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MEASLES UPDATE 2012: (45)
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[1] Congo DR (Province Orientale)
Date: Mon 10 Dec. 2012
Source: Radio Okapi [in French, machine trans. edited]
http://radiookapi.net/en-bref/2012/12/1 ... is-yawuma/


Nearly 100 children among over 1000 recorded cases of measles have died between October and November 2012 in the Health Area of Yawuma (Province Orientale). These figures were revealed on Mon 10 Dec 2012 by Dr. Cyprian Loseya, Chief Medical Officer of health for the district Tshopo-Lomami. 51 deaths were recorded in October 2012. According to local sources, the high number of measles cases in this Health Area are due to the poverty of the population, who lack money to bring sick children to health centers.

A team from Medecins sans Frontieres (MSF) has been in Yawuma since Thu 6 Dec 2012 to help health officials in the fight against measles. The team brought drugs and intend to train local staff.

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[The interactive ProMED-mail/HealthMap of Congo DR can be accessed at: http://healthmap.org/r/1jPk. - Mod.BM]

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[2] Nigeria (Kebbi)
Date: Sat 15 Dec 2012
Source: Daily Times [edited]
http://dailytimes.com.ng/article/37-new ... rded-kebbi


Health officials in Birnin Kebbi Local Government and Ambursa/Kardi Development Area in Kebbi State said they discovered 37 fresh cases of measles in rural communities. The discovery came 2 weeks after 7 children died of the disease.

The Director of Health in the area, Malam Yusuf Sani, said in Birnin Kebbi that the disease was discovered in Runtuwa, Gawasu in Ambursa/Kardi development area. He said treatment and isolation of the affected children as well as provision of drugs had begun.

Measles, which had so far claimed 7 lives since its outbreak, was uncovered 2 weeks ago, while 245 out of the 275 children had been treated. Sani said 38 new cases had been recorded in Runtuwa and Gawasu as well as in sections of the metropolis.

"We have been getting assistance with drugs now from the federal and state governments and NGOs," he said, and called on parents to monitor their children's movements, as the disease is airborne.

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[Kebbi is a state in northwestern Nigeria with its capital at Birnin Kebbi. Kebbi is bordered by Sokoto state, Niger state, Dosso region in the Republic of Niger, and the nation of Benin. A map of the states of Nigeria showing Kebbi state in the northwest can be accessed at: http://www.nationsonline.org/oneworld/m ... a_map2.htm.

It is unclear from this press report whether the emergency provision of "drugs" refers to measles vaccine or supportive therapy (e.g. vitamin A). - Mod.CP]

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[3] Pakistan (Sindh)
Date: Tue 11 Dec 2012
Source: Dawn newspaper [edited[
http://dawn.com/2012/12/12/funds-sought ... ns-feared/


Fearing an outbreak of measles in Larkana division following reports of several deaths in Naudero town and some villages, the district health authorities have requested the Expanded Programme of Immunisation (EPI), Sindh to provide adequate funds for launching a vaccination drive against the disease.

There were reports that at least 6 children -- 4 of them in Naudero town alone, one in Burirro village, and another in Naich village -- died of measles within a fortnight. Only on Tuesday [11 Dec 2012], an 8-year-old boy died of measles, said his relative, a resident of Gharibabad. This was the 3rd death in his family, he added. While Larkana district health officer (DHO) Dr Abdul Fatah Bughio said he could not verify the reported deaths, cases of measles were constantly being reported from upper Sindh.

"We have sent blood samples of 400 suspected measles cases to the National Institute of Health, Islamabad. Of them, 125 cases tested positive for measles, and this is enough to gauge the gravity of the situation," the DHO said. He confirmed to Dawn [newspaper] that a request for provision of adequate funds to launch an anti-measles drive had been sent to the EPI after a discussion on the issue. Addressed to the Sindh EPI project director, the communique stressed the need for launching a campaign in the division before the disease took the shape of an outbreak, he said, adding that the letter also suggested to the EPI that the required funds could be arranged through the World Health Organisation. He said a lack of sanitation and poverty topped the causes of measles spread. A round of immunisation against the disease along with a sanitation drive was recently conducted in Bakrani and Dokri areas after many cases were reported from these areas, he added. He did not come up with a satisfactory reply when asked why more measles cases were being reported even after the routine immunisation and other preventive measures. He, however, linked the situation with unhygienic conditions and poverty in the affected areas.

Dr Ashique Jokhio, the head of the immunisation surveillance, Larkana, said that he had information about 550 cases of measles and that samples of suspected cases were regularly being dispatched to the NIH. A professor of paediatrics at the Chandka Medical College Hospital, Dr Shanti Lal, said that he had examined 50 cases of measles at his clinic over the past 4 to 5 weeks.

Prof Dr Saifullah Jamro, chairman of the department of medicine and allied sciences at the Shaheed Benazir Bhutto Medical University (SBBMU), Larkana, told Dawn that poor immunisation practices in the country coupled with under-reporting of cases were major factors in aggravating the situation. He said measles was believed to be one of the leading causes of mortality in young children. He said that 139 300 deaths from measles were reported in 2010 globally; that came to nearly 380 deaths every day or 15 deaths an hour. He observed that more than 95 per cent of measles-related deaths were reported from countries with weak health infrastructure.

Vaccination against measles had reduced the death rate by 74 per cent between 2000 and 2010 worldwide, Prof Jamro said, adding that by the end of 2012, some 21 000 children in the country were vulnerable to measles. As many as 2143 cases had already been confirmed across the country, he said, while terming the situation alarming. He said Sindh topped all the provinces with 737 cases having been reported this year [2012] so far. It was followed by Khyber Pakhtunkhwa with 648 cases and Punjab with 582 cases, he added.

Prof Jamro said that from 1 Jan to 6 Oct 2012, a total of 236 outbreaks were reported in the country. Giving a breakdown, he said 51 were reported from Qambar-Shahdadkot district, 24 from Dadu district, and 23 from Khairpur district. A total of 3833 cases were reported from these districts. Of them, 543 cases were reported from Qambar-Shahdadkot followed by Larkana with 371 cases and Dadu with 320 cases, he said. During this period, 67 deaths from measles were reported, he said, adding that 14 of them were reported from Karachi, 13 from Qambar-Shahdadkot, and 7 from Sukkur.

"Devastating rains and floods have aggravated the situation in the districts, and a nationwide measles elimination campaign needs to be launched on an urgent basis," he said.

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[Of general interest is the statistic computed by Prof Jameo: "...that 139 300 deaths from measles were reported globally in 2010, which equates to nearly 380 deaths every day or 15 measles deaths an hour." More than 95 per cent of measles-related deaths are reported from countries with weak health infrastructure, such as Pakistan.

Larkana is a district of Sindh province in Pakistan. According to the 1998 census of Pakistan, it had a population of approximately 2 million inhabitants. The ProMED-mail/HealthMap of Sindh province can be accessed at: http://healthmap.org/r/4wnA. - Mod.CP]

MEASLES UPDATE 2012 (46)
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Pakistan (Sindh)
Date: Mon 17 Dec 2012
Source: Vaccine News [edited]
http://vaccinenewsdaily.com/medical_cou ... two-weeks/

The death of a 6 year old girl in the Pakistani province of Sindh over the weekend has increased the death toll from a measles outbreak to 28 people in the last 2 weeks. A local television station reported hospital sources as saying 7. They said the Upper Sindh region was still reeling from a series of floods that occurred in August and September 2012, according to APA.az [Azerbaijan Press Agency].

District health officer Dr Abdul Fatah Bughio said that he could not confirm the death toll, but he was certain there have been more than 100 measles cases reported in the region since the outbreak began. He said unsanitary conditions, unhygienic food, and general poverty have exacerbated the situation. Families in areas affected by flooding have reported that stagnant rain water is still surrounding their houses and that [they] are concerned because the authorities have yet to offer any help.

Dr Saifullah Jamro, from the Shaheed Benazir Bhutto Medical University, said Pakistani health officials have confirmed 2143 measles cases across the country since the beginning of the year [2012, from an APA.az report]. The World Health Organization reported that a June 2012 measles outbreak in Sindh claimed the lives of 27 children under the age of 5.

[byline: Jeffrey Bigongiari]

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[A map of the locations of the districts of Sindh province of Pakistan can be seen at: http://reliefweb.int/map/pakistan/pakis ... 6-jan-2011. - Mod.CP

A ProMED-mail HealthMap for Pakistan can be seen at http://healthmap.org/r/1iGJ.]

MEASLES UPDATE 2012 (47)
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A ProMED-mail post
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ProMED-mail is a program of the
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*****

[1] Pakistan (Karachi)
Date: Fri 28 Dec 2012
Source: The International News [edited]
http://www.thenews.com.pk/Todays-News-4 ... in-Karachi


Between 500 and 600 cases of measles were reported from different areas of Karachi over the last few weeks, and the number of children affected from the potentially deadly, airborne viral disease was on the rise, but provincial health authorities ... remained oblivious to the alarming situation ..., medical experts stated on Thursday [27 Dec 2012].

"I have seen 4 cases of measles myself. One was admitted to the Abbasi Shaheed hospital, one at Ziauddin Hospital, and 2 children were brought to my clinic who had measles," Pakistan Pediatric Association (PPA) President Professor Dr Iqbal Memon told The News. He said measles cases had been reported from Saddar, Orangi town, SITE, Sachal Goth, Gadap and Sohrab Goth. "Pediatricians are treating children with measles and also reporting these cases to town health officials and the WHO's Measles Cell. As per my knowledge, between 25 and 30 percent of measles cases of the total in Sindh were from Karachi. We have asked our member pediatricians to report measles cases to provincial and city health officials," he added.

Dr Memon said a special vaccination campaign against measles should also be launched in Karachi as children were contracting the viral disease. "Measles is an airborne viral disease, and it is a health risk for children who are not vaccinated against it," Dr Iqbal Memon said, adding that at least one round of measles vaccination was necessary in the metropolis. He suspected that Sindh health officials were more concerned about completing the polio vaccination drive, which was cancelled in Karachi on 18 Dec 2012 after the killing of 4 polio vaccinators. "1st, they are planning to administer oral polio vaccine drops to children, and then they might recognise the measles threat and take measures against the disease."

On the other hand, the Expanded Program on Immunisation (EPI) Sindh Project Director Mazhar Khamesani said no measles cases were reported from Karachi or brought to their knowledge by the city health authorities. "Normally, town officials report the cases to provincial health authorities, but so far, no cases have come to the fore," he claimed.

He said that EPI Sindh was launching a 10-day campaign in 7 districts of Sindh to vaccinate around 3 million children against measles from Mon 31 Dec 2012. The EPI Sindh Director said the outbreak of measles was reported from the rain-affected districts of Sindh, although there was no laboratory confirmation. "Like polio, measles cases have to be verified from the National Institute of Health (NIH) Islamabad, and to my knowledge, so far, the disease has not been detected in any samples," he said.

According to him, the districts that would be covered during the 10-day campaign included Khairpur, Sukkur, Shikarpur, Kashmore, Jaccobabad, Larkana and Qambar Shahdadkot. He lamented the fact that many parents do not take their children to doctors, and due to the complications, some children lost their lives. "During the campaign, children from 9 months to 10-years-old would be vaccinated against measles." Khamesani said that under the routine immunisation [programme], children are given 2 doses of vaccination against measles, one at 9 months and the 2nd at their 15th month.

[Byline: M. Waqar Bhatti]

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[2] Pakistan (Sindh)
Date: Mon 24 Dec 2012
Source: South Asia News Agency (SANA) [edited]
http://www.sananews.net/english/measles ... -kandhkot/


The government has imposed a state of emergency in hospitals after 45 children died of measles in Kandhkot. The phase of casualties due to measles continued as the death toll of innocent children has risen to 45 within 21 days.

According to local people, within a short period of 21 days, at least 45 children have fallen victim to the disease, while hundreds of children are being treated in different hospitals. Terror and horror have gripped the entire area where people are scared of their future.

The Health Department has taken note and [declared] an emergency in government hospitals. According to health sources, blood samples of more than 100 children have been sent for medical tests.

On the other hand, locals have blamed lack of doctors and non-availability of vaccines at local hospitals during the outbreak.

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[Kandhkot is a city in Kashmor District in the Sindh province of Pakistan. The city is a major hub for the grain and cattle industry. It can be located in the interactive map of Sindh province at: http://www.ugo.cn/admin2/en/1271403.htm. - Mod.CP

A ProMED-mail HealthMap for Pakistan can be found at http://healthmap.org/r/1iGJ.]

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[3] Pakistan (Sindh)
Date: Mon 24 Dec 2012
Source: The News Tribune [edited]
http://www.thenewstribe.com/2012/12/24/ ... es-deaths/


Federal Minister for Religious Affairs, Khurshid Shah has said that an emergency has been declared in the places affected by the deadly outbreak of measles in Pakistan's Sindh province, which has so far claimed 50 lives.

"The move has been made following the rise in the death toll due to the epidemic," he said. He also said the deaths were due to the "negligence of officers of the health department."

It is believed that the 50 children lost their lives to the deadly disease in Kandhkot and other districts of the province in the last 2 weeks as a consequence of inadequate stock of measles vaccine.

[Byline: Hassan Siddiqui]

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[Sukkuris is the 3rd largest city of Sindh province, situated on the west bank of the Indus River in Sukkur District. It can be located in the interactive map of Sindh province at: http://www.ugo.cn/admin2/en/1271403.htm. - Mod.CP

A ProMED-mail HealthMap for Pakistan can be found at http://healthmap.org/r/1iGJ.]

MEASLES UPDATE (01): AFRICA, ASIA
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In this update:
Africa
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[1] Congo DR (Bikenge, Maniema province)
Asia
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[2] - [5] Pakistan (Sindh province)
[6] Pakistan (Rawalpindi, Punjab province)

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Africa
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[1] Congo DR (Bikenge, Maniema province)
Date: Wed 3 Jan 2013
Source: Radio Okapi [in French, machine trans., edited]
http://radiookapi.net/actualite/2013/01 ... e-bikenge/


More than 50 cases of measles, including 2 deaths, in one week were reported by the medical director of the health centre in Bikenge, a mining town 200 km [124 mi] east of Kindu, in Maniema [province]. This disease attacks particularly unvaccinated children zero to 5 years of age, says a doctor. Some of these children are being cared for in the Bikenge Health Centre; others are being treated in private clinics, and some at home.

According to the Medical Director of the Bikenge Health Centre, none of these facilities have resources to accommodate all patients. In order to avoid contamination, sick children should be separated and quarantined to avoid further spread of the disease. Emergency government aid will be required to prevent further fatalities. He also called on parents to ensure their children are vaccinated.

[Radio Okapi bulletins have reported other measles outbreaks in the adjacent Orientale Province recently:
- As many as 100 children died as a result of measles virus infection in Yawuma during a 2 month period;
- 40 people have died since June [2012] in Buta;
- Measles continues to spread in the Tshopo Lomami health district.

It has also been reported that more than 65 000 children are being vaccinated in Ludimbi-Lukula [Kasai-Oriental Province].

--
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[Maniema is a province of the Democratic Republic of the Congo. Its capital is Kindu. Maniema is bordered by the provinces of Kasai-Oriental to the west, Orientale to the north, North Kivu and South Kivu to the east, and Katanga to the south. A map of the provinces of Congo DR can be accessed at http://www.mapsofworld.com/democratic-r ... l-map.html and a HealthMap/ProMED-mail interactive map at http://healthmap.org/r/4JoX. - Mod.CP]

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Asia
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[2] Pakistan (Sindh province)
Date: Sun 30 Dec 2012
Source: The Nation [edited]
http://www.nation.com.pk/pakistan-news- ... ied-so-far


The [Sindh] Provincial Health Minister Dr Sagheer Ahmed announced that as many as 411 519 children, [from] 9 months to 10 years of age, will be vaccinated against measles in the province.

Around 130 004 children [have already received] the anti-measles vaccinations in the most affect districts of Sindh province, he said in a statement issued on Saturday [30 Dec 2012]. The Health Minister said that the anti-measles campaign was being held simultaneously in Jacobabad, Kashmore, Larkana, Kambar, Nawabshah, Shikarpur, and Ghotki districts, while the government had organised 20 anti-measles camps to provide vaccination facilities in all affected area.

He stated that at least 1235 measles cases had so far surfaced in the province, while in total 56 deaths had been reported. The Minister said that Sindh Health Secretary Sindh Aftab Ahmed Khatri had been directed to monitor the campaign.

