination refusals, as well as increased migration in cities such as Bishkek and Osh, where migrant children are not served in local primary health care facilities and thus miss scheduled vaccinations.
Vaccine hesitancy is increasing in the country. Since 2016, the Republican Center for Immunoprophylaxis has received an increasing number of reports of vaccination refusals. In 2021, more than 10,000 refusals were reported. Currently, an estimated 17,000 refusals have been reported at health facilities in the county. The current number of measles cases may be underestimated and is expected to increase in the coming weeks. The following factors may contribute to a further increase in cases:
(a) This year has been much warmer than average in the fall and winter, and this has been a positive development. On December 5, Bishkek experienced the hottest day of December in the history of meteorological observations in the country, with temperatures reaching +18.6 degrees Celsius. (https://24.kg/english/281618 _ Record _ high _ air _ temperature _ registered _ in _ Bishkek _ on _ December _ 5/) .
However, in the coming weeks, the country is expected to experience cold weather and heavy snowfall, with temperatures dropping to -23 degrees Celsius in some parts of the country, forcing people to stay indoors with poor ventilation for long periods, contributing to the spread of measles.
b) With the onset of the flu season, the country has experienced an increase in the incidence of acute respiratory infections, which will put additional strain on the already overburdened health services.
c) Traditionally, the New Year is celebrated by all ages and almost all schools and kindergartens organize a big assembly with all children attending school to celebrate the New Year. The government is expected to announce the schedule of New Year's Eve holidays soon, but they are expected to last a week (January 1 to January 8, 2024). Usually during these long holidays, many families return to their homelands to meet and socialize with their families and friends.
d) Insufficient vaccination rate: As of November 30, 479,386 children have been vaccinated with the MMR vaccine, representing 79% of the total target group of children aged 9-84 months in the locations targeted in the first campaign. However, in major urban areas such as Bishkek, vaccination coverage is much lower than the average in the operation's other target regions (Chui, Jalal-Abad, and Osh regions, and Osh city). In 2024, the government plans to conduct a supplementary immunization campaign covering the second half of children aged 9-84 months across the country (approximately another half million children) in regions and cities not covered by the first campaign.
This leaves a large cohort of children susceptible to measles.