21 February 2012, Kabul, Afghanistan. Measles is a highly infectious disease that causes complications and deaths, even in previously-healthy individuals. Measles is fully preventable by a proven safe vaccination. We call on all Afghans to vaccinate their children. For public safety, two doses of measles vaccine across all age groups from 9 months up to 15 years of age is recommended by the World Health Organization (WHO).
In Ghor and Baghdis provinces, the Ministry of Public Health and WHO reported twenty confirmed child mortality cases due to measles and pneumonia. The measles outbreak initially affected the villages of Lafra Valley (Sarji and Gawkushta in Ghor, also Jawand in Badghis.) To contain the recent outbreak, WHO recommends that all neighbouring provinces participate in the Measles vaccination. The outbreak is compounded by severe weather that hampers access. Also low immunization and poor public health service coverage contribute to the spread of Measles.
To contain this epidemic, that affected most of Cheghchran district, the Ministry of Public Health, Afghan Center for Training and Development (ACTD) and WHO set up five temporary clinics, with abundant medical supplies, in Baghdis and Ghor. As a result, more than 6,200 patients were treated by the medical emergency teams, and over 3,600 vaccinations against measles were applied. Afghans will find temporary clinics in Sarji, Pay Zaqand, Hamel, Espakhan, Zaqand Jow, Ma shams, Gaw Koshtah, Kazak, Jaw Ghaz, Sare Abe Frah, Sertakhy olya, and Sertakhte Sofla to assist them with their medical needs. Four additional mobile health teams were also established covering Qiaghok, Qotus, Pozalij Sufla, Pozalij Ulia , Guand Aab, Dahan i Sufaq, Sarban Madrasa, Bahari, Parsa Ha, and Rostam Ha in Lafra Valley.
- The measles virus is in the paramyxovirus family and normally grows in the back of the throat and lungs. Measles is a human disease and is not known to occur in animals.
- Measles is one of the leading causes of death among young children even though a safe vaccine is available. After getting the virus, the patient does not show any symptoms for two to three weeks. However, the infected patient can infect others four days before showing a rash and four days after the rash.
- Two doses of the vaccine are recommended to ensure immunity, as about 15% of vaccinated children fail to develop immunity from the first dose.
- Severe measles is more likely among poorly nourished young children, especially those with vitamin A insufficiency, or whose immune systems have been weakened.
- Movement of unaware-infected person can lead to measles exportation to regions previously free of measles, if the population is not immunized. Travellers, migrants and refugees should ensure that they have had two doses of measles- vaccine before their trip.
- People who recover from measles are immune for the rest of their lives.
This outbreak confirms that the overall immunization coverage remains low, with disparities throughout Afghanistan, particularly between rural and urban areas, secure and insecure zones. Among under-five-year-old children, the most vulnerable ones, are those living in hard-to-reach communities; where the lack of access to immediate treatment can lead to high mortality rates.
Signs and symptoms
Measles signs and symptoms:
- Usually a high fever, which begins about 12 to 20 days after exposure to the virus, and lasts four to eight days.
- A runny nose, a cough, red and watery eyes, and small white spots inside the cheeks can develop in the initial stage.
- After several days, a rash erupts, usually on the face and upper neck. Over about three days, the rash spreads, eventually reaching the hands and feet. The rash lasts for five to six days, and then fades. On average, the rash occurs 14 days after exposure to the virus (within a range of seven to 18 days).
Most measles-related deaths are caused by complications associated with the disease. Complications are more common in children under the age of five, malnourished children, and immunologically impaired, or adults over the age of twenty. The most serious complication are severe respiratory infections such as pneumonia, encephalitis, ear infections, severe diarrhea and related dehydration, blindness and deafness.
The highly contagious virus is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. The virus remains active and contagious in the air or on infected surfaces for up to two hours. It can be transmitted by an infected person from four days prior to the onset of the rash to four days after the rash erupts.
Severe complications from measles can be avoided though supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.
All children in Afghanistan diagnosed with measles should receive two doses of Vitamin A supplements, given 24 hours apart. This can help prevent eye damage and enhance immunity. Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%.
WHO recommends routine measles vaccination for children, combined with mass immunization campaigns in Afghanistan, these are key public health strategies to reduce measles deaths. The measles vaccine has been in use for over 40 years, it is safe and effective.
In 2010, about 85% of the world’s children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.