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A measles vaccine is prepared. (Photo: Fiona Goodall / Getty Images)
Fewer people showing up to receive measles life pricks can be one of the unintended consequences of the coronavirus war.
A senior public health official has expressed concern that the blocking of Covid-19 could lead to a delay in vaccines against other serious diseases, especially measles.
Melinda Suchard, director of the Center for Vaccines and Immunology at the National Institute of Communicable Diseases (NICD), warned this week of a “negative impact” of Covid-19 on routine vaccination of children.
“There may be less demand for vaccination because mothers may have logistical difficulties in attending vaccination clinics due to transportation problems,” he said.
“During the shutdown, the National Advisory Group on Immunization suggested that mothers delay vaccination until after the shutdown, as a short delay will not be harmful to children. However, it is vitally important that mothers reach the neglected vaccines as soon as possible. “
He advised mothers to contact their vaccination clinics to confirm when they should attend.
Suchard emphasized that when attending vaccination clinics, social distancing and hand washing were important.
“Dating is preferable, to avoid long lines. Mothers can also wear cloth masks, “she said in a statement.
Suchard emphasized that South Africa was not facing a measles outbreak, although there were occasional cases.
A measles outbreak is defined as three cases within a district within one month.
“The total number of measles cases for the year is 22, but these have not been grouped in any particular geographic area,” he said.
The NICD confirmed a measles outbreak in the northwest province in October 2019, with three cases reported in four weeks.
After laboratory tests confirmed the presence of the measles virus, a vaccination campaign was started immediately.
In the first half of 2019, 13 cases were reported in South Africa, four of which were in the Western Cape.
All four were unvaccinated siblings, ages 12 to 19. They had just visited a country in Eastern Europe.
South Africa’s vaccination program works well overall, and perhaps only a middle-class minority sometimes balks at having their children vaccinated.
The Health Department estimated that measles vaccine coverage in 2019 was 83% for the first dose (administered at six months of age) and 79% for the second dose (12 months of age).
In 2018, the NICD recorded 64 cases of measles.
So even before Covid-19, one in five children was not fully immunized against measles, Suchard said.
Elsewhere in Africa, measles remains an urgent public health problem, and the DRC is the worst affected.
The disease has claimed more than 6,000 lives in the DRC in the latest outbreak, according to the World Health Organization (WHO).
The WHO estimates that the total number of suspected measles cases in the Central African country is more than 310,000 since the beginning of last year.
And at the end of last year, the global measles figure exceeds 413,308 reported cases.
However, unlike Covid-19, where researchers are struggling to develop a vaccine, one has long existed for measles. In fact, it exists since 1963 and has proven to be a great success.
There were a number of reasons for the worrying recent increase, notably the conflict in the DRC and the simultaneous Ebola outbreak. Measles deaths more than double those of Ebola.
The growing public mistrust of vaccines in many countries may also be a factor. And this could bode well for any preventive Covid-19 vaccine.
Suchard advised mothers to ensure that their children are fully immunized to prevent outbreaks of life-threatening illness for children.
Measles is particularly important since measles can cause large outbreaks that spread quickly. Measles can cause diarrhea, brain infection, blindness, or death in children. Measles vaccines are routinely administered at 6 and 12 months of age. If some measles vaccines have been omitted, they should be brought up to date as soon as possible, ”he said.
Roving Reporters requested comments from the Health Department nationwide and in KwaZulu-Natal on Friday, but no response was received at the time of publication.
Measles is one of a number of diseases that once caused panic, but have been successfully treated with vaccines for many years. The Centers for Disease Control and Prevention lists 14 of these diseases and include polio, tetanus, hepatitis A, hepatitis B, whooping cough, whooping cough, mumps, and diphtheria.
Before 1963, measles epidemics broke out every two to three years and claimed approximately 2.6 million lives each year. Vaccines have been very successful against the disease. But it took a while to get there.
Measles was identified as early as the 9th century by Muhammad ibn Zakariya al-Razi or Rhazes. Rhazes, a Persian polymath, is credited with writing the first account of measles and the ability to distinguish between measles and smallpox.
In the more than 1,000 years that have passed, progress in disease research and control has gradually reduced the number of measles epidemics. In 1963, the vaccine was a pioneer in the United States. Other countries followed suit, some using other measles vaccines not derived from the original measles strain.
According to the WHO, vaccines prevented an estimated 23.2 million deaths from measles between 2000 and 2018.
Why a resurgence now, not only in the Democratic Republic of the Congo, but also in countries where the disease was hit long ago?
Earlier this year, the WHO attributed the epidemic in the war-torn DRC to:
- Low vaccination coverage;
- Malnutrition;
- Weak public health systems;
- Outbreaks of other epidemics; and
- Difficulties in accessing and providing medical care, exacerbated by insecurity in some areas.
Meanwhile, on the other side of the world, in Samoa, a measles outbreak has strained the health system of the Pacific Island State.
On January 20, 2020, Reliefweb, a United Nations humanitarian information service, confirmed that a measles outbreak on the island had claimed 83 lives since October 2019, with 5,707 cases reported.
The Samoan government imposed a state of emergency, which was finally lifted on December 28. It included a vaccination campaign that inoculated 95% of the right people. Samoa had not reported, until April 14, 2020, any deaths from Covid-19, but was in a state of emergency with a blockade.
The United States recorded 1,276 measles cases last year, the highest total since 1992. The figure represented a four-fold increase from the 2018 total, and was more than 20 times the number of cases reported in 2010.
