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14 September 2011: Measles is an ever present threat to child survival

Polio cases are also reported in neighbouring countries. Only through vigilance and vaccination of all children under five years can these diseases be kept under control.

By Dr Rufaro Chatora, WHO Tanzania Representative and Dorothy Rozga, UNICEF Tanzania Representative

Measles Outbreak in Zanzibar and the Mainland

Recent outbreaks of measles, in parts of Zanzibar and in some areas on the Mainland, are a cause for concern. Discussion with community members in affected areas reveals that there is some misinformation about the measles vaccine and tragically this has stopped some parents from choosing to protect their children from the disease. 

In view of the very serious risks that measles poses, we would like to clarify what has been happening, to emphasise the importance of measles vaccination, and to openly pledge our continuing support to health authorities on the Mainland and in Zanzibar as they work to fight outbreaks of the disease and strengthen routine immunization services.

A highly contagious disease

Many parents remember when measles was a leading cause of death among children under five in Tanzania.  Concerted effort at routine immunization targeting all children at the age of 9 months, plus supplementary measles vaccination campaigns, has helped to reduce the terrible toll of this disease. However, it is only through constant vigilance and vaccination that we can keep this killer disease under control.

Sadly, measles has re-emerged as a threat to the survival of Tanzania’s children and to the important health gains achieved over the last decade. This is primarily because many children are not being vaccinated.  Failure to vaccinate children against measles leaves them vulnerable to the disease which can cause disability, including blindness, as well as severe diarrhoea, ear infections, pneumonia and death. Measles can be especially dangerous in children who are poorly nourished, or infected with HIV and AIDS.

Measles is a highly contagious viral infection and children under 5 years are most vulnerable. It is transmitted via droplets from the nose, mouth or throat of infected persons – usually via sneezing and coughing. The first symptoms usually appear 10–12 days after infection, and include high fever, runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards. The rash fades after five to six days.

Safe, inexpensive and effective vaccine

The measles vaccine has been in use for more than 40 years. It is safe, inexpensive (less than a Tshs 1,500 per dose) and effective. Most children need only one dose of the vaccine at the age of 9 months to be protected from the disease. However, about one in every ten children needs two doses of the vaccine to ensure protection from measles. All children obtain improved immunity to the disease if they receive a second measles vaccination when they are about two years or older.

The vaccine has very few side-effects and can be safely given to children who are suffering from malaria, flu or other illnesses. There is no evidence of anyone developing resistance to the measles vaccine. The vaccine helps to build immunity by stimulating the body to create the antibodies that will fight the disease. People who have had measles are immune to the disease for life. If you are not sure if your child has had measles, giving the measles vaccine will not cause any harm to the child.

Since one in every ten children is not protected from measles even after vaccination, a pool of children is created who remain susceptible to infection. Over a period of years, this pool of unprotected children gradually increases and so does the risk that the disease will spread. The situation is worse if immunization coverage is less than 100 percent.

Imagine there is a village where 100 infants are born every year, but only 80 are vaccinated.  In any one year this means 28 children in the village are vulnerable to measles – the 20 children who were not vaccinated and 8 children for whom the vaccine did not provide protection. This means that out of the 500 children in this community who are under five years old, more than 100 are not protected from measles – so if a visitor comes to the community who is carrying the disease, it can easily spread among those children who are most vulnerable. And, when these unprotected children pass the infection from one to the other, there will be a measles outbreak.  Such outbreaks often happen during the hot dry season and have higher severity in those regions where vaccination coverage is low.

We therefore recommend that all children be vaccinated at the age of nine months or as soon as possible thereafter. We further recommend measles campaigns targeting all children between nine and fifty nine months that should take place every three to five years preferably during the months of June or July.

Children under nine months do not need to be vaccinated because they are usually protected from the measles virus by the anti-bodies they obtain from their mothers at birth or through breast-milk. 

Response to Measles Outbreak

WHO and UNICEF are supporting Government efforts to respond to the current measles outbreaks in Zanzibar and the Mainland. To be successful, we must ensure that virtually all children between 9 and 59 months are vaccinated against the disease. We call on all Tanzanians – including parents and care givers, religious leaders, faith-based organizations, the mass media, private sector, teachers, health workers and leaders at all levels, to use their influence to support this important cause.

A word to parents:
If you think your child has measles, please take her or him to a nearby health facility immediately. Follow the health workers advice on treatment and ensure that your child is given vitamin A. All children diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This can help prevent eye damage and blindness. Vitamin A supplements have been shown to reduce the number of deaths from measles by 50 percent. 

Help to prevent the spread of the disease by keeping children with measles away from other children; give your child extra and nutritious food and fluids – including oral rehydration treatment if he or she is suffering from diarrhoea. And if your child is under two years old, please continue to breastfeed.

Given the right care, with nutritious foods, fluids and vitamin A, most children will recover from measles without lasting effects – but let’s not take any risks. Let us make sure all children under-five years in Tanzania are protected by measles vaccination.

About polio vaccination
To prevent polio, all infants should receive polio vaccine at birth and three further doses by the time they are 12 weeks old.  Government targets are to ensure at least 80 percent of infants are fully immunized and has exceeded this target every year since 2001. However, additional campaigns are needed in order to fully eradicate the disease and when the risks of new cases emerge.  Tanzania recorded its last case of polio in 1996, however the resurgence of cases in Kenya – which had also been polio-free for many years – raises the risks from polio in Tanzania. All parents are therefore urged to ensure their children under five years are fully vaccinated against polio. Please talk to health workers at your nearest clinic if you have questions about vaccination.

For more information please contact:
Nemes Iriya, WHO, Phone: +255754663355

Sara Cameron, UNICEF,  Phone: +255 22-219-6600



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