--
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[Maps of Pakistan can be seen at http://www.mapsofworld.com/pakistan/map ... an-map.jpg and http://healthmap.org/r/2NT8. A map of Sindh Province is available at http://www.findpk.com/yp/html/Sindh-Pakistan-Map.png. - Sr.Tech.Ed.MJ]

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[3] Pakistan (Sindh province)
Date: Sun 30 Dec 2012
Source: News Track India, Indo Asian News Service (IANS) report [edited]
http://www.newstrackindia.com/newsdetai ... stan-.html


On Sunday [30 Dec 2012], 7 more children died of measles in Pakistan's southern province of Sindh, taking the toll due to the disease to 154 in the month, media reports said. Citing the Urdu TV channel Dunya, the Xinhua [news agency] said the disease broke out during the last week of October [2012] in northern areas of Sindh province that had been hit by floods in August and September.

Children between the ages of 2 and 9 years were affected. Health officials said that over 1200 measles-affected children have been admitted to hospitals since November [2012].

They said the major reasons behind such a massive spread of the disease were malnutrition and unhygienic conditions in which the affected children were living. Most of the affected children were living together in congested [accommodation] and were passing the disease to other children, a senior health official was quoted as saying. Families of the affected children said stagnant rain water was still present in their surroundings even after 3 months since the floods hit the province.

The Sindh Health Ministry said an anti-measles vaccination drive has been launched in the affected areas. Around 130 000 children have been vaccinated so far.

This is the 2nd major outbreak of the disease in Sindh this year [2012]. In June, the World Health Organization said that 27 children under 5 years died due to measles in the province.

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[4] Pakistan (Sindh province)
Date: Mon 31 Dec 2012
Source: Pakwatan.com [edited]
http://www.pakwatan.com/pakistan-news.php?id=6251


A deadly measles outbreak in the interior of Sindh [province] has left at least 161 children dead in the last 30 days. According to reports gathered from different parts of upper Sindh, including Sukkur, Ghotki, Kandhkot, Thal, and Tangwani, 5 children lost their lives due to measles virus [infection] in the last 24 hours. Sensing the gravity of situation, teams from the Sindh Health Ministry have established different centers for vaccination. More than 150 teams are also conducting house-to-house vaccination in Khairpur.

According to the statistics, 80 children died of measles in the most affected district, Kandhkot, [where] hundreds of children are still admitted to hospital. 7 children died in different areas of interior Sindh, including Tangwani, Kashmore, and Pir Baksh on Sunday [30 Dec 2012]. In the Salehpat, a district of Sukkur, measles has claimed 9 more lives last [in the past 24 hours].

Reports say the viral infection is wrecking havoc in Sukkur, Ghotki, Shikarpur, Kashmore, Jacobabad, Larkana, Qamber-Shahdadkot, and Salehpat.

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[5] Pakistan (Sindh province)
Date: Wed 2 Jan 2013
Source: Dunya News [edited]
http://dunyanews.tv/index.php/en/Pakist ... of-measles


A deadly measles outbreak in interior Sindh has left at least 240 children dead in a month as 7 more die of measles on Wed 2 Jan 2013, the FP News desk reported.

According to reports gathered from different parts of Sindh, 3 children have died in Kandhkot in the past 24 hours, taking the toll in the area to 108. Another child died today in Lakhi Ghulam Shah area of Shikarpur. So far, 8 children in Larkana and two from Nawabshah have lost their lives. In Sukkur District, the toll has reached 63 after deaths of 5 more children in Saleh Put area. 12 children in Ghotki, 4 in Thal, and 35 children died of measles in Khairpur in past few weeks. Other affected areas include Gaddu, Kashmore, Tangwani, and 80 other rural areas.

According to the District Health Officer, 277 000 registered children will be vaccinated against measles. The vaccination campaign has [yet] to [be] launched completely in Ghotki area.

Sindh province, the area hardest hit by the measles outbreak, has also been battered by repeated floods in recent years that have damaged hospitals and clinics.

Measles is an extremely infectious disease spread by coughing and sneezing or personal contact. It causes a fever, cough, and a rash all over the body. Most people who contract the disease recover, but it can be fatal for malnourished children. Complications from the disease can include blindness, an infection that causes brain swelling [encephalitis], dehydration and diarrhea, and pneumonia.

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[6] Pakistan (Rawalpindi, Punjab province)
Date: Sat 5 Jan 2013
Source: The Nation [edited]
http://www.nation.com.pk/pakistan-news- ... es-surface


Four new cases of measles, all of them from Rawalpindi, were reported to the Pakistan Institute of Medical Sciences (PIMS) on Friday [4 Jan 2013]. Dr Sidra from the Isolation Ward at PIMS stated that 3 new patients had been admitted on Friday [4 Jan 2013] and are all from the same family. Total number of admitted patients has risen to 9 at PIMS. The doctor said though their condition is stable, they have been suffering from conjunctivitis and pneumonia.

Officials from Expanded Programme of Immunisation (EPI) maintained that the provincial administrations and the Islamabad Capital Territory administration and Director Services Health of Capital Development Authority had received vaccine but their all efforts remained concentrated on polio [vaccination] and they had neglected routine vaccination of other diseases.

According to health experts in rural areas where the cases are being reported, children from 100 homes in the area should have been vaccinated by the city administration but nothing has been done so far to control the outbreak.

--
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[Rawalpindi is a city in the Pothohar region of Pakistan near the country's capital city of Islamabad, in the province of Punjab. Rawalpindi is the 4th largest city in Pakistan after Karachi, Lahore, and Faisalabad. It can be located on the HealthMap/ProMED-mail interactive map at http://healthmap.org/r/1qVK. - Mod.CP]

MEASLES UPDATE 2013 (02)
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In this update
----
Africa
----
[1] Congo DR (Bikenge, Maniema province)
[2] Uganda (Hoima)

Asia
-----
[3] Pakistan (Sindh)
[4] Pakistan (Islamabad)
[5] Pakistan (Hyderabad)
[6] & [7] Pakistan (Karachi)


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[1] Congo DR (Bikenge, Maniema province)
Date: Tue 8 Jan 2013
Source: Radio Okapi [in French, machine trans., edited]
http://radiookapi.net/actualite/2013/01 ... -de-kunda/


Outbreak of measles in Kunda territory of Maniema province
---------------------------------------------------
Vice Governor Jerome Bikenge Musimbi announced on Mon 7 Jan 2013 that 5 of 6 clinical samples from Bikenge, analyzed in the laboratory of the National Institute of Biomedical Research (INRB), had tested positive for measles virus. The vice governor of Maniema invited parents in the vicinity of the Bikenge Health Area to have their children vaccinated in the fight to contain the speed of measles virus infection.

According to official statistics, 75 cases have been identified now, including one death in the Kunda Health Area, which is located located Bikenge district in the southern province of Maniema. Jerome Bikenge Musimbi asked everyone to participate actively in identifying additional cases and requested parents to take their children for immunisation.

Previously Director of the Bikenge Health Center had reported more than 50 cases of measles, including 2 deaths, in one week [see Measles update (01): Africa, Asia 20130106.1484307]. This disease attacks particularly unvaccinated children from zero to 5 years.

--
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[Maniema is a province of the Democratic Republic of the Congo. Its capital is Kindu. Maniema is bordered by the provinces of Kasai-Oriental to the west, Orientale to the north, North Kivu and South Kivu to the east, and Katanga to the south. A map of the provinces of Congo DR can be accessed at:
http://www.mapsofworld.com/democratic-r ... l-map.html and a HealthMap/ProMED-mail interactive map at http://healthmap.org/r/4JoX. - Mod.CP]


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[2] Uganda (Hoima)
Date: Wed 9 Jan 2013
Source: The Daily Monitor [edited]
http://www.monitor.co.ug/News/National/ ... index.html


Measles death toll hits three
------------------------
The death toll from a measles outbreak in Hoima District has reached 3, although local leaders reported that 2 other people died from symptoms similar to those of the disease. Two of the victims aged 6 and 10, died on Saturday [5 Jan 2013] at Nyairongo Village in Kabwooya Sub County, a day after developing severe diarrhoea, Mr Vincent Opio, the area councillor, said.

The district health officer, Mr Fredrick Byenume, said the 3rd victim was a 2-year-old Congolese child who succumbed to the disease after admission at Kaseeta Health Centre on Monday [7 Jan 2013]. Mr Byenume, however, said all the victims had not been medically confirmed to have the disease. [Sever diarrhoea would not normally be indicative of measles virus infection].

Although the disease started as a strange illness in the area, tests conducted at the Uganda Virus Rsearch Institute in Entebbe last week confirmed an outbreak of the killer disease. Medical officials said those affected by the disease had either never been immunised or did not completed their immunisation schedules.

Mr Byenume said a mass Immunisation and sensitisation campaign had commenced in the affected communities. By press time, [another?] 5 patients had been hospitalised and were receiving treatment at Kaseeta Health Centre III. The district health officer said 30 other patients in Kaseeta Parish had active signs of the disease and had received treatment. He said those who had sought medication at the health facility were showing signs of recovery.

[Byline: Francis Mugerwa]

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[Hoima District is a district in Western Uganda. Like most other Ugandan districts, it is named after its main municipal centre, Hoima. Its location can be found in the map of Uganda at http://en.wikipedia.org/wiki/Hoima_District. - Mod.CP]


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[3] Pakistan (Sindh)
Date: Mon 7 Jan 2013
Source: The Express Tribune [edite]
http://tribune.com.pk/story/490249/dead ... ral-sindh/

Measles claims 10 more lives in rural Sindh
------------------------------------
As the measles outbreak slithers on, the epidemic took lives of 10 more children in rural Sindh on Sunday [6 Jan 2013], taking the death toll to at least 50 since the beginning of January [2013].

Four children passed away in Badin and Thatta districts. A 4-year-old child from Pir Sikandar Shah village in Badin's Tando Bhago taluka died after suffering from the disease for over a week. The child's father, told The Express Tribune that he also lost his 2-year-old daughter a week ago due to the illness. "A local doctor was treating my children. I brought my children late for treatment," their father said, adding that his children had not been inoculated [previously]. A 2-year-old child died in Tando Bhago's Ward No 2 area, another 2-year-old died in Badin's Nindo town, and a 4-year-old died in Adam Lashari village of Thatta.

Six children have died of measles in different parts of upper Sindh. A 3-year-old and a 4-year-old died in Hafiz Suleman Dahar village near taluka Daharki of Ghotki. A 4-year-old Sudheer Sundarni died in Jurio Sundrani village near taluka Qadirpur in Ghotki, while a 3-year-old died in Akbar Khan Lashari village near taluka Thull in Jacobabad district.

In Kashmore district, a 2-year-old died in Mohammad Ali Samejo village near taluka Ghouspur and a 5-year old died in village Nasrullah Nandvani near taluka Tanrwani.

In Dadu, a district-wide measles immunisation campaign was supposed to start, after Deputy Commissioner Nasir Abbass Soomro issued directives to the health department. However, despite the passage of 4 days, the campaign has not yet begun. Soomro had asked the health team to vaccinate children in the district's schools besides initiating a door-to-door campaign.

While the death toll climbs in parts of southern Sindh, the health department appears to be oblivious to this development. Dr Aqeel Qureshi, the focal person for measles, refused to officially confirm any deaths in Hyderabad division. He said only a few dozen children had been brought to public sector hospitals and they had all been cured. "Health teams are carrying out [a] vaccination drive in villages in rural Sindh where measles cases have been reported," he added.

[Byline: Z Ali / Sarfaraz]

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[Another report highlighting the a lack of coordination in masses vaccination in Pakistan. A map of Sindh province can be accessed at: http://www.sindh.gov.pk/dpt/maps/images/7.gif. - Mod.CP]


******
[4] Pakistan (Islamabad)
Date: Wed 9 Jan 2013
Source: The Express Tribune [edited]
http://tribune.com.pk/story/491311/curb ... -outbreak/


Curbing measles: Strategies adopted to combat outbreak
------------------------------------------------
Health experts and officials of the capital administration at a meeting held at the Pakistan Institute of Medical Sciences (PIMA) on Tuesday [8 Jan 2013] devised short and long term strategies to prevent blowing up of measles into an epidemic.

So far, in January this year [2013], 21 cases of measles have been confirmed in the capital, the majority of which are reported from katchi abadis and rural areas where the coverage of routine immunisation is low, according to the officials affiliated with Expanded Programme on Immunisation (EPI). [Mass migration from rural areas to cities has resulted in the proliferation of 'katchi abadis' or unplanned settlements in all of Pakistan's cities. - Mod.CP]. Tabish Hazir, head of Paediatrics Department at Children Hospital, told The Express Tribune that 2 strategies were chalked out, one for the short term to tackle the outbreak before it attains epidemic proportions and the other for the long term.

Under a short-term strategy, a liaison through a hotline service will be established between hospitals and the EPI for ensuring a quick response to a case reported from the twin cities. CDA and ICT have been asked to identify high-risk zones in their jurisdiction so that mop-up campaigns can be carried out under which all the children below the age of 15 will be vaccinated against measles, he said. All the hospitals will be given a reminder to strictly follow the guidelines meant for the treatment of patients suffering from measles.

CDA Health Services Director Dr Hassan Urooj expressed concern of a vaccine shortage in the capital if every child under the age of 15 [were to be] be vaccinated against the disease. He also said there was an acute shortage of vaccinators in his directorate. There are only 12 vaccinators in the capital which means one for 10 000 to 12 000 children which is insufficient especially during a crisis. When contacted, EPI National Programme Manager Dr Zahid Larik said at present there was no vaccine shortage in the country. "Currently, there is no vaccine shortage in any of the provinces or in the capital. There is a misconception about the measles outbreak in the country that is caused due to the shortage of vaccines which is completely wrong. It happens due to low coverage of routine immunisation and underreporting of cases," he said.

A core group comprising officials from all concerned departments will plan a mass awareness media campaign on measles and will ensure 100% coverage of routine immunisation in their areas under the long-term strategy.

The meeting was attended by the heads of the public and private hospitals, officials of Islamabad Capital Territory (ICT), CDA and EPI.

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[5] Pakistan (Hyerabad)
Date: Thu, 10 Jan 2013
Source: The International Tribune [edited]
http://tribune.com.pk/story/491932/meas ... -outbreak/


Measles epidemic: Officials play blame game over outbreak
--------------------------------------------------
As another 6 children died from measles during the last 24 hours, the Pakistan Medical Association (Sindh chapter) demanded that an inquiry commission be set up to fix responsibility for the unabated spread of the disease in the province. A total of 2475 cases were detected in Sindh [provnce] in December [2012] alone, according to Health Minister Dr Sagheer Ahmed. At a press conference on Tuesday [8 Jan 2013] night, Dr Sagheer said district health officers and vaccinators, the key players in the Expanded Program for Immunisation (EPI) and Peoples Primary Healthcare Initiative (PPHI), were responsible for the measles outbreak in upper Sindh. "They are accusing each other but they are all responsible for the situation," said Dr Sagheer, while avoiding to say what official action will be taken against them. While one of the reasons that routine immunisation has been weakened is a dispute over jurisdiction between the EPI and PPHI, district health departments are also blamed for not responding immediately to the health crisis while it was developing.

Dr Sagheer said that the virus has spread to Hyderabad and Mirpurkhas divisions, where health departments have been ordered to set up centres for vaccination and to send teams to affected areas. The minister said 1.5 million more doses [of vaccine] have been procured from Islamabad. According to him, measles claimed 210 lives in 2012, including 93 in December [2012]. However, these figures are considered to be an underestimation by many. "If the health officials are putting the total at 300, the actual figure will be more than double of what they tell," said the chief minister's relief adviser, Haleem Adil Shaikh. The adviser asserted at a press conference that the health departments are not even maintaining a proper record of the cases and deaths reported. He pointed out that, "A belated response came after improper routine immunisation, and it let the virus [disease] exacerbate". "Shifting accusations from one department to another will not do. We demand official action against those responsible," said PMA Sindh General Secretary Dr Pir Manzoor Ali.

[Byline: Z Ali]

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[6] Pakistan (Karachi)
Date: Sat 12 Jann 12 2013
Source: The International News [abridged & edited]
http://www.thenews.com.pk/Todays-News-4 ... h-minister


Karachi: 11 measles deaths in 2013, admits Health Minister
--------------------------------------------------
Sindh Health Minister Dr. Sagheer Ahmed on Friday [11 Jan 2013] admitted that at least 11 children had died so far due to measles in Sindh since 1 Jan 2013, while around 1537 new positive cases were reported over the last 10 days. "As many as 2.9 [?] children in 8 of the worst affected districts of Sindh were vaccinated. There were 425 fixed vaccination centers and 997 mobile teams working round-the-clock in these areas," the Minister told a meeting that was convened to review the measles outbreak. Dr. Sagheer Ahmed said that since the outbreak in the province during 2012, over 15 000 measles cases were reported, while deaths related to the disease were 11 in 2013. He maintained that the large-scale campaign was causing a vaccine shortage and said that the federal government, the World Health Organisation (WHO) and UNICEF had been requested to provide more vials. The minister told the meeting that federal health authorities and international organisations were informed that in order to achieve the 95 percent vaccination ratio, an adequate quantity of the measles vaccine was required.

