Warning issued of increased measles outbreaks in children

On 27 April 2022, the World Health Organization (WHO) and UNICEF issued a joint news release, warning of a heightened risk for the spread of vaccine-preventable diseases which could trigger larger outbreaks, particularly of measles, affecting millions of children this year. 

Pandemic-related disruptions, increasing inequalities in access to vaccines and the diversion of resources from routine immunisation, are leaving too many children without protection against measles and other vaccine-preventable diseases. 

The risk for large outbreaks has increased as communities relax social distancing practices and other preventive measures for COVID-19 implemented during the height of the pandemic. In addition, with millions of people being displaced due to conflicts and crises including in Ukraine, Ethiopia, Somalia and Afghanistan, disruptions in routine immunisation and COVID-19 vaccination services, lack of clean water and sanitation, and overcrowding increase the risk of vaccine-preventable disease outbreaks. 

Worldwide, 17,338 measles cases were reported in January and February 2022, an increase of 79% from the 9,665 cases noted during the first two months of 2021. As measles is very contagious, cases tend to show up quickly when vaccination levels decline, raising concerns that outbreaks of measles could also forewarn outbreaks of other diseases that do not spread as rapidly. 

Apart from its direct effect on the body, which can be lethal, the measles virus also weakens the immune system and makes children more vulnerable to other infectious diseases, such as pneumonia and diarrhoea. Most cases occur in settings that have faced social and economic hardships due to COVID-19, conflict, or other crises, and have chronically weak health system infrastructure and insecurity. 

In 2020, 23 million children missed out on basic childhood vaccines through routine health services, the highest number since 2009 and 3.7 million more than in 2019. 

As of April 2022, there were 21 large and disruptive measles outbreaks around the world reported in the previous 12 months, although these figures are likely higher as the pandemic has disrupted surveillance systems globally, with potential underreporting. Countries with the largest measles outbreaks in the past year included Somalia, Yemen, Nigeria, Afghanistan, and Ethiopia, with insufficient measles vaccine coverage being the major reason for outbreaks. 

As of 1 April 2022, 57 vaccine-preventable disease campaigns in 43 countries that were scheduled to take place since the start of the pandemic are still postponed, impacting 203 million people, most of whom are children. Of these, 19 are measles campaigns, which put 73 million children at risk of measles due to missed vaccinations. In Ukraine, the measles catch-up campaign of 2019 was interrupted due to the COVID-19 pandemic and thereafter due to war. Routine and catch-up campaigns are needed wherever access is possible to help make sure there are not repeated outbreaks as in 2017 to 2019, when there were over 115,000 cases of measles and 41 deaths in the country, which was the highest incidence in Europe. 

Coverage at or above 95% with two doses of the safe and effective measles vaccine can protect children against measles. However, COVID-19 pandemic related disruptions have delayed the introduction of the second dose of the measles vaccine in many countries. 

As countries work to respond to outbreaks of measles and other vaccine-preventable diseases, and recover lost ground, UNICEF and WHO, along with partners such as Gavi the Vaccine Alliance, the partners of the Measles & Rubella Initiative (M&RI), the Bill & Melinda Gates Foundation and others, are supporting efforts to strengthen immunisation systems by utilising the following measures.

• Restoring services and vaccination campaigns so countries can safely deliver routine immunisation programmes to fill the gaps left by the backsliding.
• Helping health workers and community leaders communicate actively with caregivers to explain the importance of vaccinations.
• Rectifying gaps in immunisation coverage, including identifying communities and people who have been missed during the pandemic.
• Ensuring that COVID-19 vaccine delivery is independently financed and well-integrated into overall planning for immunisation services so that it is not carried out at the cost of childhood and other vaccination services.
• Implementing country plans to prevent and respond to outbreaks of vaccine-preventable diseases and strengthening immunisation systems as part of COVID-19 recovery efforts. 

Sources: WHO, 27 April 2022 and UNICEF, 27 April 2022