RIO DE JANEIRO, BRAZIL – While there is great expectation regarding immunizers that will protect against Covid-19 – two of them approved by ANVISA on Sunday – the vaccination coverage for other diseases fails to reach the minimum required. Six of the seven deaths caused by measles in Brazil in 2020 occurred in children under 18 months. The seventh victim was a 34-year-old man. None of them had a history of vaccination against the disease.
Last year, 8,419 cases of measles were confirmed in the country by December 19th. And there are still 371 under investigation.
The state of Pará holds the highest number of confirmed cases – 5,375 diagnoses – and five deaths. Rio de Janeiro is next, with 1,347 cases and one death; São Paulo, with 864 diagnoses and one death; Paraná, with 377 cases; Amapá, with 177 infections; and Santa Catarina, with 110 positive diagnoses. Fifteen states had fewer than 100 cases of measles virus infection.
Vaccination is the only means of protection against the disease. However, vaccination coverage has not reached the minimum percentage to prevent the virus from circulating in Brazilian territory. Since 2017, the first and second doses of the triple viral vaccine in children – which in addition to measles also protects against mumps and rubella – has not reached the 95% coverage required to protect the population.
Ministry of Health data show that by October 2nd, 2020, the first dose had been administered to only 70.64% of the target public (children aged 12 months), and the second dose – which includes protection against chickenpox – was administered to 55.77% of children aged 15 months.
The zero dose of the triple viral vaccine, implemented by the Ministry of Health in August 2019 and recommended for children aged six months and over, is now administered only to babies living in states with an active measles outbreak, which according to the latest epidemiological bulletin are Pará, Rio de Janeiro, São Paulo and Amapá. It does not replace the first and second doses. Adolescents and adults up to 29 years of age should take two doses of the measles vaccine in case they have no vaccination history. Between 30 and 59 years of age, only one dose is required if the person has never been vaccinated.
Juarez Cunha, president of the Brazilian Society of Immunization (SBIm), lists some of the reasons for low vaccination coverage in Brazil.
“There is a phenomenon called ‘vaccine aversion’, which means that we recommend vaccination, the vaccine is available for free, and yet it is not administered or it is delayed – explains Cunha: – And among the factors of avoidance are complacency (perception that the disease is not dangerous), lack of confidence (not only in the efficacy and safety of the vaccine, but in the governments, institutions and healthcare professionals, which has been undermined by fake news) and convenience (hours of posts’ operation).”
In 2016, Brazil received a certificate of measles eradication from the Pan American Health Organization (PAHO). However, the country lost this certification in 2019, after an outbreak of the disease for over a year, with new cases emerging. In 2018 Brazil recorded 10,274 positive diagnoses of the disease, with an outbreak in Amazonas and Roraima. In that year 12 people died as a result of the disease.
In 2019, the number of confirmed cases was much higher: 18,203 infections, with 15 deaths. The outbreak occurred in the states of São Paulo (with the highest number of cases), followed by Paraná, Rio de Janeiro, Pernambuco, Santa Catarina, Minas Gerais and Pará.
The lack of control of the disease occurs not only in Brazil, but in several countries. According to the World Health Organization, deaths from measles worldwide reached their highest level in 23 years in 2019. According to an analysis made with the Centers for Disease Control and Prevention (CDC) in the United States, 207,500 people died from the virus worldwide that year. The figure was 50% higher than three years earlier, according to the study.