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Boosting measles vaccine penetration in Nigeria

By Rasak Musbau

The World Health Organisation (WHO) just rolled out a troubling statistic. It said that Nigeria, with 3.3 million children, tops the list of   countries with the most children unvaccinated against measles. Following closely on Nigeria’s heels are India (2.9 million children), Pakistan (two million), Indonesia (1.2 million), Ethiopia (0.9 million) and Democratic Republic of Congo (0.7 million).

An airborne virus, measles is transmitted by respiratory droplets from the nose, mouth or throat of an infected person. It is a leading cause of death among children, worldwide. In Nigeria, measles is the fifth leading cause of under-five child mortality and 50 per cent of deaths of all vaccine-preventable diseases. Measles infection and mortality was found to occur all year round irrespective of whether it was rainy or dry season, reinforcing the endemic nature of measles in this part of West Africa. In 2016 alone, Nigeria witnessed 183 measles outbreaks affecting 158 local government areas (LGAs).

What is worrisome to health authorities in the country and should be of serious concern to everyone is that the measles virus can spread in a person four days before the onset of the telltale rash, making people with the virus to become contagious even before they are actually aware that they have measles. Another fact that makes measles virus really scary is that it can live on surfaces for up to two hours and in an unimmunized population, one person with measles can infect 12 to 18 others.

This is way higher than other scary viruses like Ebola and HIV. With Ebola, one case usually leads to two others while in the case of HIV, one case leads to another four.  A person with measles can cough in a room, and — if you are unvaccinated — hours later, you could catch the virus from the droplets in the air that they left behind. This accounts for why everybody must be a change agent and social mobiliser propagating measles immunisation rather than being merely contended after getting our own children vaccinated.

According to the Centre for Disease Control (CDC), the horrible mathematics of measles looks like this: one out of every 20 children with measles gets pneumonia; one in 1,000 will develop encephalitis (swelling of the brain); and one or two in 1,000 children will die. The optimal age for infantile measles vaccination is an important health issue since maternal antibodies may neutralize the vaccine antigen before a specific immune response develops. Delaying vaccination, on the other hand, may increase the risk of complicated disease. Getting only one dose of the vaccine instead of the recommended two also seems to increase people’s chances of getting measles if they are ever exposed.

However, as a child approaches 14 years, incidence of measles reduces to 0%, confirming WHO’s position that measles is a childhood problem and of huge concern in developing nations such as Nigeria. Usually, after an incubation period of 10 to 12 days, measles comes on as fever, cough, stuffy nose and bloodshot/watery eyes. Loss of appetite and malaise are equally common signs of measles. Several days after these initial symptoms, an uncomfortable spotty, rash begins to spread all over the body, starting on the face and neck, and moving downward. The rash usually lasts for three to five days and then fades away.

In uncomplicated cases, people who get measles start to recover as soon as the rash appears and go back to normal in about two to three weeks. But up to 40 percent of patients have complications from the virus. These usually occur in children under-5, in adults over 20, and in anybody else who is undernourished or having low immunity.

The most common complication from measles is pneumonia, which accounts for most measles-related deaths. Less frequently, measles can lead to blindness, croup, mouth ulcers, ear infections or severe diarrhea. Some children develop encephalitis (swelling of the brain), which can lead to convulsions, loss of hearing and mental retardation. Again, these complications mostly arise in people whose immune systems are already weakened because of their age, pre-existing diseases or malnutrition. With a vaccine, measles is prevented through the combination of MMR (measles, mumps, and rubella) shot. Immunity from the vaccine lasts for decades. The vaccine is known to be extremely safe and very effective. It contains a live but weakened version of the virus, and it causes the immune system to produce antibodies against the virus. Should you be exposed to actual measles, those antibodies will then fire up to protect you against the disease.

The measles virus could theoretically be wiped off the face of the planet, never to infect another human again. That is because it fits the profile of diseases that can be eradicated. People, and not animals, are the only carriers of the virus (so eradication wouldn’t require killing off an entire animal species). Addressing over 40 media professionals recently, the Executive Director of the NPHCDA, Dr Faisal Shuaib, pledged that the upcoming measles vaccination campaign will be the best ever implemented by the country. Dr. Shuaib confirmed that the 2017-2018 vaccination campaign is planned to be conducted in phases by geographical zones from October 2017 to March 2018.

Nigerians must not only maximize the opportunity of this planned vaccination, we must also avoid playing politics with it, as this would   endanger the future of our children. Everything should be done to ensure that the upcoming campaign reaches all eligible children. Great lessons should have been learnt from past mistakes when vicious propaganda   was employed to confuse ignorant parents and compromise the health of their children.

Musbau writes from Ikeja, Lagos

For governments across the country, more budgetary provision should be made for this measles vaccination effort so that the necessary   infrastructure will be in place to serve as a framework for other vaccine-preventable disease interventions, as our health institutions are weak at the primary and secondary levels, especially in the remote and rural areas. Maintenance of cold chain for vaccines should also be a priority as temperatures vary, and so do the time taken to get to some vaccination locations. These could reduce vaccine quality as a result of thawing. The local government authorities are encouraged to ensure improved sanitation within the community; good sanitation is a recipe for good health and the ultimate preventive measure against diseases.

The life of every child is very important and anything that will ensure its survival must not be treated with kid gloves. With measles, poverty and ignorance can’t be an excuse any longer. Measles vaccine is free all over the country and all levels of government are doing their best to create awareness.



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June 2018
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