A very worrying increase in measles cases around the world

In a recent press release, the World Health Organization warns: Measles increased significantly in the world in 2019, with nearly 870,000 cases registered! This is the highest level since 1996. An estimated 207,500 people died from the disease last year.

For nearly a year, COVID-19 has attracted media attention. Yet many other infectious diseases continue to plague. Among them is measles, a highly contagious viral disease, which causes inflammation of the upper respiratory tract and a rash all over the body. ” Before there was a coronavirus crisis, the world was in the throes of a measles crisis, which has not gone away Said Henrietta Fore, UNICEF Executive Director.

There is no specific treatment for this disease; most people usually get better in two to three weeks. Unfortunately, this disease can sometimes cause serious complications, even fatal, in the most fragile people, especially in malnourished children and in immunocompromised people: blindness, encephalitis, severe diarrhea, ear infections and pneumonia. A vaccine has existed since 1963. Before its introduction, a major measles epidemic occurred every 2-3 years, causing approximately 2.6 million deaths in each wave.

The WHO estimates that measles vaccination prevented more than 20 million deaths between 2000 and 2016. Thus, in sixteen years, the number of deaths in the world has decreased by 84%. However, the organization is now reporting worrying figures: between 2016 and 2019, measles deaths increased by 50%! Why such a turnaround?

Insufficient vaccination coverage

An estimated 89,780 people, most of them children under the age of 5, died of measles in 2016. This number rose to 207,500 last year. For experts, this increase is mainly explained by insufficient vaccination of children, who must receive two doses of the vaccine from an early age. It is given as an MMR vaccine, which simultaneously protects against measles, mumps and rubella; the first injection should be given at the age of one, then the second between 16^is and 18^is month.

Problem: Immunization coverage is not the same in all regions of the world. Nigeria, Ethiopia, the Democratic Republic of Congo, Pakistan, India and the Philippines are among the countries with the highest number of unvaccinated infants. However, to fight measles and prevent disease outbreaks and death, coverage rates for the first and second doses of the vaccine must reach 95%. These rates must also be maintained at the national and sub-national level. But in fact, globally, the coverage rate for the first dose of the vaccine is between 84% and 85%, while the coverage rate for the second dose is only 71%. ” We must act together to help countries and inspire communities to immunize everyone, everywhere, against measles and stop this deadly virus »Warns Dr Tedros Adhanom Ghebreyesus, WHO Director General.

Several vaccination campaigns have been organized this year to increase this vaccination coverage in countries most at risk. However, the handling of the pandemic greatly shocked the entire organization, disrupting campaigns in 26 countries. ” COVID-19 has had disastrous effects on health services around the world, including immunization services », Ghebreyesus emphasizes. More than 94 million people will not be vaccinated as planned, as their country is currently experiencing a measles epidemic.

As this virus is one of the most contagious – its reproduction rate (R0) in a non-immune population is estimated to be between 15 and 20 – incomplete vaccination coverage necessarily has serious consequences. It can be transmitted directly through the air (micro-drops of saliva) or through contact with contaminated objects or surfaces, where it can remain active for up to two hours. Patients are contagious in the four days before and four days after the rash.

A question of trust

Dr. Robert Linkins, chairman of the measles and rubella initiative management team and head of the Division for Accelerated Disease Control at the Centers for Disease Control and Prevention (CDC), adds that the rise in infections is also due to the fact that health services do not always reach the populations most at risk. However, it is important to vaccinate as many children as possible before any easing of travel restrictions put in place for COVID-19.

The Measles & Rubella Initiative (or M&RI, for Measles & Rubella Initiative) is the result of a partnership between the American Red Cross, the United Nations Foundation, the United States CDC, UNICEF and CHI. Together with Gavi, the Vaccine Alliance has set itself the goal of strengthening immunization systems to completely eliminate measles and rubella by 2030 “. Right now, when we have a powerful, safe and inexpensive vaccine. Nobody should die of this disease anymore Insists Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance.

In France, where there was a slight decline in measles vaccination coverage between 2014 and 2017, the MMR vaccine became mandatory in 2017. And luckily! Because in France, as in several European countries, trust in vaccines tends to wane. At least this is the conclusion of an investigation published in The Lancet in the month of September. This study made it possible to map vaccine confidence in 149 countries, based on data collected between 2015 and 2019. Three criteria were evaluated: safety, relevance and efficacy.

It shows that at the end of 2015, Argentina, Liberia and Bangladesh had the highest percentage of respondents who strongly agree that vaccines are safe. Conversely, Japan, France and Mongolia had the lowest confidence rates (around 8%). That said, the confidence of the French rose slightly between 2015 and 2019 for the three criteria assessed. However, the authors point out that trust is relatively low in Europe, compared to other continents. This explains the recent resurgence of measles cases observed in several countries (including Ukraine, Italy, Belgium, Germany, Serbia, Czech Republic, etc.), where the MMR n vaccine is not always mandatory, but simply recommended.

While some vaccines are now on track to stem the COVID-19 pandemic and may even hit the market at the end of the year, this lack of confidence will undoubtedly be very problematic and divide populations widely.

Sources: WHO and CDC