[Byline: M. Waqar Bhatti]

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[7] Pakistan (Karachi)
Date: Sat 12 Jan 2013
Source: Daily Times, Pakistan [edited]
http://www.dailytimes.com.pk/default.as ... 13_pg12_11


The World Health Organisation (WHO) reports that more than 300 children have died from measles in Pakistan in 2012, a 5-fold increase from 2011. More than three quarters of death reported were in the province of Sindh. One hundred children died in the month of December [2012] alone, a SPCDPM statement said here Friday [11 Jan 2013].

The routine immunisation exercise across Pakistan reflects uneven coverage among provinces, districts and cities, with only certain important cities of Punjab recording a decent performance. The low coverage of the routine immunisation was an easily avoidable condition that has led to a measles outbreak in the northern Sindh and risks spreading in other parts of Pakistan. The figures for coverage are dismal; interior Sindh's coverage stood at 22-25 percent, while Karachi's coverage also remained at a low of 55 percent.

Official figures place coverage for Sindh at 80 percent, a blatant case of exaggeration and misleading reporting. Just recently, newspapers reported the discovery of 800 previously unreported cases of measles in Punjab.

There is strong interlink between the rain affected areas and the outbreak of measles as majority of the measles cases have been reported from the flood-affected areas of Ghotki, Shikarpur, Jacobabad, Sukkur, Larkana, Qambar-Shahdadkot, Khairpur and Kashmore-Kandhkot that still have rain water standing since the devastating monsoon rains in September 2012 which caused floods. SPCDPM has urged the provincial and federal governments to take an urgent, serious and concerted effort to enhance the administration of anti-measles vaccination, and in preventing malnourishment, which currently affects children across Sindh and the rest of the country and makes them susceptible to contracting measles.

Pakistan Pediatricians Association has claimed the measles had taken lives of over 300 children in the province. Huge difference of routine Immunisation coverage between provinces, districts and cities is at the root of the current measles outbreaks.

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[ProMED-mail does not normally post reports critical of governmental and admnstrtive deficiencies, but in this instance it seem appropriate. - Mod.CP]

MEASLES UPDATE (03)
*******************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


In this update:
Worldwide
---------
[1] 2010-2011 progress report
[2] WHO press release

Africa
-----
[3] Somaliland

Asia
-----
[4] Pakistan (Punjab, Sindh)
[5] Pakistan (IPS report)
[6] Pakistan (vaccination policy)


******
Worldwide
---------
[1] 2010-2011 progress report
Date: Fri 18 Jan 2013
Source: Morbidity and Mortality Weekly Report (MMWR) Weekly, 62(02); 27-31 [abbrev., edited]
http://www.cdc.gov/mmwr/preview/mmwrhtm ... mm6202a3_e


Global Control and Regional Elimination of Measles, 2000-2011
------------------------------------------------------
Widespread use of measles vaccine since 1980 has led to a substantial decline in global measles morbidity and mortality; measles elimination* has been achieved and sustained in the World Health Organization (WHO) Region of the Americas (AMR) since 2002. In 2010, the World Health Assembly established 3 milestones for measles eradication to be reached by 2015:
1) increase routine coverage with the 1st dose of measles-containing vaccine (MCV1) for children aged one year to 90 percent nationally and 80 percent in every district or equivalent administrative unit;
2) reduce and maintain annual measles incidence to <5 cases per million; and
3) reduce measles mortality by 95 percent from the 2000 estimate (1).

The Global Vaccine Action Plan (GVAP) includes monitoring progress toward achievement of goals to reduce or eliminate measles in 4 WHO regions by 2015 and 5 WHO regions by 2020(2). This report updates the previous report (3) and describes progress in global control and regional elimination of measles during 2000-2011. Estimated global MCV1 coverage increased from 72 percent in 2000 to 84 percent in 2011, and the number of countries providing a 2nd dose of measles-containing vaccine (MCV2) through routine services increased from 97 (50 percent) in 2000 to 141 (73 percent) in 2011. During 2000-2011, annual reported measles incidence decreased 65 percent, from 146 to 52 cases per one million population, and estimated measles deaths decreased 71 percent, from 542 000 to 158 000. However, during 2010-2011, measles incidence increased, and large outbreaks of measles were reported in multiple countries. To resume progress toward achieving regional measles elimination targets, national governments and partners are urged to ensure that measles elimination efforts receive high priority and adequate resources.

Immunization Activities
--------------------
WHO and the United Nations Children's Fund (UNICEF) use annual data from administrative records and surveys reported by national governments to estimate MCV1 coverage among children aged one year. Since 2003, countries also have reported the number of districts with more than or equal to 80 percent MCV1 coverage. During 2000-2011, estimated global MCV1 coverage increased from 72 percent to 84 percent; for 2011, estimated MCV1 coverage in three WHO regions was more than or equal to 90 percent. The number of countries with more than or equal to 90 percent MCV1 coverage increased from 83 (43 percent) in 2000 to 123 (63 percent) in 2011. Of countries reporting district-level MCV1 coverage, the proportion reaching more than or equal to 80 percent MCV1 coverage in more than or equal to 80 percent of districts increased from 49 percent (72 of 148) in 2003 to 56 percent (87 of 156) in 2011; in 2011, 34 percent (53 of 156) reported 80 percent MCV1 coverage in all districts. Of the estimated 20.1 million infants who did not receive MCV1 in 2011 through routine immunization services, 11.1 million (55 percent) were in 5 countries: India (6.7 million), Nigeria (1.7 million), Ethiopia (1.0 million), Pakistan (0.9 million), and the Democratic Republic of the Congo (DRC) (0.8 million).

During 2000-2011, the number of countries providing a 2nd dose of measles-containing vaccine (MCV2) through routine services increased from 97 (50 percent) to 141 (73 percent). Overall, 225 million children received measles vaccination during 39 supplemental immunization activities (SIAs) conducted during 2011. Among those 39 SIAs, 17 (44 percent) had >95 percent reported measles vaccine coverage, 12 (31 percent) included rubella vaccination, 15 (38 percent) included oral polio vaccination, and 14 (36 percent) included one or more child health interventions, in addition to vaccinations (Table 2).

Disease Incidence
---------------
During 2000-2011, the number of countries reporting annual measles surveillance data to WHO increased from 169 (88 percent) to 188 (97 percent). Effective measles surveillance includes case-based surveillance with laboratory testing to confirm cases. During 2004-2011, the number of countries using case-based surveillance increased from 120 (62 percent) to 182 (94 percent). During 2000-2011, the number of countries with access to standardized quality-controlled testing through the WHO Measles and Rubella Laboratory Network increased from 71 (37 percent) to 191 (98 percent).

During 2000-2011, the number of measles cases reported worldwide each year decreased 58 percent, from 853 480 to 354 922, and measles incidence decreased 65 percent, from 146 to 52 cases per million population per year, with declining cases and incidence reported in all WHO regions. During 2000-2011, AMR maintained measles incidence at <5 cases per million; in 2011, reported incidence in the Western Pacific Region (WPR) was 12 cases per million, a historic low. However, since reaching a low of 278 417 reported cases worldwide in 2008, annual reported cases have increased each year. From 2010 to 2011, a decrease in reported measles cases in WPR, from 49 460 to 21 050 cases, was offset by increases in reported cases, from 10 072 to 35 923 in the Eastern Mediterranean Region (EMR), 52 529 to 65 161 in the South-East Asia Region (SEAR), 186 675 to 194 364 in the African Region (AFR), and 30 625 to 37 073 in the European Region (EUR). In addition, the percentage of countries with reported measles incidence <5 cases per million population decreased, from a high of 122 (67 percent) of 183 reporting countries in 2008 to 104 (55 percent) of 188 reporting countries in 2011. During 2011, large measles outbreaks were reported by DRC (134 042 cases), India (29 339), Indonesia (2893), Nigeria (18 843), Somalia (17 298), France (1949), Zambia (13 324), Chad (8650), Philippines (6538), Sudan (5616), Italy (5189), Pakistan (4386), Romania (4189), Spain (3802), Uganda (3312), Ethiopia (3255), and Afghanistan (3013).

Mortality Estimates
----------------
Many countries, particularly those with the highest disease burden, lack data on the number of measles deaths; therefore, WHO has developed a model to estimate mortality using reported numbers of cases, measles vaccination coverage through routine vaccination and SIAs, the age distribution of reported cases, and age-specific, country-specific case-fatality ratios. The addition of 2011 measles vaccination coverage and case data for all countries, and updating of data for the period before 2011 for some countries, led to new mortality estimates for 2000-2011. During 2000-2011, estimated measles deaths decreased 71 percent, from 542 000 to 158 000; all regions and India had substantial reductions in estimated measles mortality, ranging from 36 percent to 90 percent.

MMWR Editorial Note
-----------------
During 2000-2011, increasing routine measles vaccination coverage worldwide, combined with regular SIAs in countries lacking high coverage with 2 doses of MCV, contributed to a 65 percent decrease in reported measles incidence and a 71 percent reduction in estimated measles mortality. Measles elimination has been achieved and maintained in AMR, and WPR is approaching its measles elimination goal. However, since 2008, large outbreaks of measles in AFR, EMR, EUR, and SEAR have stalled progress toward regional measles control and elimination targets.

Field investigations of recent measles outbreaks found most cases were among unvaccinated persons, suggesting the main underlying cause was persistent gaps in immunization coverage, despite overall increased measles vaccine coverage. All 5 countries with the largest number of infants who did not receive MCV1 through routine immunization services in 2011 had large outbreaks of measles during 2011, highlighting the importance of a strong immunization system. In addition, poor quality SIAs and delays in planned SIAs have resulted in low coverage, contributing to the increased number of measles-susceptible children and ongoing measles virus transmission.

In 2011, estimated global measles mortality increased from the 2010 estimate, and 99 percent of the measles mortality burden was in AFR, EMR, India, and other SEAR countries. In India, the 36 percent decrease in estimated measles mortality during 2001-2011 mainly resulted from the National Measles Catch-up Programme to provide MCV2, beginning in 2010, with MCV2 introduction in routine services in states with reported MCV1 coverage 80 percent, and with SIAs followed by MCV2 introduction in routine services in states with reported MCV1 coverage <80 percent. To prevent measles epidemics and associated morbidity and mortality, WHO recommends that all children receive 2 doses of measles-containing vaccine.

The findings in this report are subject to at least 3 limitations.1st, vaccination coverage estimates in this report include biases resulting from inaccurate estimates of the sizes of the target populations, inaccurate reporting of doses delivered, and inclusion of SIA doses given to children outside the target age group. 2nd, biases in surveillance data can occur because not all patients seek care and not all of those who seek care are reported. The use of measles surveillance data to estimate measles mortality improved on previously used methods that did not account for the effect of periodic outbreaks on mortality. Finally, the accuracy of the measles mortality model results is affected by biases in all model inputs, including country-specific measles vaccination coverage and measles case-based surveillance data.

In April 2012, the Measles and Rubella Initiative launched the 2012-2020 Global Measles and Rubella Strategic Plan to integrate rubella and measles elimination efforts, and provide strategies and guiding principles to resume progress toward regional measles elimination targets (10). The GVAP for the 2011-2020 Decade of Vaccines*** provides strategic objectives and recommended activities for increasing ownership, accountability, and vaccination coverage, as well as indicators for monitoring their impact through achievement of regional measles elimination targets. The GAVI Alliance commitment in 2012 to support eligible countries to introduce rubella vaccine using combined measles-rubella SIAs targeting children aged 9 months-14 years provides a unique opportunity to boost population immunity to both measles and rubella. The combination of new resources from immunization partners and commitments by countries to fully implement measles control and elimination strategies will help resume progress toward achieving regional measles targets.

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[Interested readers should access the original document via the source URL to view the tabulated graphic data and references accompanying the original text.

In summary: During 2000-2010, global coverage with the 1st dose of measles-containing vaccine (MCV1) increased from 72 percent to 85 percent, more than 1 billion children received a 2nd opportunity for measles immunization during measles supplemental immunization activities, and global reported measles cases decreased until 2008, then increased in 2010. By 2010, 40 percent of countries had not met the incidence target of less than 5 cases per million. As milestones toward eventual global measles eradication, the 2010 World Health Assembly endorsed a series of targets to be met by 2015.

The Global Vaccine Action Plan (GVAP) will monitor progress toward achievement of regional measles elimination targets. Estimated global MCV1 coverage increased from 72 percent in 2000 to 84 percent in 2011, and the number of countries providing a 2nd dose of measles-containing vaccine (MCV2) through routine services increased from 97 (50 percent) in 2000 to 141 (73 percent) in 2011. During 2000-2011, annual reported measles incidence decreased 65 percent, from 146 to 52 cases per million population, and estimated measles deaths decreased 71 percent, from 542 000 to 158 000.

During 2010-2011, measles incidence has increased and large measles outbreaks have been reported in multiple countries. To resume progress toward achieving regional measles elimination targets, national governments and partners are urged to ensure that these efforts receive high priority and adequate resources to achieve GVAP targets.

However the continued reluctance of the population of some countries (e.g., the UK) to accept universal MMWR vacation, together with organisational deficiencies (e.g., Pakistan) suggest that the WHO targets are optimistic. - Mod.CP]

******
[2] WHO Press Release
Date: Thu 17 Jan 2013
Source: World Health Organisation (WHO), Media Centre, News [edited]
http://www.who.int/mediacentre/news/not ... 130117/en/


Measles deaths decline, but elimination progress stalls in some regions
-----------------------------------------------------------------
The number of measles deaths globally decreased by 71 percent between 2000 and 2011, from 542 000 to 158 000. Over the same period, new cases dropped 58 percent from 853 500 in 2000 to 355 000 in 2011, according to new data released Thursday by WHO, a leading member of the Measles and Rubella Initiative. {The Measles & Rubella Initiative is a global partnership committed to ensuring no child dies from measles or is born with congenital rubella syndrome. Founded originally as the Measles Initiative in 2001, it's led by the American Red Cross, the United Nations Foundation, the U.S. Centers for Disease Control and Prevention, UNICEF and WHO. Although the WHO Region of the Americas has sustained measles elimination since 2002, and the WHO Western Pacific Region is on track to achieve elimination, large outbreaks of measles are jeopardising progress in the remaining regions that have these goals.

Success of vaccination coverage
---------------------------
WHO recommends that every child receive 2 doses of measles vaccine. The new data, published in this week's edition of the Centers for Disease Control and Prevention's (CDC) Morbidity and Mortality Weekly Report [see part 1 above] and then in WHO's Weekly Epidemiological Record, show overall progress in reducing deaths is linked largely to increased vaccination coverage.

Estimated global coverage with a 1st dose of vaccine increased from 72 percent in 2000 to 84 percent in 2011. The number of countries providing the 2nd dose through routine services increased from 97 in 2000 to 141 in 2011. Since 2000, with support from the Measles & Rubella Initiative, more than 1 billion children have been reached through mass vaccination campaigns -- about 225 million of them in 2011.

The 1st dose of measles-containing vaccine (MCV1) is recommended for children aged 9-15 months of age and a 2nd dose of measles vaccine (MCV2) is recommended to be given through routine vaccination programmes to children in the 2nd year of life or at school entry or through mass campaigns to children under 5 years of age. The exact ages will vary by country depending on the measles situation and programmatic issues.

Unprotected population
--------------------
Despite this global progress, some populations remain unprotected. An estimated 20 million children worldwide did not receive the 1st dose of vaccine in 2011. More than half of these children live in five countries:
- the Democratic Republic of the Congo (DRC) (0.8 million)
- Ethiopia (1 million)
- India (6.7 million)
- Nigeria (1.7 million)
- Pakistan (0.9 million)

Large measles outbreaks
---------------------
In 2011, large measles outbreaks were reported in all these countries and several others in:
- DRC (134 042 cases)
- Ethiopia (3255 cases)
- France (14 949 cases)
- India (29 339 cases)
- Italy (5189 cases)
- Nigeria (18 843 cases)
- Pakistan (4386 cases)
- Spain (3802 cases)

Other countries reporting large measles outbreaks in 2011 include the following:
- Afghanistan (3013 cases)
- Chad (8650 cases)
- Ethiopia (3255 cases)
- France (14 949 cases)
- Indonesia (21 893 cases)
- Italy (5189 cases)
- the Philippines (6538 cases)
- Romania (4189 cases)
- Somalia (17 298 cases)
- Spain (3802 cases)
- Sudan (5616 cases)
- Uganda (3312 cases)
- Zambia (13 324 cases)

Most of these countries are in WHO regions which have committed to eliminate measles by 2015 or 2020.

