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Measles: Preventing a Predictable Consequence of the Ebola Outbreak in West Africa

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March 14, 2015

With more than 24,000 reported cases of Ebola virus disease (EVD) in West Africa, and nearly 10,000 deaths, this unprecedented outbreak has wreaked havoc in Guinea, Liberia, and Sierra Leone, highlighted weaknesses in the health systems of the affected countries, and raised concern of further international spread.  It has renewed international attention on the importance of responding to epidemic infectious diseases and generated a huge outpouring of humanitarian assistance. The frontline responders have been heralded as heroes for their courageous efforts to control the epidemic once it started to devastate communities in West Africa.

Ebola hasn’t just killed people, in some highly affected areas it has ground to a halt the routine health services that many communities depend on to prevent other epidemic diseases.  In an article published in Science on March 13th 2015, researchers forecasted the risk of measles outbreaks as a result of the breakdown in vaccination services during the EVD outbreak in Guinea, Liberia, and Sierra Leone.  They estimate that after 18 months of health system disruption (early 2014 to late 2015, assuming 75% coverage reduction), the number of additional measles susceptible children will increase by more than 350,000.  If a measles outbreak were to occur in this setting, they estimate between 2,000 and 16,000 additional children will die from an easily preventable disease.

At the end of the article, the researchers call out a potential solution to this increasing risk of a measles outbreak, stating that “…there is a clear, relatively inexpensive, and one-time intervention that could erase the impact of Ebola-related health care disruptions.  Coordinated campaigns across the three Ebola-affected countries…targeting those children who missed critical routine vaccinations during the Ebola epidemic with measles and polio vaccines, and possibly other life-saving childhood vaccines, could thwart a second public health disaster and avoid nearly 12,000 deaths from measles alone.” 

 Coordinated campaigns across the three Ebola-affected countries…targeting those children who missed critical routine vaccinations during the Ebola epidemic with measles and polio vaccines, and possibly other life-saving childhood vaccines, could thwart a second public health disaster and avoid nearly 12,000 deaths from measles alone.”Over the past two decades, partners such as WHO, CDC, UNICEF, and others have supported many countries in conducting measles vaccination campaigns.  This is a proven way to control measles transmission, especially in countries where routine immunization services are sub-optimal.  An added benefit of this approach is that the vast majority of measles campaigns are integrated with other health interventions, including Vitamin A supplementation, oral polio vaccine, deworming medication, and insecticide-treated bed nets. 

Once the EVD outbreak is on the retreat, every effort should be made by partners and the affected countries to reinstitute routine health services, including immunization.  Re-establishing routine immunization to levels preferably exceeding those seen pre-EVD outbreak, providing catch-up vaccination opportunities, and strengthening surveillance are all essential to help these countries recover.  In addition, given the particular infectious nature of measles, an integrated measles vaccination campaign should be conducted in Guinea, Liberia, and Sierra Leone within six months after the EVD outbreak is over.  This is a worthy effort intended to avert another public health disaster in the region and one that partners and donors should be willing to support.

 
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