Such was the severity and longevity of the outbreak that the United States barely managed to maintain its “measles elimination status,” which has been in place since 2000.
In August of last year, the guardian reported a “sharp increase in measles in England amid fears about” anti-vaxxers “”, with the highest quarterly figures observed since 2009. At this stage, the WHO had withdrawn the “measles-free state” of Greater Brittany.
Albania, the Czech Republic and Greece lost their measles status at the same time.
How contagious is measles?
The findings vary, but according to virologists, the disease has a Basic Reproduction Number (R0) value of 12-18. This means that a person who has measles could, on average, infect 12 to 18 people in a fully susceptible population.
The definition is necessarily a bit vague. This is because the susceptibility of a population to a particular disease varies from country to country, from region to region.
In some countries, people tend to be better fed. In others, the prevalence of other diseases that compromise the immune system may play an important role. Think here of South Africa with its high incidence of tuberculosis and AIDS.
Demographics, including the age distribution of the population, the poverty or living conditions of a population, and the climate affect R0. None of this explains another major phenomenon: super spreaders. When it comes to spreading the disease, some of us are simply better for biological reasons or our social habits.
The 187 WHO member states in November 2019 reported a total of 413,308 measles cases.
In a June 2019 travel advisory, the WHO warned of an increase in measles cases in countries with generally high overall vaccination coverage. This was because the disease has spread rapidly among groups of unvaccinated people.
The outbreaks have proved a setback for WHO, which had targeted 2020 as the year for measles and rubella elimination in five of its regions, as part of a global vaccine action plan.
The WHO website lists six common misconceptions about immunization, which were in part to blame for the resurgence of cases. These are:
- “The diseases had already started to disappear before vaccines were introduced, due to better hygiene and sanitation.”
- “Most people who get the disease have been vaccinated.”
- “There are” hot batches “of vaccines that have been associated with more adverse events and deaths than others. Parents should find the number of these batches and not allow their children to receive vaccines from them.”
- “Vaccines cause many harmful side effects, diseases, and even death, not to mention possible long-term effects that we don’t even know about.”
- “Vaccine-preventable diseases have been virtually eliminated from my country, so there is no need for my child to be vaccinated.”
- “Giving a child several vaccines against different diseases at the same time increases the risk of harmful side effects and can overload the immune system.”
Religious beliefs, mistrust of drug companies, and the belief that risks outweigh benefits were other reasons why people avoided vaccination. A scientific paper published in 1998, but later widely discredited, has also fueled misconceptions about immunization.
In 1998 Andrew Wakefield and co-authors published an article in The lancet reporting the appearance of behavioral symptoms in eight of the 12 children studied, after administration of the measles, mumps and rubella (MMR) vaccine.
The newspaper was retracted by the magazine in 2010, 12 years after its publication, but continues to be cited. The retraction occurred in two stages: a partial retraction by 10 of the 12 authors in 2004; and a final retraction in 2010, by the editors of the magazine.
But by then the damage was done … and continues to be done.
Wakefield’s article and subsequent protest led to a thorough investigation by Brian Deer, an investigative journalist. Deer’s 14-year investigation is recounted in his book. The doctor who fooled the world.
In short, Wakefield’s claims “led to a decade-long health crisis in the UK, and sparked epidemics of fear, guilt, and infectious disease, which would be exported to the United States, Europe, Australia, and other developed countries, spawning all kinds of concerns about vaccines. “
Despite this acclaimed investigation, conducted for The Sunday Times London, UK Channel 4 television and BMJ continued to cite the discredited document.
Wakefield continued to generate controversy with his film Vaxxed: from cover-up to catastrophe, who subsequently withdrew from the 2016 Tribeca Film Festival. The withdrawal was supported by festival co-founder Robert de Niro, who has a son on the autism spectrum. The actor had initially accepted the screening of the film, which raises a link between autism and vaccines, but then had doubts.
In February 2020 Forbes the magazine asked the question, “Would you trust your son with this former anti-Vax doctor?”, after Wakefield released his sequel, Vaxxed II: The Truth of the People.
Could it be that the “anti-vaxxers” were basing their campaign on a single admittedly flawed document, despite evidence to the contrary?
In the years immediately following the original Wakefield paper, more comprehensive studies have been completed, with considerably larger study groups. These included studies in 2002 (537,000 children), 2005 (30,000 children), and 2019 (657,461 children).
The more cautious conclusion stated that the study “provides strong evidence against the hypothesis that the MMR vaccine caused autism.
However, a seed of doubt has grown in the public mind in the past two decades. Could this hinder the deployment of new vaccines in the future, when new diseases emerge?
WHO Director-General Tedros Adhanom Ghebreyesus says misinformation about vaccines was already at a “crisis level”.
“Facebook and Twitter or other social media groups should really understand this,” Ghebreyesus said, adding that he had asked social media giants to do more to combat false information.
Vaccines have been shown to work. With measles they have saved millions of lives.
Bad press, including the variety of social media, has certainly caused some to avoid vaccines. But times may be changing.
With much of the world’s population now under some form of blockade, many are experiencing severe pre-vaccine public health care for the first time.
This time, the case of vaccines may be easier to do. DM
Fatima Khan has experience in laboratory education and research. She is enrolled in Itinerant reporters’Environmental journalism training program and is an associate editor. Additional reporting by Matthew Hattingh, Roving Reporters.
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