The measles outbreaks pose a serious challenge to the regional elimination efforts and signal where national health systems and routine immunization programmes need strengthening. Resuming progress in reducing measles cases and deaths means strengthening health systems so that they can provide effective immunization services and laboratory-supported surveillance for vaccine-preventable diseases to all children.

The outbreaks also indicate the need to ensure that parents are fully aware of the benefits of immunization and the risks associated with not vaccinating children.

Measles Initiative partnership
-------------------------
Launched in 2001, the Measles Initiative is a partnership -- led by the American Red Cross, United Nations Foundation, U.S. Centers for Disease Control and Prevention, UNICEF and WHO -- committed to reducing measles deaths worldwide.

In April of 2012, the partners of the Measles Initiative introduced a new global plan to jointly tackle measles and rubella using the same strategy and a combined measles-rubella vaccine. This new strategy is represented in its new name, the Measles & Rubella Initiative. The Initiative's goal is now to reduce measles deaths worldwide by 95 percent between by 2015 and to eliminate measles and rubella in at least 5 of 6 WHO regions by 2020.

World Health Assembly agreed milestones
-----------------------------------
In 2010, the World Health Assembly established three milestones towards the future eradication of measles to be achieved by 2015:
- increase routine coverage with the first dose of measles-containing vaccine (MCV1) for children aged 1 year to 90 percent nationally and 80 percent in every district or equivalent administrative unit;
- reduce and maintain annual measles incidence to <5 cases per million; and
- reduce estimated measles mortality by >95 percent from the 2000 estimate.

Global Measles and Rubella Strategic Plan
-----------------------------------
Since then, WHO and partners in the Measles and Rubella Initiative have developed a Global Measles & Rubella Strategic Plan 2012-2020. The plan presents a 5-pronged strategy to cut global measles deaths by at least 95 percent by 2015 compared with 2000 levels and to achieve measles and rubella elimination in at least 5 WHO regions by 2020. The strategies include: high vaccination coverage; monitoring spread of disease using laboratory-backed surveillance; outbreak preparedness and response and case management; communication and community engagement; and research and development.

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Africa
-----
[3] Somaliland
Date: Tue 15 Jan 2013
Source: Sabahi [edited]
http://sabahionline.com/en_GB/articles/ ... wsbrief-05


Somaliland government works to contain measles outbreak
--------------------------------------------------
The Somaliland regional government announced a measles outbreak in the Marodi Jeh region on Sunday (13 Jan 2013). 52 measles cases were documented last week, Director of Public Health in the Ministry of Health Ali Sheikh Omer said.

Some of the infected patients have been admitted to Hargeisa General Hospital for treatment. "Eleven of them were transferred from regions outside Hargeisa, and the infected patients are of varying ages," Omer told Sabahi.

The Ministry of Health is trying to prevent the outbreak from spreading to other parts of the region as the rainy season begins, said Somaliland Deputy Minister of Health Nim'o Hussein Ghawdan.

The ministry sent 12 mobile medical teams to rural areas in Marodi Jeh on Sunday on a mission to vaccinate children aged 6 months to 15 years, Omer said. They also sent 11 teams to Hargeisa, where the vaccine is being offered at clinics for mothers and children. In the past few years, there have been several outbreaks of the disease in the Somaliland region, with several deaths linked to the disease in Togdheer in July 2012. The ministry will begin a measles vaccination campaign in mid-2013, Omer said.

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[According to Wikipedia, Somaliland is an unrecognised self-declared de facto sovereign state that is internationally recognised as an autonomous region of Somalia. The government of Somaliland regards itself as the successor state to the British Somaliland protectorate, which became independent on 26 June 1960 as the State of Somaliland, before uniting with the Trust Territory of Somalia (the former Italian Somaliland) on 1 July 1960 to form the Somali Republic.

A map of Somaliland can be accessed at: http://pt.wikipedia.org/wiki/Ficheiro:S ... egions.png. -Mod.CP]

******
Asia
-----
[4] Pakistan (Punjab, Sindh)
Date: Sat 19 Jan 2013
Source: The Frontier Post [edited]
http://www.thefrontierpost.com/news/16278/


11 children die of measles in Punjab, Sindh death toll above 410
------------------------------------------------------
A deadly measles outbreak has left at least 11 children dead in Punjab [province] while the death toll has mounted to 410 in Sindh [province], Frontier news News desk reported on Saturday [19 Jan 2013}.

According to reports gathered from different parts of Sindh, three children died in Kandhkot on Friday [18 Jan 2013), rising the toll to 151. Meanwhile, 84 in Sukkur, 48 in Shikarpur, 47 in Khairpur, 33 in Ghotki, 14 in Thul, 8 in Larkana, while 4 children died of measles in Hyderabad [all in Sindh province].

The death toll was mounted to 7 after the death of 4 children today in Jacobabad [Sindh province].

In Punjab, 4 children died in Dera Ghazi Khan while measles claimed 7 lives in Rajanpur, Ahmedpur, Sharqia, Liaqatpur, Taxila, Hujra Shah Muqeem [all Punjab province].

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[A map of the provinces of Pakistan can be accessed at: http://pakistanpressclub.com/pakistan-2 ... kistan/53/. - Mod.CP>

******
[5] Pakistan (IPS report)
Date: Wed 16 Jan 2013
Source: News Medical [edited]
http://www.news-medical.net/news/201301 ... break.aspx


Experts blame lack of immunization coverage for Pakistan's measles outbreak
-----------------------------------------------------------------
In 2012, measles "claimed the lives of more than 300 children in Pakistan," with more than 200 of those deaths from Sindh province, and health experts and the WHO are saying "the huge difference in routine immunisation coverage between the provinces, districts and cities is at the root of the measles outbreak," Inter Press Service (IPS) reports.

"The government has started a mass immunization campaign from 1 Jan 2013 for children aged 9 months to 10 years in 8 districts of Sindh," according to the news service. "The outbreak casts serious doubts over official claims that 82 percent of under-fives in Sindh are immunized," according to the IPS, D.S. Akram, a pediatrician with the non-governmental organization HELP, which works on maternal and child health in Sindh. "These figures are an overestimate and in measles vaccination it is around 50 percent at best."
Some health officials said flooding and heavy rains over the past 5 years have contributed to health workers' inability to reach certain areas, and others said malnutrition contributed to the measles deaths. The IPS reports that, "Many experts have long held that with much money and political commitment directed towards eradication of polio, routine immunization took a backseat"

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******
[6] Pakistan (vaccination policy)
Date: Sat 19 Jan 2013
Source: The Lancet, Volume 381, Issue 9862, Page 189.
http://www.thelancet.com/journals/lance ... a3=E24A35F


Public health failings behind Pakistan's measles surge
---------------------------------------------
Child health experts in Pakistan say that the country's measles outbreak could have been prevented if the government had heeded warnings about poor vaccine coverage, Haris Riaz reports. Poor quality and ailing vaccination programmes, beleaguered with corruption, have been blamed for Pakistan's recent surge in measles.

The epidemic, which started in October 2012, has claimed more than 200 lives and has resulted in a large number of hospital admissions. Compared with the 64 deaths in 2011, measles witnessed a staggering upsurge in 2012 with a record 306 fatalities, according to WHO. The number of measles cases has also increased from 4000 in 2011 to 14 000 in 2012.

Zulfiqar Bhutta, Founding Chair of the Division of Women and Child Health at Aga Khan University, Karachi, Pakistan, tells The Lancet that the community demand for childhood vaccines is not being fulfilled in most areas of the Sindh province, where most of the deaths (210 of 306 in 2012) have occurred. He insists that the poor coverage is due to the lack of human and vaccination resources "to those who need it the most. We have also confused people over the years by delivering some vaccines such as polio door to door and insisting that parents take their young infants and children many a mile for other vaccines," he adds.

"This was a tragedy in waiting. We have been predicting for a while now that without adequate cover with routine immunisations in many parts of Pakistan, notably in rural populations, there was bound to be a situation where you would have an outbreak like this." Bhutta suggests that the problem has been compounded by several factors including devolution of health care to provinces and transition of services such as the extended programmes of immunisation without adequate preparation.

He adds: "One contributing factor to excess mortality could be the massive rates of malnutrition, particularly in Sindh, which probably would lead to reduced immunity and adverse consequences of disease. The fact that the disease [measles] is completely preventable and has been prevented in countries including Afghanistan with a much more meagre health care system, puts the blame squarely and solely on the failure of routine immunisation systems."

Bhutta denounces the reports suggesting a link between floods and the measles epidemic. "The floods of 2010 and 2011 could have contributed to the outbreak, but the distribution of the disease belies that. These are much more mainstream regions which have just witnessed a massive failure of public health preventive programmes."

Firdous Jahan, Head of the Family Medicine Department at Oman Medical College, Oman, who has previously worked at Aga Khan University, adds that the vaccination campaigns in Pakistan are fraught with corruption. "There is tremendous corruption at the highest level necessitating a transparent organisation responsible for audit of the funds and accountability of the involved personnel." She thinks that WHO should consider diverting funds from the governmental agencies to "credible" agencies.

President of the Pakistan Paediatric Association, Iqbal Memon, recommends that the vaccination be done in a regional manner rather than countrywide immunisation on predesignated days. He emphasises the need for more vaccination centres, provision of vaccines to paediatric practitioners, and increased accessibility to the vaccination centres for the public.

Abdul Momin Kazi from the Department of Pediatrics and Child Health, Aga Khan University, says: "Health has never been a high priority for government. In addition to the poor health system, low health budget, lack of awareness, misconceptions regarding polio vaccine, and corruption are key hurdles. Social unrest due to the war on terror, mistrust due to a fake vaccination campaign, [and the] issues of refugees and conflict zones add to the complications."

"The majority of measles cases we encountered were unaware of immunisation; those who were aware lacked access," says Aisha Mehnaz, Head of Paediatrics at the Civil Hospital Karachi. She adds that with the exponential increase in the population, the allocation of funds to the health sector should also be amplified.

Ashfaq Mala from Konpal, a non-governmental organisation working against child abuse in Pakistan, blames government agencies for making false claims about coverage and estimates that the actual coverage is "much less than 70 percent." He also expresses concerns about training of personnel and the ability of centres to maintain an appropriate cold chain.

Meanwhile, the government has tried to respond to the outbreak with a drive to immunise around 3 million children in high-risk zones during the first weeks of January.

[Byline: Haris Riaz]

--
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[While critical of the performance of the central government of Pakistan, this document makes constructive proposals for reversing of the recent decline in immunisation coverage in Pakistan. - Mod.CP]

MEASLES UPDATE (04)
*******************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


In this update

Africa
-----
[1] Nigeria (Kebbi)

Asia
----
[2] Pakistaan (Punjab)
[3] Pakistan (Punjab)
[4] Pakistan (Sindh)
[5] Pakistan) Balochistan, Punjab, Sindh)
[6] Pakistan (vaccination policy)
[7] Pakistan (vaccine failure)

******

[1] Nigeria (Kebbi)
Date: Tue 22 Jan 2013
Source: Premium Times [edited]
http://premiumtimesng.com/news/116418-k ... -areas.htm


Nigeria has one of the highest case [numbers] of children unvaccinated against measles, reflective of the World Health Organisation's [WHO] report that Nigeria has over 9 per cent of children worldwide who are unvaccinated against measles. Health authorities in Birnin Kebbi Local Government Area and Zauro development areas of Kebbi State uncovered 93 fresh cases of measles in remote communities.

The Director of Health in the area, Yusuf Sani, said this in an interview in Birnin Kebbi on Tuesday [22 Jan 2013]. Mr. Sani said that fresh cases were uncovered in 13 remote settlements, including Bori, Anguwar Kayi, Dukko, Kalango, Anguwar Ali modu and Burga. Other settlements affected are Sabuwa, Gargariya, Akwara, Angwar Gero and Takalafiya in Fadama Zauro development area. 37 cases of measles had earlier been uncovered with 5 deaths recorded. Mr. Sani, however, said the victims had been treated, while preventive drugs, [and treatment had also been] provided for 300 children that had not been infected.

"Out of the 93 fresh cases uncovered, no deaths had been recorded, but efforts would be made to ensure that the scattered locations of the settlements were reached and medication provided," the director further stated. He said health officials would ensure that severe cases were isolated for effective monitoring and cure to prevent spread. "We would work closely with national and international health organisations to contain the spread of the disease that had emerged a month ago," the health director said. "We would enlighten parents on the relevance for preventive measures and prompt treatment to avoid spread of the airborne disease."

The WHO had last Thursday in a report, announced that 9 per cent of 20 million children who had not receive the 1st dose of vaccine against measles in 2011 are Nigerian children. WHO further stated 1.7 million Nigerian children did not receive the 1st dose of the vaccine in 2011. The organisation recommends that every child should receive 2 doses of measles vaccine.

--
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<promed@promedmail.org>

[A map of Nigeria showing Kebbi state in the north-west of the country can be accessed at: http://www.ialnigeria.com/home/index.ph ... Itemid=128. - Mod.CP]

[A HealthMap ProMED-mail map of Nigeria can be found at http://healthmap.org/r/1qGF.]

******
[2] Pakistan (Punjab)
Date: Sun 20 Jan 2013
Source: The Nation [edited]
http://www.nation.com.pk/pakistan-news- ... reaches-23


One other measles patient was admitted in Holy Family Hospital (HFH) bringing the total number of measles patients in Rawalpindi to 23. The latest victim is said to be a 16-year-old resident of Dhoke Kala Khan. She was bought into the emergency ward of the Holy Family Hospital late Friday night [18 Jan 2013] with high fever. After medical aid, it was diagnosed that she had measles. According to doctors, medical care is being provided to her, and she is in stable condition. District Health officer Khalid Randwah [stated] that this is the 23rd case of measles which has come forward in Rawalpindi. He said so far, 22 patients have been treated and sent home. According to the World Health Organization (WHO), more than 300 children have died from measles in Pakistan in 2012, a 5-fold increase from 2011.

Meanwhile, the absence of doctors at the emergency ward of the Pakistan Institute of Medical Sciences (PIMS), one of the largest hospitals of the capital city, depicts the sorry state of this mega hospital. Sick patients, the elderly and children are made to wait for several hours before a doctor becomes available to see them at the emergency ward. Attendants complained that there are only 2 or 3 doctors working the entire ward due to which sick patients have to wait for a long time before they get any treatment. It has been learned that most of the doctors are on extended leave, [and as a result], there is a shortage of staff at the emergency ward. The patients complained that some of them are suffering from chest infections, asthma, heart disease, and some are elderly, due to which they are unable to stand in long queues, but the PIMS administration is oblivious to their sufferings. Meanwhile, they demanded that the concerned authorities pay greater attention to this grave issue so that the masses could get some relief.

--
Communicated by:
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[This situation is further evidence of the crisis in medical care in Pakistan. Rawalpindi is a city in the Pothohar region of Pakistan near the country's capital city of Islamabad, in the province of Punjab. Rawalpindi is the 4th largest city in Pakistan after Karachi, Lahore and Faisalabad.

A map of Punjab showing the location of Rawalpindi can be accessed at: http://pamirtours.pk/maps/punjab%20districts%20map.htm. - Mod.CP]

[A HealthMap ProMED-mail map of Pakistan can be found at http://healthmap.org/r/1iGJ.]

******
[3] Pakistan (Punjab)
Date: Thu 24 Jan 2013
Source: The International Tribune [edited]
http://tribune.com.pk/story/498230/meas ... -reported/


92 cases of measles have been confirmed in Lahore, according to the Health Department. A 10-year-old died of measles at Mayo Hospital's paediatric ward on Wednesday [23 Jan 2013], doctors said, becoming the 1st casualty of the disease in the city. The child was brought to the hospital on Tuesday [22 Jan 2013] night and had developed pneumonia. Another 10 children with measles were also admitted to Mayo Hospital.

"They are being kept in isolation, as measles is a droplet infection, meaning it is highly contagious. If a child with measles is kept in the ward with other children, there is a 90 per cent chance all of them will catch measles," said a doctor at the paediatric ward. "We may also face problems in accommodating all the children in isolation due to space issues."

A Health Department official said that 12 children infected with measles had been admitted to other public hospitals in Lahore, taking the total number of known cases in the city to 92. Chief Minister Shahbaz Sharif on Wednesday [23 Jan 2013] expressed concern about the rising number of measles cases and directed the Health Department to prepare an emergency plan within 2 days for the prevention of measles. He directed officials to make sure that anti-measles vaccine is available in the province and to launch a public awareness campaign regarding preventive measures. Children in the affected areas must be vaccinated, he said at a meeting with Health Department officials.

