Push to elim­i­nate measles, rubella con­tin­ues in the face of chal­lenges


MEM­BER coun­tries of the World Health Or­gan­i­sa­tion’s South­east Asia Re­gion (WHO SEAR) have pledged to carry out the elim­i­na­tion of measles and rubella by 2020 through an ex­ten­sive vac­ci­na­tion pro­gramme.

How­ever, only five out of 11 coun­tries have achieved their vac­ci­na­tion goal, and the grow­ing anti-vac­ci­na­tion move­ment among par­ents has pre­sented a chal­lenge.

Thai­land’s De­part­ment of Dis­ease Con­trol (DDC) is also com­mit­ted to this goal, but de­spite a sat­is­fac­tory rate of measles vac­cine cov­er­age in other parts of the coun­try, the on­go­ing in­sur­gency in the Deep South has cre­ated a prob­lem with the vac­ci­na­tion cam­paign there.

In the Seven­ti­eth Ses­sion of the Re­gional Com­mit­tee of WHO SEAR in Mal­dives last week, all 11 mem­ber states agreed to fur­ther push for­ward the com­mit­ment to elim­i­nate measles and rubella. These are both pre­ventable dis­eases but they kill up to 134,200 chil­dren around the world an­nu­ally, in­clud­ing 54,500 from SEAR coun­tries.

Dr Pem Nam­gyal, WHO SEAR di­rec­tor, de­part­ment of fam­ily health, gen­der and life course, said measles is an in­fec­tious vi­ral dis­ease that presents with fever and rash. It of­ten oc­curs in small chil­dren and some­time re­sults in res­pi­ra­tory co-in­fec­tions with bac­te­ria, caus­ing pneu­mo­nia, which is usu­ally fa­tal in small chil­dren. Rubella, which is some­times called Ger­man measles, causes sim­i­lar symp­toms but is a greater con­cern if present in preg­nant women, as it can lead to ab­nor­mal­ity to the foe­tus.

Nam­gyal said that even though these dis­eases could be pre­vented by vac­ci­na­tion, many coun­tries in WHO SEAR still failed to pro­mote widee­nough vac­cine cov­er­age. Any cov­er­age be­low 95 per cent of the pop­u­la­tion puts chil­dren at con­sid­er­able risk of catch­ing these pre­ventable dis­eases.

“It is a prime goal for our re­gion, since the SEAR com­mit­tee res­o­lu­tion in 2013 to elim­i­nate measles from the re­gion,” he said. “But as per the lat­est sta­tis­tics only Mal­dives, Thai­land, Sri Lanka, Bhutan and North Korea have met the goal of 95 per cent measles vac­ci­na­tion cov­er­age.”

Nam­gyal stressed that for ev­ery 325 mil­lion more chil­dren the measles vac­cine reached, 600,000 measles deaths would be avoided.

How­ever, he cau­tioned that there were still many chal­lenges to be over­come to achieve the to­tal con­trol of measles and rubella in­fec­tion.

These in­cluded ex­pand­ing the vac­ci­na­tion pro­gramme among the vast pop­u­la­tions of coun­tries such as In­dia and In­done­sia, in­stalling sur­veil­lance stan­dards for measles and rubella mon­i­tor­ing, and main­tain­ing strong po­lit­i­cal com­mit­ment and ad­e­quate re­sources to carry out this goal.

“We are also fac­ing a new wor­ry­ing trend among par­ents, as some of them refuse to let their chil­dren get a vac­ci­na­tion. This will jeop­ar­dise the ef­fort of clos­ing the im­mu­nity gap in the re­gion as a whole,” he stressed.

“The wide cov­er­age of measles vac­ci­na­tion has played a sig­nif­i­cant role in re­duc­ing the in­fant mor­tal­ity rate by 64 per cent since 1990. It was es­ti­mated that more than 5.9 mil­lion deaths due to measles have been averted due to the global vac­ci­na­tion cam­paign.”

But an es­ti­mated 4.7 mil­lion chil­dren in SEAR still did not re­ceive measles and rubella vac­ci­na­tions in 2016.

Mean­while, DDC deputy di­rec­tor­gen­eral Dr Ta­narak Pli­pat stated that the sit­u­a­tion of measles and rubella con­trol in Thai­land was promis­ing, as the vac­ci­na­tion cov­er­age rate in most part of the coun­try was at 95 per cent and be­yond, with the ex­cep­tion of Pat­tani, Yala and Narathi­wat.

“All Thai cit­i­zens can get measles and rubella vac­cine free of charge,” Ta­narak said. “But we have to ad­mit that the vac­ci­na­tion cov­er­age in the Far South is still lower than aver­age, which is be­cause the vac­ci­na­tion cam­paign in that re­gion faces dif­fi­cul­ties from on­go­ing South­ern in­sur­gency.”

He said the anti-vac­ci­na­tion idea was not preva­lent in Thai­land, but the Public Health Min­istry had not ig­nored the prob­lem and ac­tively pro­motes the mes­sage that peo­ple should re­ceive a full course of vac­ci­na­tions.

There were 2,231 recorded cases of measles in Thai­land since the be­gin­ning of this year. The in­fec­tion rate was 3.4 cases per 100,000 pop­u­la­tion and there had been no death from measles this year.

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