Eliminating measles by 2020?

I was one of the members of the Maldivian team that attended the WHO SEAR (South East Asia Region) consultation meeting in New Delhi to discuss whether the region could agree to set a Measles elimination target. Sitting in the same conference hall with highest authorities and experts on Measles from around the world was a huge learning experience for myself. I am sure it was the same for many of the other participants as well.

Most regions of the world have controlled Measles to pre-elimination levels already. SEAR remains the only region which is far, far behind in achieving that goal. One country in particular, India, for various geopolitical reasons is the stumbling block in this endeavor. The larger majority of measles cases and deaths from Measles at present occur in a few states of India. Much effort is being put in to tackle the problem. However, we came to the realization that much more needs to be done. 

According to available knowledge, Measles elimination is biologically possible and feasible. Many of the experts believed that provided a concerted effort is put in and sustained for a few years across the world; in particular in the hots spots of UP and Bihar of India, we would be able to eliminate measles from the region and then eradicate it from the world. An estimated 130,000 kids continue to die in India from Measles every year; a number that could well be prevented by use of currently available measles vaccines.

Well, the meeting decided to advice the regional high level meeting - which will be underway in Nepal in a few days time - to set the goal of 2020 for elimination.

Maldives with our high coverage of measles vaccines should be ready to push for elimination should the target be set. Much would need to be done to ensure that vaccine uptake is sustained at the currently high levels to make the effort fruitful. Our biggest challenge would be to address the emerging issue of vaccine refusal in the Maldives.

I hope to be involved in a meeting to address this very issue in the very near future. 

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Posted by Dr Abdulla Niyaf at 4 Sep 2009, 3:17 PM
Categories: Public Health
Tags: Measles Eradication WHO Elimination
 
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  • 5 Sep 2009, 3:41 AM Jaa wrote:
    Interesting. And, I didn't know refusal to vaccination was a emerging issue in the Maldives! Would be interesting to hear your opinion on the social impacts if this trend were to continue...
    Reply to this
    1. 25 Sep 2009, 2:26 PM Dr Abdulla Niyaf wrote:
      It is a worrying development. One that has been increasing over the past few year. We (my colleagues and I) currently encounter one case roughly every month where parents refuse to vaccinate their kids. There are 2 groups among them; one who refuse based purely on perceived religious beliefs while others quote internet-based "scientific" publications as reasons to refuse vaccinations; although I find the majority within the latter group to be "morphologically" similar to the previous group.

      Vaccination does not offer a fail proof 100% protection from an illness! A smaller number of kids who get vaccinated may not build within themselves the immune response in strength adequate enough (seroconversion) to protect against future infections. However, a larger significant number do. It is this high number of post-vaccination seroconversion rate that is in effect protecting those who are not seroconverted following vaccination AND even those who are not vaccinated at all; from catching the illness. The protected kids act as barriers against spread of infection within the community; a concept called Herd Immunity.

      In the event that a critical number of kids either fail to get vaccinated or fail to develop seroconversion following vaccination, the level of community protection offered by Herd Immunity (for that particular illness) may be too small to stop transmission of illness. That is to say: the chance of an infected kid coming in contact with an unprotected kid (who is likely to get infected) is increased, allowing the disease to spread within a community! That is the concern.

      We, in Maldives, take pride in the significant gains made in the improved child and infant health indicators like low Infant Mortality Rate. It is arguable that a significant contribution to this achievement was made by the success in controlling vaccine preventable illnesses like Polio, Diptheria, Tetanus, Pertusis, Measles and Mumps. Such control allowed a significant reduction of disease associated mortality and morbidity. That in turn made it possible for us to concentrate on other aspects of infant and young child health. 

      A consultation process with those on the other side of the great divide could help identify the exact reasons for vaccine refusal and address them.



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