Special Assistant on Health Khawaja Salman Rafique, the Planning and Development chairman for the Health, Law, Prosecution and Home secretaries, the acting inspector general of police, the Lahore commissioner, the Gujranwala commissioner, the Lahore DCO, the Health director general, the director general of the Forensic Science Laboratory, and Dr Faisal Masood also attended the meeting.

40 cases of measles have been reported in Multan, and 3 children are currently under treatment, but there have been no deaths from the disease, according to EDO (Health) Dr Munawar. He said vaccination teams had been set up to inoculate children in affected areas. He said that the disease had arrived in the district from Sindh [province], where some 200 children are thought to have died in a recent outbreak.

Six new measles patients were reported in Gujranwala on Wednesday [23 Jan 2013]. Health officials said the children were being treated at the Civil Hospital. Health Director General Dr Nisar Cheema said the number of measles patients being reported in the Punjab was far less than [in] Sindh, and the outbreak had not yet become an epidemic in the province. He said that more cases of measles had been reported in the Punjab in previous years than in this year [2013] so far.

--
Communicated by:
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[The statement that more cases of measles had been reported in the Punjab in previous years than in this year (2013) so far is encouraging and a 1st sign of success in the control of measles virus infection in Pakistan. - Mod.CP]

[A HealthMap ProMED-mail map of Pakistan can be found at http://healthmap.org/r/1iGJ.]

*****
[4] Pakistan (Balochistan, Punjab, Sindh)
Date: Mon 21 Jan 2013
Source: Dawn [edited]
http://dawn.com/2013/01/21/4-more-child ... f-measles/


A deadly measles outbreak has left at least 4 more children dead, mounting the death toll to 459 across the country, while 429 children have died in Sindh [province] alone. According to reports gathered from different parts of Sindh [province], 2 children died in Kandhkot during the last 24 hours, raising the overall toll for the district to 157. Among the most-affected cities, 84 are in Sukkur, 55 in Shikarpur, 50 in Khairpur, 33 in Ghotki, 14 in Thul, 8 in Larkana, while 4 children died of measles in Hyderabad.

In Punjab [province], 15 children have died of measles since the outbreak gripped the province. Four children died in Dera Ghazi Khan, while measles claimed 7 lives in Rajanpur, Ahmedpur, Sharqia, Liaqatpur, Taxila, and Hujra Shah Muqeem.

Meanwhile, 10 children have died in Balochistan [province], while measles claimed 5 lives in Mohmand Agency.

--
Communicated by:
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[A map of the provinces of Pakistan can be accessed at: http://www.mapsofworld.com/pakistan/pak ... l-map.html. - Mod.CP]

[A HealthMap ProMED-mail map of Pakistan can be found at http://healthmap.org/r/1iGJ.]

******
[5] Pakistan (vaccination policy)
Date: Tue 22 Jan 2013
Source: The Express Tribune [edited]
http://tribune.com.pk/story/497091/prev ... s-vaccine/


The Health Department has decided to lower the age at which children get their 1st measles vaccination from 9 months to 6 months in areas where cases of the disease are being reported. In a meeting here on Monday [21 Jan 2013] to review the situation in the province, authorities also decided to launch an awareness campaign urging parents to get their children vaccinated and to make a set of guidelines for measles treatment, participants of the meeting told The Express Tribune.

Currently, the 1st vaccine injection against measles is administered to children at the age of 9 months. Additional Director General for Vector Borne Diseases Dr Jaffar Ilyas, who attended the meeting, said that it had been decided that in all localities where measles cases were being reported, children would be administered the 1st [dose] at the age of 6 months. They will get the next shot after a year or so. "In routine practice, the 2nd shot is administered at the age of 15 months," he said.

A paediatrician who attended the meeting said that senior paediatricians would make a plan to guide doctors on how to treat the disease. He said the disease was particularly dangerous for children suffering from malnutrition. "Not many children who get measles die of it. Usually, it is that they get pneumonia, which can be fatal," he said. "Those suffering from the disease should be given vitamin A, besides usual clinical treatment." He said that the guidelines would be finalised by Tuesday [22 Jan 2013] and circulated to all executive district officers for health in the Punjab.

In a statement, Chief Minister Shahbaz Sharif said that he had sought a report on the disease situation from Special Assistant to the Chief Minister for Health Khawaja Salman Rafique. Talking to reporters after the meeting, Rafique said that the Punjab was better prepared to handle a measles outbreak than Sindh, where hundreds are thought to have died of the disease. Rafique said that 1476 measles cases had been reported during the current year in the Punjab, whereas there had been 7 suspected deaths: 5 in Rajanpur and one each in Gujranwala and Kasur.

He said that the Punjab government had taken steps to ensure medical care of measles patients and to stop the spread of the disease. He said "mop-up" campaigns were being carried out in the affected areas, in accordance with World Health Organisation (WHO) guidelines, to vaccinate children aged 6 months to 10 years.

Rafique said that a social mobilisation campaign would be carried out through the media to inform parents about the importance of vaccinations. At the district level, DCOs were in charge of surveillance of the disease, vaccinations and monitoring of case reporting. He said that the Health Department had more than 1.2 million anti-measles doses in stock, while 2 million more were being procured through UNICEF, for which a payment of Rs 243.7 million [USD 4.5 million] had been made. He said that the purchased vaccines would arrive within 2 weeks.

The meeting was attended by Health Secretary Arif Nadeem, Health Director General Dr Nisar Ahmed Cheema, Expanded Programme of Immunisation Director Dr Tanvir Hussain, Dr Babar Alam of WHO, Mushtaq Rana of UNICEF, Prof Tahir Masood of the Institute of Child Health and Children's Hospital, paediatrician Dr Ashraf Sultan, and Dr Akhtar Rashid Malik, provincial coordinator of the Lady Health Worker Programme.

--
Communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org

[A HealthMap ProMED-mail map of Pakistan can be found at http://healthmap.org/r/1iGJ.]

******
[6] Pakistan (vaccination policy)
Date: Thu 24 Jan 2013
Source: The Daily Telegraph, AFP report [edited]
http://www.dailytelegraph.com.au/news/b ... 6560516976


More than 100 children have died of measles in Pakistan this month, the World Health Organization (WHO) said on Wednesday [23 Jan 2013], calling it "an alarming outbreak." "Some 103 Pakistani children have died from 1-19 Jan 2013 this year because of post-measles complications such as pneumonia, post-measles encephalitis and diarrhoea," WHO spokeswoman Maryam Yunus told AFP [Agence France Presse]. 63 of the cases occurred in the southern province of Sindh, which was hit by severe flooding in 2010, 2011 and 2012. More than 300 Pakistani children died of measles in 2012, a staggering increase on the previous 12 months and a result of 3 consecutive years of flooding, officials said. WHO said 64 children died of measles in Pakistan in 2011, 28 of them in Sindh. It was not immediately able to provide statistics for earlier years.

The WHO said most of the cases occurred between October and December [2012] in northern parts of Sindh but was unable to provide a breakdown. The UN body said 33 children died in southwestern Baluchistan province, which is plagued by separatist insurgency and sectarian strife. The most populous Punjab province reported 7 children's deaths. Half of a total of 2447 cases were reported from Sindh province, of which Karachi is the capital. "It is certainly an alarming situation. ... It is an outbreak," said a WHO spokesperson. She said WHO and UNICEF provided a combined 4.4 million doses of measles vaccines since last year [2012] to target the children in Sindh's flood-affected areas. A senior health ministry official confirmed the WHO figures. "We can't dispute the figures. Our own teams have similar reports," he said. "Something must have gone wrong. ... We are weighing where have we gone wrong," he said. The WHO spokeswoman said a key factor behind more deaths in Sindh was malnourishment, particularly in the flood-affected districts. A ministry official said the number of deaths in January 2013 are already at "a record high."

--
Communicated by:
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<promed@promedmail.org>

[A HealthMap ProMED-mail map of Pakistan can be found at http://healthmap.org/r/1iGJ.]

******
[10] Pakistan (vaccine failure)
Date: Thu 24 Jan 2013
Source: The International Tribune [edited]
http://tribune.com.pk/story/498137/with ... ead-havoc/


The death toll from the nearly 2-month-old measles outbreak has reached 485 according to unofficial statistics, yet there are parts of Sindh where the vaccine has yet to reach.

During a meeting on Tuesday [22 Jan 2013] night at Sukkur circuit house, adviser to chief minister on relief Halim Adil Shaikh told The Express Tribune that there are some desert belts of Sukkur where the vaccinators have not reached. The health workers have been allocated 4-wheelers and have nearly Rs 3.4 million [USD 34 800] at their disposal, but their performance has been very poor, he felt.

Shaikh met the residents of several villages in Salehpat taluka and even some parts of Khairpur district, who told him that no vaccinators have visited them. The residents of Bagan Shambhani village complained that they are hardly one km away from the main road, but they were missed. The situation in health centres is also poor, as there is a shortage of doctors and paramedics, the adviser said. The authorities are to blame for not recording the actual number of deaths from measles, Shaikh said. 11 children have died in Sarohi village alone, he pointed out.

According to Shaikh, several children who were brought into Civil Hospital, Sukkur, and Red Crescent Hospital contracted measles even though they were vaccinated. This is quite alarming because it means that the vaccines are not kept cold when they are transported from one location to another, he said.

A father lost his 2-year-old son on Wednesday [23 Jan 2013] morning at Red Crescent Hospital even though he was vaccinated. The family lives in Arain village near Sukkur, where the child was vaccinated a few weeks ago. Some time later, the boy showed symptoms of measles, and the doctors advised the family to take him to Sukkur, but the little boy could not make it.

A resident of Budho Chohan village, which is around 10 km from Sukkur, told The Express Tribune that his 2-year-old son was vaccinated one month ago, but he contracted the virus 5 days ago. Similarly, the daughter of a resident of Shikarpur was vaccinated 3 weeks ago, but she also contracted the virus. Others claimed that 5 children have died from measles in their village in the past one month. There are several patients in Civil Hospital who were earlier vaccinated but are still suffering from measles.

Sukkur district health officer Dr Jay Ram Das confirmed that it is possible to contract the virus even after vaccination. "It depends upon the immune system of the child," he told The Express Tribune. The success rate of the anti-measles vaccine is not more than 85 per cent, he added. Sometimes, children's immune systems do not accept the vaccine, and they fall prey to the virus. In these cases, Dr Das said, they give vitamin A drops to the children, besides taking extra post-measles care so that they are safe from further complications.

[Byline: Sarfaraz Memon]

--
Communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org>

[This and the preceding report illustrate the frustrations of the many dedicated people trying to develop a comprehensive measles immunisation programme in Pakistan . - Mod.CP]

[A HealthMap ProMED-mail map of Pakistan can be found at http://healthmap.org/r/1iGJ.]

MEASLES UPDATE (05)
*******************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


In this update

Africa
-----
[1] Algeria (Adrar)
[2] Congo DR (Djolu)
[3] Namibia (Oshikoto)

Asia
---
[4] Pakistan (Punjab)
[5] Pakistan (Sindh)
[6] Pakistan (Sindh)


******

[1] Algeria (Adrar)
Date: Tue 29 Jan 2013
Source: Le Quotidien D'Oran [in French, machine trans. edited]
http://www.lequotidien-oran.com/index.p ... 2013-01-29


87 cases of measles were reported on Monday [28 Jan 2013] in the province of Adrar, according to the head of the Department of Preventative Medicine of the State Health Department.

The epidemic occurred in the districts of Bordj Badji Mokhtar [in southwestern Algeria (in Adrar province) near the border with Mali], with 72 cases so far, and in Reggane, with 15 cases, which include 6 cases in the town of Sali and 9 cases in the town of Reggane. A vaccination campaign has been launched in Bordj Badji Mokhtar and Reggane, according to the Director of Public Health at Reggane.

There are fears of a larger outbreak, since people 6 months to 60 years of age can contract measles. Containment measures are now in place to prevent further expansion of the disease.

Blood samples have been sent to the Pasteur Institute emergency department to establish the status of other patients, according to doctors in Adrar. The DSP has sent a medical team to the affected area to initiate a vaccination campaign. So far, 700 people have been vaccinated.

The health department has not released any figures with regard to fatalities, but the situation remains serious, especially in Bordj Badji Mokhtar, which is located 800 km from the capital city of Adrar province.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[A map of the provinces of Algeria can be accessed at: http://www.lib.utexas.edu/maps/africa/a ... dmin01.jpg.

A ProMED-mail HealthMap for Algeria can be found at http://healthmap.org/r/1A_U. - Mod.CP]

[Adrar is a province (wilaya) in southwestern Algeria named after its capital city of Adrar (http://en.wikipedia.org/wiki/Adrar_Province). For a map of Algeria that shows the location of the province of Adrar, see http://en.wikipedia.org/wiki/File:Alger ... p-2009.svg. - Mod.ML]

******
[2] Congo DR (Djolu)
Date: Wed 23 Jan 2013
Source: Le Potentiel [in French, trans. abbreviated Mod.CP, edited]
http://www.lepotentielonline.com/110-on ... er-a-djolu


The Kinshasa Office of the United Nations DRC [Democratic Republic of Congo] Humanitarian Affairs (OCHA/DRC) announced on Wed 23 Jan 2013 that more than 100 measles cases and 11 deaths had been recorded since 13 Jan 2013 in the Djolu Health Zone in the Tshuapa District (Equateur province).

UNICEF, in collaboration with the Provincial Inspectorate of Health has prepared 25 measles emergency kits for distribution to the 32 Health Zones affected. These will be distributed to the affected Health Zones in the province. However, rapid distribution of these kits may be delayed by difficulties associated with poor access roads. In 2012, more than half of the Health Zones of the province were affected by measles.

The epidemic of measles reported in Maniema is continuing, where 1691 cases were reported in 2012, particularly in the Health Zones of Kabambare, Lubutu Obokote, and Punia. Since the beginning of this year [2013], 68 cases including 3 deaths have been recorded in the Health Zone of Kunda.

In North Kivu, UNICEF launched a 5-day campaign on Tue 22 Jan 2013 to vaccinate 1.2 million children aged 6 months to 15 years. It is being conducted in the Health Zones of Binza, Karisimbi, Kirotshe Masisi, Rutshuru, and Rwanguba, all of which have been affected by population movements. The Health Zone of Beni has been reporting measles cases for several weeks.

More than 27 000 displaced children in North Kivu were immunized against measles virus infection last week, said OCHA spokesman Sylvestre Mudingayi. This campaign was conducted by the Ministry of Health, UNICEF and Medecins sans Frontieres (MSF). Between January and November 2012, outbreaks of measles were reported in 10 of 11 provinces.

The World Health Organisation believes that nearly 55 000 cases and 1509 deaths have occurred in North Kivu. 650 cases have been confirmed, 6 times more than in December 2011. Recent civil unrest has caused displacement of populations and looting of health centres, and general insecurity is threatening significantly the outcome of the revaccination campaigns. In November 2012, the Secretary General of the Ministry of Health, Pierre Lokadi, announced that measles epidemics had been recorded in Kinshasa and the 2 Kasai provinces Orientale and Equateur. He explained that this was due to several factors, including the shortage of vaccines, and promised that his ministry would cooperate with partners to fight the epidemic throughout the DRC. "It is planned to organize follow-up campaigns to prevent further epidemics of measles. But this has not been achieved yet on account of shortage of vaccine."

--
Communicated by:
ProMED-mail from HealthMap alerts
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[Maniema is a province of the Democratic Republic of the Congo. Its capital is Kindu. Maniema is bordered by the provinces of Kasai-Oriental to the west, Orientale to the north, North Kivu and South Kivu to the east, and Katanga to the south.

A map of the provinces of Congo DR can be accessed at: http://www.mapsofworld.com/democratic-r ... l-map.html and a HealthMap/ProMED-mail interactive map at http://healthmap.org/r/4JoX. - Mod.CP]

******
[3] Namibia (Oshikoto)
Date: Wed 30 Jan 2013
Source: Namibian [edited]
http://www.namibian.com.na/news/full-st ... k-spreads/


The measles outbreak that was earlier confined to villages in Omuthiya Constituency has spread to the Oniipa Constituency, Oshikoto region, according to Director of Health Peter Angala. Angala stated that 6 new measles cases have been confirmed in Omadhiya village, 4 in Onguma, 3 in Ompugulu, one in Okankuzi/Oshigambo, one in Ohadiwa/Onamunkulo, one in Onalulago, one in Onaame, and one in Onamulunga village, all of which are located in Oniipa Constituency. So far, Angala said, 30 cases have been confirmed. Some of the affected people are receiving treatment at the Onandjokwe and Oshakati hospitals. Angala told "The Namibian" that they have sent health teams to the Omuthiya and Oniipa Constituencies to vaccinate people between the ages of 6 and 35.

