RIO DE JANEIRO, BRAZIL – Measles deaths worldwide reached their highest level in 23 years last year. The data is based on a report released on Thursday, November 12th, by the World Health Organization (W.H.O.) together with the Centers for Disease Control and Prevention (CDC) in the United States.
The increase is striking for a vaccine-preventable disease, and public health experts fear the disease may grow as the coronavirus pandemic continues to disrupt immunization and detection efforts.
The global count in 2019 – 207,500 deaths – was 50 percent higher than three years earlier, according to the survey. In Brazil, 18,203 measles cases were reported in 2019, when 15 people died from the disease. Of the 15 deaths in 2019, 14 occurred in the state of São Paulo and one in Pernambuco.
While the U.S. reported no deaths from measles, it recorded an annual record of 1,282 cases in 31 states, the largest since 1992, according to data updated earlier this month.
Underestimated cases in 2020
Public health experts said the growing numbers are a consequence of years of insufficient vaccine coverage. They fear that the pandemic will exacerbate the spread of measles, a disease that is even more contagious than Covid-19.
“We are concerned about the opening of new immunity gaps because of Covid, in addition to those that already existed,” said Natasha Crowcroft, W.H.O. senior technical consultant for measles and rubella. “We cannot continue this way and expect a different outcome ,”she added, asking for more resources and their creative implementations.
Although the reported measles cases so far have been lower this year, public health experts are holding these numbers in check. They fear there will be a drastic underestimation because of global disruptions in health care caused by the pandemic, thus reducing measles detection and medical care – as well as prevention efforts.
Measles outbreaks have already occurred this year in at least half of the 26 countries that had to suspend vaccination campaigns because of the pandemic. As of this month, 94 million people are at risk of missing out on measles vaccines, according to the W.H.O. Although measles cases may indeed be suppressed as a side effect of precautions to prevent the spread of the coronavirus, experts say that, at best, the current low numbers represent only a temporary respite.
Similar to a forest fire
International epidemiologists compare last year’s measles outbreak to a slow-growing forest fire that would have ultimately exploded. For a decade, vaccination rates worldwide have stagnated, ensuring good coverage in many regions, but still failing to reach the high percentage required to contain the spread. Many outbreaks, including 25 cases in the United States last year, originated from travelers from other countries.
Of the 184 countries analyzed in the study, only nine accounted for 73 percent of cases in 2019: Central African Republic, Democratic Republic of Congo, Georgia, Kazakhstan, Madagascar, North Macedonia, Samoa, Tonga and Ukraine.
Growing vaccine safety skepticism around the world has contributed to lower vaccination rates. “There has been growing carelessness and a deceleration in some high-coverage countries,” said Robin Nandy, chief immunization officer at UNICEF. “We’re still losing a large proportion of children in areas health services cannot reach, rural areas or urban shantytowns, or where there is armed conflict.”
Efforts to eradicate measles represent, in large part, a decades-long story involving the coordination of teams from the world’s wealthiest cities and their poorest outposts. In fact, from 2010 to 2016, measles-related deaths and cases decreased to 18 cases per million people.
In parallel, vaccination coverage has begun to stagnate. To prevent a measles outbreak, 95 percent of the population should be immunized with two measles shots (the triple viral vaccine). But since 2010, rates for the first vaccine, ideally administered when a child is about one year old, have stagnated at a worldwide average of about 85 percent; although comprehensive coverage for the second shot, usually administered between the ages of four and six, has increased, it now stands at only 71 percent. In Brazil, the second dose is given at 15 months.
In 2019, measles cases reported worldwide totaled 120 per million people, almost seven times more than in 2016.
Source: O Globo