Measles remains uncontrolled despite vaccination campaign

The national measles vaccination campaign ended a month ago on 20 May. Yet measles remains uncontrolled.

Although deaths have declined, hospitals are still receiving an average of around 1,000 patients every day with symptoms of measles.

Specialists say that the Directorate General of Health Services (DGHS) is not acting on their recommendations.

Meanwhile, an internal analysis by the World Health Organization’s Dhaka office indicates fluctuations in the number of suspected and confirmed measles cases.

According to the organisation’s latest analysis, circulated on 9 June, the number of people with measles symptoms and the number of confirmed measles-related deaths declined during the week of 1–7 June compared with the previous week (25–31 May).

However, the number of people attending hospitals with measles symptoms and the number of confirmed measles cases increased slightly.

Professor Pravath Chandra Biswas, director general of the DGHS, told Prothom Alo, “We are observing a downward trend in the number of measles cases. The number of infections in June is lower than that from May. We hope that transmission will decline further by the end of June.”

A decline in measles transmission is not the same as bringing measles under control.

After the outbreak emerged in early March, the government launched a nationwide measles-rubella vaccination campaign on 5 April.

The campaign concluded on 20 May, four weeks ago. Public health and immunisation specialists point out that children generally develop immunity (antibodies) against measles within two to three weeks of vaccination.

Questions are therefore being raised as to why, even four weeks after the campaign ended, more than a thousand children on average continue to visit hospitals each day with measles symptoms. The situation is also causing concern among the public.

According to a press release issued on Friday, by the DGHS Integrated Control Centre, 1,078 people with measles symptoms visited hospitals across the country during the previous 24 hours (from 8:00 am Thursday to 8:00 am Friday), while four people with measles symptoms died.

During the same period, 96 confirmed measles cases were identified. More than 3,000 people with measles were admitted to public and private hospitals.

Specialists say that measles can only be considered under control when people stop visiting hospitals with measles symptoms, confirmed cases cease, and there are no measles-related deaths.

The national vaccination campaign targeted children aged between six months and five years.

In practice, however, measles infections have occurred among children younger than six months and older than five years.

Adults have also contracted the disease. Despite this, the DGHS has not published any age-specific data. Nor has it assessed whether immunity levels have increased following vaccination.

The DGHS’s Communicable Disease Control (CDC) unit holds primary responsibility for these activities. However, the unit has not taken any visible initiative. When contacted by mobile phone yesterday, Friday the unit’s director did not answer calls.

Professor Pravath Chandra Biswas, director general of the DGHS, told Prothom Alo that the Institute of Epidemiology, Disease Control and Research (IEDCR) would soon begin several activities. He added that a new director had been appointed to the institution.

Public health specialists, meanwhile, argue that authorities should not only assess whether vaccination is generating immunity and whether the vaccines are working effectively, but should also take steps to prevent further transmission.

They say that measures are needed within households, communities and hospitals. For example, infants under six months of age who contract measles should be isolated.

The government has also provided little public guidance on preventive measures or on what people should do to protect themselves and others.

Professor Mahmudur Rahman, former director of the IEDCR and a public health expert told Prothom Alo, “I advised the Directorate General of Health Services to take several measures. These included establishing triage arrangements in hospital outpatient departments to separate patients with fever and skin rashes from others; keeping hospital doors and windows open; ensuring that healthcare workers wear masks; promoting regular handwashing with soap and water; and restricting visitors in hospitals. I do not believe these measures are being implemented.”