According to him, thousands are flocking to the fixed and mobile clinics to be vaccinated. He said some of his health workers are in the villages and clinics gathering information about how the people contracted measles. Angala said that veterinarians treating anthrax are also travelling with the health officials. There is also an anthrax outbreak in the region, with more than 20 confirmed human cases at Oniipa and 2 deaths.

"We are hard at work. As we are talking, the 2 outbreaks are under control. We are in contact with all community leaders, such as village headmen, church leaders, councilors, and the governor of Oshikoto, Penda yaNdakolo, who are all giving us their support in the eradication of these 2 diseases," Angala said.

A mobile clinic was set up at Omulunga village, which is centrally located, and is covering a lot of people in the Oniipa Constituency. The campaign should be finished by Friday [1 Feb 2013), Angala said.

[Byline: Oswald Shivute]

--
Communicated by:
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[Oshikoto is one of the 13 regions of Namibia. The northern part of the region is agricultural, whereas the main economic activities in the southern part are cattle rearing and mining. The 2 areas have important cultural and historical links in that the Ndonga people have extracted copper at Tsumeb since the earliest times in order to make rings and tools.

An interactive map showing the location of the Oshikoto region of Namibia can be accessed at: http://www.maplandia.com/namibia/oshikoto/.

A ProMED-mail HealthMap of Namibia can be found at http://healthmap.org/r/1i9l. - Mod.CP]

******
[4] Pakistan (Punjab)
Date: Sat 2 Feb 2013
Source: The Frontier Post [edited]
http://www.thefrontierpost.com/news/17302/


Four more children died of measles in Lahore on Saturday [2 Feb 2013] as the number of deaths caused by the disease reached 18. Contrary to claims of the Punjab government, there has been no let-up in deaths of children due to measles.

Four more children, who were under treatment at Gangaram and Children's hospitals in Lahore, succumbed to the disease. The victims were identified as a 2-year-old, a 2.5-year-old, a 6-year-old, and a 10-month-old baby.

The number of children killed by the disease across Punjab has reached 18. Of those, 10 belonged to Lahore.

--
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[Again, the veracity of the government of the province is being questioned.

A ProMED-mail HealthMap of Pakistan can be found at http://healthmap.org/r/1iGJ. - Mod.CP]

******
[5] Pakistan (Sindh)
Date: Sat 26 Jan 2013
Source: Central Asia online, Agence France-Press (AFP) [edited]
http://centralasiaonline.com/en_GB/arti ... wsbrief-03


More than 100 children have died of measles in Pakistan this month [January 2013], the World Health Organisation (WHO) said on 23 Jan 2013, calling the outbreak "alarming." "Some 103 Pakistani children have died from 1-19 Jan [2013] this year because of post-measles complications such as pneumonia, post-measles encephalitis, and diarrhoea," WHO spokeswoman Maryam Yunus told AFP. 63 of the cases occurred in Sindh province, which was hit by severe flooding in 2010, 2011, and 2012. The flooding is thought to be a factor.

More than 300 Pakistani children died of measles in 2012, a staggering increase from the previous year, when 64 children died of measles, according to the WHO. "It is certainly an alarming situation," Yunus said. She said WHO and UNICEF had provided a combined 4.4 million doses of measles vaccine since last year [2012] to target the children in Sindh's flood-affected areas.

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[A map of Sindh province of Pakistan can be accessed at: http://www.sindh.gov.pk/dpt/maps/images/2.jpg.

A ProMED-mail HealthMap of Pakistan can be found at http://healthmap.org/r/1iGJ. - Mod.CP]

******
[6] Pakistan (Sindh)
Date: Sat 2 Feb 2013
Source: Pakistan Observer [edited]
http://pakobserver.net/detailnews.asp?id=194138


The deaths of scores of children in the recent measles outbreak in different parts of the country has exposed the weak routine immunisation system in Pakistan in general and the province of Sindh in particular.

Regional Manager of the Society for Protection of the Rights of Children (SPARC) Iqbal Detho, while talking to APP, stated that Pakistan is among the 10 countries that account for almost 2/3rds of the world's un-immunised children. He said that 53 percent of children in the province of Sindh had not received the vaccine despite its availability. He said that Child Rights Movement (CRM), Sindh chapter is concerned about the enormous difference in routine immunisation coverage between the provinces, districts, and cities, which he maintained is at the root of the measles outbreak in the country.

Prominent consultant pediatricians have put the blame of these under-5 child deaths due to measles on mismanagement at the district level, neglect of routine immunisation, and lack of awareness among parents regarding routine immunisation.

WHO presented a report to the government which stated that the primary reason for the outbreak was a failure to complete the immunisation programme. The report also confirmed that the country's continuous struggle with a fraught health care system, unsanitary conditions in many regions, and lack of education about how to prevent children from getting the disease contributed towards this outbreak as well.

Iqbal Detho maintained that no medical teams or vaccinators had as yet visited the affected areas of the districts despite the reporting of deaths on a daily basis and complaints of a large number of children having been affected by measles. He claimed that villagers are helpless, as neither the vaccine nor the medical staff are available at the local health facilities, and numerous children are suffering, but their helpless parents can do nothing but wait for the vaccinators or doctors supposed to be sent to the village by the health department. He said that it is high [time] to respond to the situation effectively and take steps that may strengthen the routine immunisation system in Pakistan on a sustainable basis, which will also help eradicate polio from the country.

He recommended that the Sindh Health Department should launch a high quality, widespread vaccination campaign against measles across the province and ensure the availability of vaccines at vaccination centres to eradicate the disease from the province.

He said that the federal and provincial governments should start allocating specific resources to scale up routine immunisation targeting uncovered areas and children from the poorest segments. The government and the donor agencies should launch awareness raising campaigns to highlight the importance of routine immunisation and to get the children vaccinated with 2 doses to eliminate their chances of contracting the viral disease.

There are approximately 10 000 vaccinators throughout Pakistan, strongly limiting immunisation coverage, he said, and added that the Sindh government needs to increase the number of vaccinators so that there is one vaccinator for every 5000 people in order to reach sufficient numbers of children. He said that it is essential for the provincial government to use and expand the set of responsibilities of LHWs to include the administration of vaccinations, particularly in the uncovered areas and poor segments.

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[A ProMED-mail HealthMap of Pakistan can be found at http://healthmap.org/r/1iGJ.]

MEASLES UPDATE (06)
*******************
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ProMED-mail is a program of the
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In this update

Africa
------
[1] Nigeria (Kaduna)

Asia
----
[2] Pakistan (Punjab)
[3] Pakistan (Punjab)
[4] Pakistan (Punjab)


******

[1] Nigeria (Kaduna)
Date: Wed 6 Feb 2013
Source: AllAfrica, Daily Trust [edited]
http://allafrica.com/stories/201302060984.html


An outbreak of measles has been reported in 5 communities of Kaduna-South Local Government Area of Kaduna State. It was gathered that several persons in Barnawa, Kakuri, Tudun Wada, Kinkinau and some few areas within Kaduna metropolis have been affected by the disease. Speaking to Daily Trust, a resident of Kakuri said: "Many children and a few adults have been affected. If you visit hospitals in our area, you will see many people suffering from the disease there."

When contacted, the Kaduna state commissioner for health, Turaki Kalik, confirmed the incident, adding: "Adequate arrangements have been made to stop the disease from spreading. We received reports of outbreaks of measles in Barnawa, Kakuri, Tudun Wada, Kinkinau and some other areas, and we have mobilised resources and manpower to ensure that it is brought under control," Kalik said. According to the commissioner, the outbreak was due to the change in weather and some other factors [?]. "We are anticipating outbreaks of meningitis, as well as Lassa fever. So, as I speak to you, the state government is fully prepared with drugs and other necessary items in case it happens," he added.

[byline: Sunday Isuwa]

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[Information on vaccination coverage in Kaduna would be welcomed. Maps of Kaduna state can be accessed at http://www.ncocusa.com/constituencies_kaduna.html. - Mod.CP

A ProMED-mail HealthMap for Nigeria can be found at http://healthmap.org/r/1qGF.]

******
[2] Pakistan (Punjab)
Date: Wed 6 Feb 2013
Source: The Express Tribune [edited]
http://tribune.com.pk/story/503123/2971 ... -dec-2012/


Special assistant to the chief minister of health Khawaja Salman Rafique said on Tuesday [5 Feb 2013] that 2971 cases of measles have been reported in the province since December 2012. He said that the government was keeping a watchful eye on the measles situation, and necessary arrangements had been made for controlling the disease as well as treatment of patients in hospitals. He said measles had started receding. Rafique was addressing a press conference on the measles outbreak at the committee room of the Health Department on Tuesday [5 Feb 2013]. Special secretary Babar Hayat Tarar, director general health Dr Nisar Ahmad Cheema, additional secretary health (Estt) Asfandyar Khan, UNICEF provincial chief Dr Rana Mushtaq, and director EPI Dr Tanvir Hussain were also present on the occasion.

Rafique said that guidelines had been given to all the hospitals and district offices of the Health Department for controlling measles and treatment of patients. He said that the meetings of steering committee comprising pediatricians were being held on a regular basis. He said action will be taken against any officer found guilty of negligence in controlling measles. Dr Cheema said that MMR injections had not been approved by the World Health Organization (WHO) for Pakistan and, as soon as the recommendation was made by the WHO, the injection would be included in the EPI programme.

Rafique said that parents were being advised through print and electronic media. He added that female health workers were approaching parents at the community level to ensure that their children were vaccinated. He said that children from the ages of 6 months to 10 years were being vaccinated under the mop-up campaign in areas from where measles cases had been reported.

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[A map of Punjab (Pakistan) can be accessed at http://www.findpk.com/yp/html/punjab_.html. - Mod.CP

A ProMED-mail HealthMap for Pakistan can be found at http://healthmap.org/r/1iGJ.]

******
[3] Pakistan (Punjab)
Date: Thu 7 Feb 20113
Source: Daily Times [edited]
http://www.dailytimes.com.pk/default.as ... 013_pg11_6


Holy Family Hospital (HFH) deputy medical superintendent Dr Javed Hayat said on Wednesday [6 Feb 2013] that 21 patients suffering from measles had been admitted to the hospital this year [2013].

"13 patients have been discharged after recovering from the disease, and 8 are still under treatment," said Dr Javed Hayat. He also said that the hospital was prepared to deal with any situation arising due to the outbreak of measles. He added that all arrangements had been made as per the directives of the Punjab government.

Meanwhile, Rawalpindi district health officer Dr Javaid Chaudhry said that an anti-measles vaccination campaign had been launched in the district to prevent spread of the disease. He also said that the district health administration was making rigorous efforts to curb the disease. He claimed that the situation was still under control and hoped that the disease would not spread in the district. Dr Javaid Chaudhry added that arrangements had been made at all the hospitals in the city for the treatment of patients suffering from measles. He also said: "All possible preventive measures are in place to meet any untoward incident."

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******
[4] Pakistan (Punjab)
Date: Sat 9 Feb 2013
Source: The International News [edited]
http://www.thenews.com.pk/Todays-News-2 ... -in-Hafiza


Three more children suffering from measles were admitted to the DHQ Hospital here on Friday [8 Feb 2013], increasing the tally to 12 in a month. Child specialist Dr Ashfaq Ahmad said that all the patients suffering from measles were being provided treatment, and their condition was out of danger. Meanwhile, medical superintendent Dr Irshadullah said that a special ward had been established in the hospital, and all medicines were being provided free. He added that the staff had been deputed round-the-clock to provide better treatment to the patients.

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[A map showing the location of Hafizabad in Punjab province can be accessed at http://www.pap.gov.pk/index.php/members ... ct/en/9/39. - Mod.CP

A ProMED-mail HealthMap for Pakistan can be found at http://healthmap.org/r/1iGJ.]

MEASLES UPDATE (07)
*******************
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ProMED-mail is a program of the
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In this update

Africa
-----
[1] Uganda (Hoima)

Asia
---
[2] Pakistan (WHO/UNICEF/GAVI)
[3] Pakistan (Punjab)


*****

[1] Uganda (Hoima)
Date: Wed 13 Feb 2013
Source: Daily Monitor [edited]
http://www.monitor.co.ug/News/National/ ... index.html


Measles claims one more in Hoima, brings death toll to 5
------------------------------------------------
The death toll of people who have succumbed to measles in Hoima has increased to 5, following the death of a 3-year-old at the weekend, district officials have said. The district health inspector, Mr Fredrick Byenume, said his office had recorded a total of 141 cases since measles broke out 2 months ago in Kabwooya Sub-county.

The area district councillor, Mr Vincent Opio, said there were more people dying in communities with symptoms similar to measles. Mr Opio said Sayuni, Kabegaramire, Nyairongo, Rwenkobe, Ibahura, Karokarungi, Dongo, Rwengabi and Nyakabaale villages were between 5 to 14 kilometres away from the centre, the only government facility in Kaseeta parish treating measles case. "People are having difficulty to access Kaseeta Health Centre which is about 5 to 10 kilometres away from various villages," he said. Mr Opio said residents wondered why the government had not yet conducted a mass immunisation drive in the area. "Schools have opened. Children, who may be infected with the disease, could be mixing with those who have yet to contract the epidemic. This may worsen the infection rates," he said.

Mr Byenume, however, said plans were underway to start a mass immunisation outreach in the affected communities starting this weekend. The measles epidemic, which broke out in this district in January in Kabwooya, is reportedly spreading to neighbouring Kiziranfumbi and Kyangwali sub-counties.

Medical experts say all measles patients are below 5 years of age. The epidemic has so far claimed 3 children between the ages of 2 and 10 and a 35-year-old resident of Nyanseke Village.

[Byline: Francis Mugerwa]

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[Hoima is located approximately 225 kilometres (140 mi), by road, northwest of Kampala, Uganda's capital and largest city. A map of the Districts of Uganda can be accessed at:: http://www.ugandapicks.com/2010/11/late ... ricts.html. - Mod. CP]

******

[2] Pakistan [WHO/UNICEF/GAVI]
Date: Sat 16 Feb 2013 [edited]
Source: The Express Tribune [edited]
http://tribune.com.pk/story/508129/meas ... rtunities/


Measles outbreak blamed on 'missed opportunities'
-------------------------------------------
A joint mission of World Health Organisation (WHO), United Nations Children's Fund (UNICEF) and Global Alliance for Vaccines and Immunisation (GAVI) on Friday [15 Feb 2013] concluded that the high incidence of measles across the country was a result of missed opportunities, specifically the failure to vaccinate children routinely and reach them through supplementary immunisation activities (SIAs). A 4-member joint mission including Dr Nadia Teleb, Regional Advisor from Eastern Mediterranean Region (EMR), Dr Robert Kezaala, Measles Focal Point at UNICEF headquarters, Selenge Lkhagva, UNICEF Supply Division and Anne Cronin, Senior Programme Officer of the GAVI Secretariat in Switzerland, arrived in Pakistan on Tue 12 Feb 2013 on a 4-day visit to review the current measles situation and recommend actions to control measles outbreaks in Pakistan.

Concerned departments continue to falsely report high coverage of routine immunisation services. The coverage reports were proven wrong by local independent surveys carried out in all provinces. The surveys gave a clear picture of immunisation service coverage, indicating lower coverage of a 1st and 2nd dose of the measles vaccine in various provinces. These findings were revealed by the joint mission during a high level meeting held at the National Institute of Health (NIH) with officials of the federal and provincial Expanded Program on Immunization (EPI) officials and other departments concerned.

The mission further revealed that even the coverage of measles supplementary immunisation activities (SIAs) from 2010-2012 across the country were reported as high, yet the incidence of measles remains high and 50 percent cases indicate zero doses of the vaccine, which proves the numbers incorrect.

The joint mission gave its recommendations to control the outbreak of measles, including: strengthening routine immunisation by ensuring ownership, accountability at all levels, strengthening reporting, monitoring and a supervision system in line with the national EPI policy and improved access to quality service delivery and vaccine management system.

[Byline: Sehrish Wasif]

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[Hopefully these recommendations will be implemented. - Mod.CP]

*****
[3] Pakistan (Punjab)
Date: Wed 13 Feb 2013
Source: The Frontier Post, Lahre [edited]
http://www.thefrontierpost.com/article/207071/


142 new cases of measles reported in Punjab province
----------------------------------------------
The Health Department of the Punjab government has said that 142 more cases of measles have been reported in the province, a private news channel reported on Tuesday [12 Feb 2013]. Out of the 142 cases, at least 50 patients were reported from Lahore. The overall toll has mounted to 3678 in the province so far.

Measles is caused by measles virus, a single-stranded, negative-sense enveloped RNA virus classified the genus _Morbillivirus_ within the family _Paramyxoviridae_. Humans are the natural hosts of the virus; no animal reservoirs are known to exist. This highly contagious virus is spread by coughing and sneezing via close personal contact or direct contact with secretions.

