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Measles outbreaks threaten progress in child mortality in west and central Africa

Insufficient immunization put children at risk

Brazzaville/Dakar, 22 April 2010 – Sixteen countries of West and Central Africa are in the throes of a measles outbreak, with 22,364 cases and 185 deaths, in the year to 28 March. 

A shortfall in funding for follow-up measles campaigns of around $59 million worldwide and $16* million for Africa only puts children at risk if efforts are not sustained through an appropriate response from donors and governments. Vaccination efforts, both through campaigns and routine immunization, must be sustained and efficiently implemented.

Efforts by African governments with support of partners such as the Measles Initiative — led by the American Red Cross, the United Nations Foundation, the U.S. Centers for Disease Control and Prevention, UNICEF and the World Health Organization— have resulted in a reduction of 92% of cases during 2000-2008 in the Africa region. 
However, in West and Central Africa, most of the countries have immunized only about 80 percent or less of their populations through routine immunization, when the recommendation is to reach 95%. "Such a figure means they can expect to have large, sustained outbreaks every three to four years" said WHO Regional Director for Africa, Dr Luis Gomes Sambo.

"To eliminate the risk of resurgence, countries must continue follow-up vaccination campaigns every two to four years until their healthcare systems can routinely provide two doses of measles vaccination to all children and provide treatment for the disease" said Sambo.

"We fail to vaccinate every child. That is why we have a pool of susceptible victims which builds up as a perfect breeding ground for measles outbreaks", says UNICEF Director for West and Central Africa, Dr. Gianfranco Rotigliano.

Unreached children are usually to be found among the most vulnerable communities, the poorest and those who lack access to health care especially in peri-urban centers and rural areas and that are only reached through outreach services. "Reaching the unreached is essential, especially in the context of food insecurity and widespread malnutrition. Unhealthy children risk deaths with measles" said Rotigliano.

Worrying indications were observed in the region last year. A major outbreak in Burkina Faso resulted in more than 50,000 cases and 340 deaths and localized outbreaks in Benin, Guinea, Mali, Niger, and Senegal accounted for 16,808 reported cases and 68 deaths.

Already this year, sixteen countries have measles outbreaks in West and Central Africa and among them are countries such as Sierra Leone and Liberia.

2010 is a pivotal year to reach the United Nations goal of reducing measles mortality by 90% from 2000 to 2010. If nothing is done to counter the resurgence in measles cases, we risk reversing the progress made so far.

"The funding gap must be met so that countries can continue to undertake large-scale campaigns to prevent child deaths and sustain the gains. Reaching the 2010 goal will also require strengthening routine immunization and disease surveillance systems to rapidly detect and control outbreaks" added Dr Sambo.

To respond to outbreak, campaigns are ongoing or planned in the affected countries.

Follow-up campaigns are planned, funding permitting, in 2010 in: Congo, CAR, Gabon, DRC, Mauritania, Niger, Nigeria, Senegal, Togo, Burkina Faso, Ghana, Mali.

"Our work is not over. We need a sustained political and financial commitment to fight this leading killer of children. We cannot drop our guard", added Dr Rotigliano.

*funding needs for follow-up campaigns are estimated at more than 100 million worldwide and 39million for the Africa region.

About the epidemic
The countries affected as of 28 March are:
Benin (85 cases, 0 deaths), Burkina Faso (1,258 cases, 10 deaths), Central African Republic (31 cases, 0 deaths) Côte d’Ivoire (491 cases, 3 deaths), Cameroon (1,338 cases, 6 deaths), Chad (5,832 cases, 79 deaths), RD Congo (3,976 cases, 13 deaths), Guinea (1,013 cases, 2 deaths), Mauritania (863 cases, 9 deaths), Liberia (1,341 cases, 34 deaths), Mali (774 cases, 1 death), Niger (352 cases, 1 death), Nigeria (3,804 cases, 26 deaths), Senegal (560 cases, 0 deaths), Sierra Leone (351 cases, 1 deaths), Togo (295 cases, 0 deaths).

About measles
Spread through coughing or sneezing, measles is among the world’s most contagious diseases and one of the leading causes of death among children worldwide, especially those who are malnourished, according to World Health Organization (WHO) and UNICEF.

Between 2000 and 2008, global measles mortality in all ages was reduced by 78%, from an estimated 733,000 deaths in 2000 to an estimated 164,000 deaths in 2008, according to the Measles Initiative, a partnership funded in 2001 and lead by the American Red Cross, the United Nations Foundation, the U.S. Centers for Disease Control and Prevention, UNICEF and the World Health Organization.

An estimated 400 children die from measles every day (2008). Even healthy and well-nourished children, if unvaccinated, are at risk of the disease and its severe health complications such as pneumonia, diarrhoea, and encephalitis (a dangerous infection of the brain causing inflammation). But in vulnerable populations, especially where malnutrition is widespread, such as the ones from West and Central Africa, the disease becomes deadly.

About routine immunization against measles
Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths. It costs about one US dollar to immunize a child against measles.

It is recommended to achieve 95% of coverage for each vaccine, including measles, in children under one year of age.
In 2008, about 83% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.

In West and Central Africa, only 66% (average) received one dose of measles vaccine by their first birthday through routine health services in 2008, from 23% in Chad to 96% in Cape Verde.

Two doses of the vaccine are recommended to ensure immunity, as about 15% of vaccinated children fail to develop immunity from the first dose.

For immunization coverage, see immunization tables (measles=MCV).

For more information, please contact:
Collins Boakye-Agyemang, WHO AFRO, Tel:+472 413 9420,  Email: boakyec@afro.who.int 
Gaelle Bausson, UNICEF West and Central Africa, Tel:+221 77 450 5816, Email:gbausson@unicef.org 




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