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[A map showing the location of Punjab province and the city of Lahore can be accessed at: http://pamirtours.pk/maps/punjab%20map.htm. - Mod.CP]

MEASLES UPDATE (08)
*******************
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*****

Uganda (Hoima)
Date: Mon 18 Feb 2013
Source: The Daily Monitor [edited]
http://www.monitor.co.ug/News/National/ ... index.html


The death toll of people who have died of measles in Hoima district has risen to 6 after the disease claimed a 2-year-old at the weekend. The last fatal case occurred on 8 Feb 2013 following the death of a 3-year-old in Nyanseke village. The District Health Inspector, Mr Fredrick Byenume, said his office had registered 159 cases by Saturday [16 Feb 2013], up from 141 cases on 8 Feb 2013.

The disease, which broke out in Kaseeta Parish, Kabwooya Sub-county in January 2013 has created fear and anxiety among residents, as there are reports that it could be spreading to the neighbouring areas of Kiziranfumbi and Kyangwali. To avert the situation, a team of health experts led by the District Health Officer, Dr Joseph Ruyonga, began a mass immunisation campaign in Kabwooya on Saturday [16 Feb 2013] where at least 10 000 children were immunised.

Mr Byenume said the district registered an overwhelming turn out, causing shortages in vaccines. "The massive turn out caused a [shortage] of vaccines, but we replenished them, and the exercise is still ongoing. We are targeting 3000 more children," he said. The campaign targets children under 5 years of age and people who have never been immunised or did not complete their vaccine schedules. The World Health Organisation, Uganda Red Cross Society, World Vision Uganda, among other partners, participated in the exercise.

The villages worst affected by measles include Sayuni, Kabegaramire, Nyairongo, Rwenkobe, Ibahura, Karokarungi, Dongo, Rwengabi, and Nyakabaale. Three patients were admitted to Kaseeta Health Centre at the weekend with signs similar to those of measles.

Records at the health office indicate that the district has never registered such a serious measles outbreak in the last 10 years.

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[Since the previous report dated Wed 13 Feb 2013, the death toll has increased from 5 to 6, and the number of confirmed cases from 141 to 159 by Sat 16 Feb 2013.

Hoima is located approximately 225 km (140 miles) by road northwest of Kampala, Uganda's capital and largest city. A map of the districts of Uganda can be accessed at: http://www.ugandapicks.com/2010/11/late ... ricts.html. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1wa6.]

MEASLES UPDATE (09)
*******************
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ProMED-mail is a program of the
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In this update

Africa
-----
[1] Cameroon (Douala)
[2] Congo DR
[3] Nigeria (Jigawa)
[4] Nigeria (Niger)

Asia
----
[5] Pakistan (Punjab)

*****

[1] Cameroon (Douala)
Date: Wed 27 Feb 2013
Source: Le Quotidien Mutations [in French, machine trans. abridged, edited]
http://quotidien.mutations-multimedia.c ... -2012.html


Already, 111 measles cases have been investigated since the beginning of the year [2013], according to the Minister of Public Health. The Minister of Health (MOH) Andre Mama Fouda is categorical: "The prevalence of measles remains a high priority in Cameroon, with 1184 suspected cases, including 609 positive and 73 deaths. In 2013, we observed an outbreak of measles with 111 cases and 26 positive cases investigated." And that's not all, because Cameroon has 1184 yellow fever patients, of whom 111 have been confirmed.

These figures were revealed this Mon 25 Feb 2013 on the occasion of the annual meeting of the managers of national immunization programs (PEV) for Central Africa. The 4-day meeting, held in Douala, brings together members from all countries of the sub-region and the World Health Organization (WHO). It is a question for these countries to find strategies to eradicate these diseases preventable by vaccination. This meeting will, therefore, allow managers to consult PEV for effective harmonization in the fight against [vaccine-preventable] diseases.

Charlotte Faty Ndiaye, Oms representative of Cameroon, says that much remains to be done: "The vaccine-preventable diseases such as pneumonia, measles, diarrhea, and meningitis continue to be a major cause of mortality and morbidity. The average coverage of the 1st dose of measles in Africa is more than 10 times lower than the level observed in the Americas and the Western Pacific. 64 percent of the 19.3 million children not vaccinated annually with DTP3 live in low-income countries."

[Byline: Blaise Djouokep]

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[Douala is the largest city in Cameroon and the capital of Cameroon's Littoral Region. It is the commercial capital of the country. - Mod.CP]

[A ProMED-mail HealthMap for Cameroon can be accessed at http://healthmap.org/r/1Cfw.]

******
[2] Congo DR
Date: Thu 28 Feb 2013
Source: Prensa Latina [in French, machine trans. edited]
http://www.prensa-latina.cu/index.php?o ... 1&Itemid=1


An outbreak of measles has been affecting the northern Democratic Republic of Congo (DRC) since 2010, where children suffering from malnutrition were also the most affected by lack of vaccines.

The Deputy Chief of Medecins sans Frontieres (MSF) Amaury Gregoire said today [28 Feb 2013] that this epidemic "continues to affect the country since 2010 and is particularly deadly in children under 5 years of age. Mortality can reach 25 percent of the cases due to malnutrition or other additional conditions," he said. "It is unacceptable that someone still can die of measles in the 21st century," said the doctor in an MSF statement. During one year, the nongovernmental organisation had vaccinated 440 000 children. "But in the DRC, there are hundreds of thousands of children who were never immunised and continue to suffer as a result of a disease that is easily preventable," he added.

The vaccine is readily usable and cheap, but the lack of sanitation, infrastructure, roads and other factors make it very difficult to implement immunization campaigns, MSF said. According to the source, in one area, MSF has tried to vaccinate 76 000 children with only 2 refrigerators and a mobile computer.

The World Health Organization (WHO) estimated in Geneva last January [2013] that 800 000 children in the DRC had not been immunized against the disease, which has 68 million inhabitants.

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[A map of the Democratic Republic of Congo (Congo DR) can be accessed at:
http://www.mapsofworld.com/democratic-r ... l-map.html. - Mod.CP]

[A ProMED-mail HealthMap for DR Congo can be accessed at http://healthmap.org/r/1Ahy.]

******
[3] Nigeria (Jigawa)
Date: Wed 27 Dec 2013
Source: Daily Times Nigeria [edited]
http://dailytimes.com.ng/article/jigawa ... meningitis


The Jigawa government said on Wednesday [27 Feb 2013] that it had concluded plans to conduct a comprehensive measles vaccination programme to contain the spread of the disease in the state. The Commissioner for Health, Dr. Tafida Abubakar, said this in an interview in Dutse [the State Capital]. Abubakar said that the exercise was necessary in view of the reported measles outbreak in neighbouring states as well as sporadic cases of the disease recorded in some parts of the state.

He said that the ministry had deployed health personnel and vaccines to health facilities across the state to facilitate smooth conduct of the exercise. "There are cases of measles and cerebro-spinal meningitis (CSM) we have been getting sporadically in the state. We took extra caution based on the fact that the states of Kano, Katsina, Kebbi, and Zamfara are experiencing outbreaks of measles, and measles is a highly contagious disease. We also know that, to be on the safe side, we must have vaccination coverage beyond 80 and 85 per cent [95 percent according to WHO] in the population to ensure that children do not contract measles."

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[Jigawa state is one of 36 states that constitute the Federal Republic of Nigeria. It is in the northwestern part of the country. A map showing the location of Jigawa state can be accessed at: http://en.wikipedia.org/wiki/File:Niger ... te_map.png. - Mod.CP]

[A ProMED-mail HealthMap for Nigeria can be accessed at http://healthmap.org/r/1qGF.]

******
[4] Nigeria (Niger)
Date: Tue 26 Feb 2013
Source: Nigerian Tribune [edited]
http://tribune.com.ng/news2013/index.ph ... spitalised


The excessive heat being experienced in Niger state by residents has led to an outbreak of measles in no fewer than 6 communities in Chachanga Local Government Area of the state, with about 10 children hospitalised so far.

The Nigerian Tribune gathered that the outbreak of the disease was spreading fast across other communities, which included Nassarawa C, Ungwan Daji, Tayi, Albishir, Dutse Kura Gwari, and Kutirku in Chanchanga Local Government Area, but there have been no deaths recorded so far. Affected children are receiving treatment at the General Hospital, Minna.

Confirming the outbreak of the killer disease, the council chairman, Alhaji Yakubu Mohammed Sallau, has said that medical personnel were currently going around to local government areas to determine the magnitude of the outbreak, adding that an emergency response of large scale vaccination had been put in place to prevent the disease from causing further damage.

According to him, "A combined team of medical personnel from the state Ministry of Health and Chanchanga Local Government Area has visited the affected areas to verify the outbreak and determine its prevalence magnitude.

"During the measles vaccination campaign, children aged 0-1 year will be immunised. Parents are, therefore, advised to visit any clinic near them and the General Hospital Minna to get their children vaccinated," he said.

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[It is surprising that "...excessive heat being experienced in Niger state by residents has led to an outbreak of measles in no fewer than 6 communities..." It may be that humidity accompanying the excessive heat is the reason for the enhanced transmission of measles virus infection.

Niger state is a state in northwestern Nigeria and the largest state in the country. The state capital is Minna, and other major cities are Bida, Kontagora, and Suleja. It was formed in 1976 when the then North-Western State was bifurcated into Niger State and Sokoto State. A map of its location can be accessed at: http://en.wikipedia.org/wiki/File:Niger ... te_map.png. - Mod.CP]

[A ProMED-mail HealthMap for Nigeria can be accessed at http://healthmap.org/r/1qGF.]

******
[5] Pakistan (Punjab)
Date: Tue 26 Feb 2013
Source: Pakistan Observer [edited]
http://pakobserver.net/detailnews.asp?id=197656


Five more measles patients were reported on Monday [25 Feb 2013] and were admitted to Nishtar Medical Institute and Children Complex. District Coordinator for the Prevention and Control Programme of Epidemics Dr Ata ur Rehman told the APP agency that [these 5 were suspected cases]. The total number of suspected measles cases now stands at 98 so far, he added.

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[Multan is a city in Punjab, Pakistan. It is Pakistan's 3rd largest city by area and its 5th largest by population. The city is located on the banks of the Chenab river in the geographic center of the country. A map showing the locations of the cities of Pakistan can be accessed at: http://www.punjabyouthpolicy.pk/PunjabY ... Final.html. - Mod.CP]

[The interactive ProMED-mail HealthMap of Pakistan can be accessed at: http://healthmap.org/r/1iGJ. - Mod.CP]

MEASLES UPDATE (10)
*******************
A ProMED-mail post
http://www.promedmail.org
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******
[1] Georgia (Tbilisi)
Date: Thu 7 Mar 2013
Source: MIR 24 [in Russian, trans. abbreviated Mod.CP, edited]
http://mir24.tv/news/society/6621014


Currently, citizens of the Republic of Georgia can obtain free vaccination at clinics throughout the country. Nonetheless, there has been a dramatic increase in the number of cases of measles in Georgia. Epidemiologists say that this was to be expected, because the majority of the population has ignored the availability of vaccination. At present, all citizens from 6 months to 30 years of age can obtain vaccination, which is free.

A whole body red rash and fever are the principal symptoms of the disease. According to Paata Imnadze, the Director of the Center for Disease Control in Georgia, in 2008, the turnout and demand for vaccination was minimal due to civil strife and unrest. [The Russia-Georgia War of 2008 (also known as the Five-Day War, the 2008 South Ossetia Conflict, or the August War) occurred in August 2008 between Georgia on one side and Russia and the separatist governments of South Ossetia and Abkhazia on the other. - Mod.CP]. According to the National Center for Disease Control and Public Health, this is the reason for the current sharp rise in the number of measles cases among adults in Georgia. Doctors are recommending that citizens of Georgia should seek vaccination without further delay.

In the last month, about 100 cases of measles were diagnosed in Tbilisi, mostly people between 20 to 30 years of age. More than half of them require hospitalisation. Talking about the disease, the General Director of the Health Agency, Professor Tengiz Tsertsvadze, stated that the symptoms of measles involved the respiratory tract and eyes and a red body rash. Complications such as pneumonia or encephalitis might follow in some cases. In order to calm the population, Professor Tsertsvadze added that, as yet, there is no cause for panic as the epidemic is just beginning. In Georgia in 2004, a severe epidemic affected 12 000 people.

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[A map of Georgia, showing the location of Tbilisi can be accessed at: http://www.lonelyplanet.com/maps/europe/georgia/. - Mod.CP]

[A ProMED-mail HealthMap can be found at http://healthmap.org/r/5RXP.]

*****
[2] Nigeria [Kano]
Date: Mon 4 Mar 2013
Source: Premium Times [edited]
http://premiumtimesng.com/regional/1230 ... ioner.html


The Kano State Government on Monday [4 Mar 2013] said it had recorded 800 cases of measles in 11 local government areas of the state since the outbreak of the disease last week. The state Commissioner for Health, Abubakar Labaran, said this while fielding questions in Kano. He listed the affected local government areas as Kabo, Gwale, Dala, Kumbotso, Madobi, Ungoggo, Tarauni, Karaye, Municipal, Fagge and Tsanyawa.

"The 8 local government areas that made up Kano metropolis are the worst affected," he said. Mr. Labaran said the state government had taken measures to control the spread of the disease, saying no death has been recorded by any of the hospitals in the state.

Related information:
- Kebbi records 93 more cases of measles in rural areas.
- Measles kills 7 children in Kebbi as 37 fresh cases are discovered.
- According to the World Health Organisation, 9 percent of measles-unvaccinated children worldwide in 2011 are Nigerians.

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[To view the location of Kano State, access the original report via the source URL. - Mod.CP]

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[3] Nigeria (Yobe)
Date: Fri 8 Mar 2013
Source: News 24 Nigeria [edited]
http://nigeria.news24.com/National/News ... s-20130308


The Yobe Government says it recorded 361 cases of measles with 4 deaths in 14 of the 17 Local Government Areas of the state from January 2013 to date. This is contained in a statement signed by Mr Musa Alaraba, the Press Secretary to Yobe Deputy Governor in Damaturu on Friday [8 Mar 2013].

The statement said that the 4 deaths were recorded in Nangere Local Government. It stated that Potiskum recorded 87 cases, Tarmuwa 37, Nangere 33, Bursari 30, Jakusko 29, Bade 27, Fika 25, Fune 24, Gulani 22, Nguru 20, Karasuwa 12, Giedam 8, Yusufari 6, and Damaturu one.

It stated that 357 children were treated and discharged, while 4 died out of the 33 cases recorded in Nangere Local Government. The statement described reports that 87 children died in Potiskum as misleading. "The figure represents the total number of cases recorded in Potiskum, and there were no deaths. In Potiskum, all the victims were treated and discharged," it said.

The statement further stated that the state Ministry of Health introduced an integrated measles campaign alongside the routine immunisation. As a deliberate policy, the Ministry took advantage of the routine Immunisation Plus Days to administer measles' vaccines to children who missed the initial immunisation. "A surveillance network had also been introduced in all the 17 Local Governments for early disease detection and quick response," it added.

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[A map of Yobe and its districts can be accessed at: http://www.ncocusa.com/constituencies_yobe.html. - Mod.CP]

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MEASLES UPDATE (11)
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[1] Nigeria (Kaduna)
Date: Thu 14 Mar 2013
Source: News 24 Nigeria [edited]
http://nigeria.news24.com/National/News ... s-20130314


The Kaduna state government said on Thursday [14 Mar 2013] that it has recorded 500 cases of measles in 19 local government areas of the state from December last year [2012] to date. Dr Julius Gajere, the state's Rapid Response Team leader, told the News Agency of Nigeria (NAN) in Kaduna that no deaths had been recorded.

He said 83 per cent of the reported cases were in 6 local government areas. Gajere gave the names of the affected local governments as Igabi, Kaduna North, Kaduna South, Ikara, Makarfi, and Kubau. He also said that 96 per cent of the cases had manifested in children between 9 to 59 months old. "The main clinical features of the disease are fever, cough, conjunctivitis, runny nose, and maculopapular rashes. He advised the affected local councils to provide drugs, water, and clean environments to communities to prevent further spread of the disease. Gajere blamed the situation on low routine immunisation in the affected areas and urged the residents to embrace the immunisation programme.

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[A map of the states of Nigeria showing the location of Kaduna can be accessed at http://www.nigeriamasterweb.com/TearsOfMyPeople.html. - Mod.CP
A ProMED-mail HealthMap for Nigeria can be found at http://healthmap.org/r/1qGF.]

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[2] Nigeria (Kano)
Date: Wed 13 Mar 2013
Source: IRIN [abbreviated & edited]
http://www.irinnews.org/Report/97636/Su ... s-outbreak


An ongoing measles outbreak that has killed 36 children and infected over 4000 in northern Nigeria between 16 Feb and 9 Mar 2013 has been linked to a drop-off in immunizations due to vaccine shortages in regional health clinics and widespread suspicion of the vaccine, say government health officials.

Many parents have declined to vaccinate their children against measles, as they believe the vaccine is harmful, according to Ado Mohammed, director-general of Nigeria's National Primary Health Care Development Agency (NPHCDA). "Parents are largely to blame ... for their refusal to have their children immunized against preventable diseases, including measles, due to unfounded suspicion that such vaccines are harmful to children, following persistent rumours that polio vaccine causes infertility in children," he told IRIN. Distrust of vaccines has grown, as parents often do not differentiate between the polio vaccine and other immunizations, according to Mohammed. The 12 states affected by the measles outbreak mirror those where polio is endemic and where resistance against the polio vaccine is highest. Kano state has reported over 1000 measles cases, and Katsina state 1260.

Nigeria's junior health minister, Ali Pate, agrees (as did Kano state's health commissioner Abubakar Labaran Yusuf, and Katsina health commissioner Hussaini Yammama): "The measles outbreak is a direct consequence of parents refusing to immunize their children," he said, adding: "Measles is a disease that is 99 percent preventable." Following incremental progress on reducing resistance to polio vaccine campaigns, on 8 Jan 2013, gunmen killed 10 polio vaccinators in separate attacks on 2 polio clinics in Kano 2 days after a radio station aired a programme which discussed suspicion of the polio vaccine.

Infants are immunized against measles for life at 9 months as part of routine immunizations in hospitals and health centres. "I don't allow my children to take any immunization, because I don't believe they are safe. The west has been insisting we give polio vaccines to our children, which we have refused, and now they insist we take our children for routine immunization, which I see as another way of giving our children what we are trying to avoid in the polio vaccine," a father of 5, told IRIN.

Health workers and parents said a shortage of vaccines has also contributed to low routine immunization coverage. A nurse at a government hospital in Kano told IRIN that many parents return to hospital week after week for routine vaccinations only to find doctors have run out of medicine. "At a certain stage, they become fed up and stop going because they come to think that it is a waste of time and energy," he told IRIN. Nigeria's Health Ministry supplies vaccines to states through NPHCDA for use in regional health centres. "Some local governments don't pick up the vaccine deliveries that we supply to states, which creates shortages at primary health care centres, depriving willing parents' access to such vaccines for their children," Mohammed told IRIN.

The national health authorities have procured 10 million doses from the UN Children's Fund (UNICEF) to try to vaccinate 7 million children in the affected states over the coming days as an emergency response to the outbreak. NPHCDA will also supply solar-powered refrigerators to affected areas to stockpile vaccines. Health officials, WHO, and UNICEF were already planning a nationwide measles campaign for 33 million under-5s in June and August 2013.

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[3] Nigeria (Kano)
Date: Sun 10 Mar 2013
Source: Leadership [edited]
http://leadership.ng/nga/articles/49655 ... _sets.html


From March to June every year, dwellers across the sub Saharan African region bear the brunt of the hot season that culminates in the rainy season. Kano, due to longitudinal and latitudinal effects, is among cities that come under severe heat waves throughout the 4 months, bringing discomfort from the steaming heat, scorching sun, and biting hot winds. But it is not the environmental discomfort that causes people to shudder as the season approaches, but fatal diseases that also come during the period. Killer diseases like measles, meningitis, and cholera ravage people, mostly during hot weather.

The 1st to rear its ugly head is measles, which unofficial figures placed at around 8000 children infected, as proclaimed by a victim from Tukuntawa area, Kano, who lost one child to the disease. A housewife lamented that the season is to blame, since "children suffer much from measles this time around, although it may attack them during other seasons, but that is very rare. During this period, the epidemic attacks with much severity, hence the loss of lives. It may not be so severe in other seasons."

The lady, who said she had some primary knowledge in midwifery, said the disease is more fatal to children from the age of 2. "It descends mercilessly on children from 2 years up. Babies who are under breast feeding normally have mild attacks, which could go in 3 days even, but it may last a week with older children. But it attacks only once in a lifetime, as there are no records of people infected twice.

At the Infectious Disease Hospital, Weatherhead, Kano, the scene indicates an atmosphere of ambivalence, as families visit patients that have been admitted. "I noticed my child's nose running, followed by a high temperature, and then his lips became red with sores. Our parents have tutored us on how to recognise the symptoms of measles, so I rushed the baby to the hospital," a mother revealed as she tended her child at the IDH. A nurse who spoke on condition of anonymity revealed that in the last one week, more than 40 children had died due to measles.

The state commissioner of health, Dr Abubakar Labaran, told Leadership on Sunday [10 Mar 2013] that the state has put resources in place to control the spread of measles in the state. In his submission in Lafia, the senior registrar of the Dalhatu Araf Specialist Hospital (DASH), Lafia, Dr Halim Odiachi, said that the hospital is coping with a measles epidemic outbreak in which 38 cases have so far been reported, most of which occurred because of parents' attitudes towards immunising their children.

In Zamfara, Leadership Sunday checks in some hospitals and primary health centres in the state capital Gusau found elements of growing spread of measles attacks among small children who are receiving treatment in some hospitals.

On this issue, the commissioner explained that the government is on top of efforts for treatment and curbing further infection of measles across the state, noting that the disease is usually more pronounced and active during the hot period of each year, explaining further that due to the proactive measures taken by the government, there are very minimal recorded cases of measles compared to other states.

He said in the meantime, many field officers of his ministry were still in the rural areas across the state keeping surveillance on any appearance of cases of measles with a view to taking evasive measures.

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[It is unlikely that the seasonality of measles in Nigeria is related to high environmental temperature. Measles virus infectivity is rapidly reduced by desiccation and elevated temperature. More likely, the seasonality is due to local patterns of agricultural and social activities seasonality, demographic characteristics, and spatial heterogeneities (Bharti N, et al. Epidemiol Infect. 2010 Sep;138(9):1308-16. doi: 10.1017/S0950268809991385. Epub 2010 Jan 25). In temperate areas, measles disease occurs primarily in late winter and spring (see: http://www.cdc.gov/vaccines/pubs/pinkbook/meas.html#epi.

In relation to this seasonality, Bharti N, et al. have analysed seasonal fluctuations of measles in Niger using nighttime lights imagery (Science. 2011 Dec 9;334(6061):1424-7. doi: 10.1126/science.1210554). "Measles epidemics in West Africa cause a significant proportion of vaccine-preventable childhood mortality. Epidemics are strongly seasonal, but the drivers of these fluctuations are poorly understood, which limits the predictability of outbreaks and the dynamic response to immunization. They show that measles seasonality can be explained by spatiotemporal changes in population density, which was measured by quantifying anthropogenic light from satellite imagery. They found that measles transmission and population density are highly correlated for 3 cities in Niger. With dynamic epidemic models, they demonstrated that measures of population density are essential for predicting epidemic progression at the city level and improving intervention strategies. In addition to epidemiological applications, the ability to measure fine-scale changes in population density has implications for public health, crisis management, and economic development."

It would be interesting to know the outcome of this type of analysis in Nigeria. - Mod.CP

A ProMED-mail HealthMap for Nigeria can be found at http://healthmap.org/r/1qGF.]

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[4] Nigeria (Kebbi)
Date: Tue 12 Mar 2013
Source: AllAfrica, Daily Trust [abbreviated & edited]
http://allafrica.com/stories/201303120749.html


Kebbi state commissioner of health Shehu Sambawa stated that the state had recorded over 2500 cases of measles in 14 local government areas in the last 2 months. Receiving drugs [vaccine?] donated by Save the Children at Malaria Control Unit in Birnin Kebbi yesterday [11 Mar 2013], Sambawa said avoidable epidemic diseases that include cerebrospinal meningitis (CSM), measles, and gastroenteritis are the common and the most serious health problems that can lead to high deaths among the populace.

The commissioner said the frequency and magnitude of the outbreak constitutes an obstacle to the efforts by the state in controlling the morbidity and mortality of these diseases. Handing over the drugs, the Kebbi state field manager of Save the Children International, Ahmed Saidu, said the group conducted an assessment of the situation and is supporting the government and people of the state with the drugs estimated for about 1000 children across the affected communities in the state.

[byline: Garba Muhamad]

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[5] Nigeria (Niger)
Date: Tue 12 Mar 2013
Source: Premium Times [edited]
http://premiumtimesng.com/regional/1243 ... ioner.html


At least 17 people have died from measles in Niger state. This was disclosed by the state commissioner for health, Ibrahim Sule. There has been an increase in the number of reported deaths from measles in Nigeria, particularly in northern states. Several deaths have been recorded in states like Kano, Bauchi, Kebbi, Katsina, and Yobe.

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[6] Rwanda
Date: Wed 13 Mar 2013
Source: CIDRAP News [edited]
http://www.cidrap.umn.edu/cidrap/conten ... 3scan.html


A measles-rubella vaccination campaign being launched today [12 Mar 2013] in Rwanda marks the start of an effort to vaccinate more than 700 million children in 49 countries against the 2 diseases, according to the GAVI Alliance (the Global Alliance for Vaccines and Immunization -- Press Release: http://www.gavialliance.org/library/new ... d-rubella/).

The goal is to introduce the dual vaccine in all the countries by 2020, the alliance said in its press release. It said Rwanda, which is already effectively controlling measles, is the 1st African country to provide measles-rubella vaccine nationwide with GAVI support. Over the next 4 days, Rwandan health workers aim to vaccinate close to 5 million children between the ages of 9 months and 14 years. Five other countries -- Bangladesh, Cambodia, Ghana, Senegal, and Viet Nam -- plan to launch similar drives with GAVI support by the end of this year [2013].

Measles and rubella are unrelated diseases but cause some of the same symptoms and are often confused with one another, the alliance noted. In pregnant women, rubella can cause miscarriage and severe birth defects, such as blindness, deafness, and heart problems.

Vaccination efforts reduced global measles cases by 71 percent between 2000 and 2011. But as measles wanes, rubella cases, which in the past might have been mistaken for measles, begin to emerge, pointing up the need for the vaccine. GAVI is providing about USD 6.8 million to support the Rwandan immunization drive.

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[Other points from the GAVI Press Release are the following: "Thanks to widespread vaccination, rubella is no longer the threat it once was in many countries. But for millions of mothers and their children in poorer countries, rubella poses an ongoing danger. Africa and South East Asia have the highest number of estimated CRS cases and the lowest uptake of rubella-containing vaccine. The human and economic toll of rubella in those regions is staggering. GAVI funding for measles and rubella vaccine campaigns will help countries to rapidly scale up introduction of rubella vaccine and protect women and children. In fact, every day of delay means about 300 newborn children enter the world with life-altering disability because of rubella infection in pregnancy. With the technical know-how available, we have a chance to make history by eradicating measles and rubella once and for all. Measles kills an estimated 430 people -- mainly young children -- every day. In 2000, about 548 000 children died from measles, whose symptoms include a high fever, severe skin rash, and a cough. At least 90 per cent of children must be covered by measles vaccine to protect communities against measles. GAVI is funded by governments (Australia, Canada, Denmark, France, Germany, Ireland, Italy, Japan, Luxembourg, Netherlands, Norway, Republic of Korea, Russia, South Africa, Spain, Sweden, United Kingdom, and the United States)." - Mod.CP

A ProMED-mail HealthMap for Rwanda can be found at http://healthmap.org/r/1jzc.]

MEASLES UPDATE (12)
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[1] Chad (Djabal Camp)
Date: Fri 22 Mar 2013
Source: Radio Dabanga [edited]
http://www.radiodabanga.org/node/45259


Health authorities of a Sudanese refugee camp in Chad announced the emergence of 4 cases of measles in the area. This skin disease is highly contagious, they warned.

Adam Hassan of Djabal Camp's Medical Centre said all 4 cases of measles were diagnosed within the same family. He noted that 370 people aged between 9 months and 15 years old had been vaccinated against the disease. Nevertheless, the health official advised Djabal's residents to "stay away from those infected with measles due to its highly contagious nature." Hassan further advised them not to touch tools or clothes used by the sick and to refrain from eating their food.

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[Camp Djabal is one of 2 Darfur refugee camps located in southeastern Chad. Only secondary, unpaved roads travel to this area; that is a good 6 hours from the central NGO hub of Abeche. Surrounding Camp Djabal are half a dozen Internally Displaced Persons camps, home to local Chadians who have been displaced from their villages due to inter-ethnic violence that has been on the rise. Resources dedicated to Camp Djabal and the other camps in the area are few. Firewood is scarce. Education offered in the camp only reaches level 6, and the students are eager for more. Without this opportunity, the older boys will most likely return to Darfur in search of a school, work, or most likely a rebel group to join.

Djabal can be located in the map at: - Mod.CP]

[A ProMED/HealthMap of Chad can be found at http://healthmap.org/r/1CnT.]

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[2] Ghana (Tamale)
Date: Wed 20 Mar 2013
Source: GhanaWeb [abbreviated and edited]
http://www.ghanaweb.com/GhanaHomePage/h ... ?ID=268271


The Tamale Teaching Hospital (TTH) continues to record fresh cases of measles [known as "kuagu" in the local dialect] after an outbreak of the disease towards the end of 2012. A total of 108 children were admitted to the hospital last year [2012] after contracting measles. Two of them died later as a result of complications from the disease.

This year [2013], 27 cases have already been reported at the TTH between January and February 2013, thereby raising concerns of the possibility of fresh outbreaks. During a visit to the Children's Ward of the TTH, the Daily Graphic newspaper learned that almost each week, children are being brought to the hospital with symptoms of measles. The 2 paediatric consultants in charge of the children's ward, Dr Anthony Amankwa Amponsem and Dr Hassan Mumuni, said they had confirmed most of the cases as measles.

They said that sometime last year [2012], the hospital noted that there was an outbreak of the disease in Tamale and surrounding communities and, therefore, instituted mechanisms to manage the situation. "We allocated a separate ward for measles admissions because the disease is contagious," said Dr Amponsem, who is the head of the Paediatric Faculty of the hospital. "We are still getting new cases, but it appears the numbers are declining," he further stated.

At the time of the visit, there were 3 babies with their mothers isolated in the ward reserved for measles patients. "We [were] brought here on Sunday," said the mother of a 6-month old child, who had some sparse rashes on her head and neck and had calamine lotion smeared all over her body. The mother said her daughter experienced a rise in body temperature, and when they brought her to the hospital, she was diagnosed as a case of measles. Another mother, who was assisting a nurse to administer some medications for her 7-month-old son, said they had been in the hospital for 3 days. Her baby still had some rashes on his buttocks. "His condition is improving because the rashes are gradually drying up," she stated with some sense of relief.

Measles is highly contagious and spreads through fluids from an infected person's nose or mouth. Health officials agree that vaccination is the most effective way to prevent the spread of the disease. In Ghana, babies are immunised against measles when they are 9 months old. They are eligible for another dose when they reach 18 months. It appears, however, that many babies are getting infected with the disease before they are 9 months old. In the view of Dr Ken Sagoe, the Chief Executive Officer (CEO) of the TTH, if the trend becomes widespread, the health service may need to shift the time of measles vaccination to 6 months to give babies better protection.

He explained that the situation in which children who had already received the vaccine had contracted the disease may be due to a number of factors. "Probably, the vaccine was not properly administered, or its potency was reduced due to improper preservation," he stated. Dr Sagoe said some children could also have immunity deficiencies, and this would make them more susceptible to such conditions. He appealed to parents and school authorities to quickly send children to the hospital when they develop symptoms such as fever, runny nose, catarrh and rashes.

Meanwhile statistics from the paediatric unit of the TTH revealed that measles is the 5th highest cause of admission, coming after malaria, pneumonia, malnutrition, and acute gastroenteritis.

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[3] Pakistan (Sindh)
Date: Wed 20 Mar 2013
Source: Central Asia Online [edited]
http://centralasiaonline.com/en_GB/arti ... wsbrief-04


An on-going measles outbreak in Sindh province has killed 20 people so far in March [2013], with more than 300 children afflicted, the provincial health department said on Tue 19 Mar 2013.

Ten deaths were reported in Tharparkar, 4 in Tando Muhammad Khan, 3 in Hyderabad, and 2 in Badin, SAMAA reported, citing health officials. A location for the 20th death was not specified.

Measles has killed hundreds of children in Pakistan this year [2013].

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[Sukkur is the 3rd largest city of Sindh province, situated on the west bank of the Indus River in Pakistan in Sukkur district. A map of Pakistan, showing Sukkkur in the northwest of the province, can be accessed at: http://pamirtours.pk/maps/sindh%20map.htm. - Mod.CP]

[A ProMED/HealthMap of Pakistan can be found at http://healthmap.org/r/1iGJ.]