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Wednesday, October 16, 2013

Measles: How Can Nigeria be Free?

Despite tremendous progress, one child still dies every 20 seconds from a disease that could have been prevented by an existing vaccine. 

According to the Kogi State Commissioner for Health, Dr Omede Idris, measles is one of the six vaccine-preventable childhood- killer diseases, especially for children under five years of age. 

Yet, measles has continued to plague the country, especially during the dry season taking its toll on the population. 

Experts define measles, also known as Rubeola or morbilli, as a highly infectious illness caused by a virus – a viral infection caused by the rubeola virus. 

The Executive Director, National Primary Health Care Development Agency (NPHCDA), Dr Ado Muhammad, says that measles is an endemic disease; meaning that it is continually present in a community and many people develop resistance. 'If measles enters an area where the people have never been exposed, the result can be devastating,' said he. 

Over the last 150 years, estimates place the total global measles death toll at 200 million people. One fifth of Hawaii's population died in the 1850s from measles. 

Scientists have identified 21 different strains of the measles virus. 

Researchers from the World Health Organisation (WHO) reported in The Lancet April, 2012 issue that global measles mortality fell 74 per cent in one decade even though the world body had aimed for a 90% reduction. 

In the year 2000, there were 535,300 reported deaths from measles worldwide, compared to 139,300 in 2010. 

The authors explained that measles remains a major cause of death in India because only 74% of children are vaccinated, a lower rate than in Africa (76%). 

The authors wrote: 'Despite rapid progress in measles control from 2000 to 2007, delayed implementation of accelerated disease control in India and continued outbreaks in Africa stalled momentum towards the 2010 global measles mortality reduction goal. Intensified control measures and renewed political and financial commitment are needed to achieve mortality reduction targets and lay the foundation for future global eradication of measles.' 

The country presently has continued to witness outbreak especially in the northern part of the country; a development the minister of state for Health, Dr Muhammad Ali Pate, blamed on the refusal of parents to immunize their children. 

According to reports, over 100 deaths have been recorded so far in the epidemic prone states of Kebbi, Sokoto, Katsina, Kano, Niger, Anambra and Jigawa. 

Pate said the pocket of cases recorded in some states could have been avoided if parents had availed their children of the free vaccination provided by the federal government. 

According to him, those who sent out messages discouraging parents from availing their children should be asked to explain why there are cases of measles in some states. 

His words, ' the measles outbreak is a direct consequence of parents' refusal to immunize their children. Measles is a disease which is 99% preventable. 

'We also have effective vaccines, freely being distributed by the National Primary Health Care Development Agency to states. At this time, we should ask those discouraging parents from immunizing their children to explain themselves'. 

He, however, said that the outbreak witnessed in some states cannot be described as an epidemic but rather, pockets of cases which cannot all be called measles until it is confirmed in a laboratory. 

Meanwhile, the NPHCDA boss added that a team of health workers were conducting surveillance and some investigations to ensure that the outbreak is contained appropriately. 

He also lamented that these outbreaks could have been averted if those mischief makers had not sent out messages to parents discouraging them from vaccinating their children, stressing that the reason why states are recording cases of measles is because there are problems with the routine immunization which is not as effective as it is supposed to be. 

Ado said the federal government made available to states, the total requirements for vaccines for routine immunization, adding that what the states are requesting is additional doses to combat the outbreak they are recording. 

His words, 'we are on top of the situation. As I am speaking to you, we are already conducting mob -up exercises in those states that are affected, and the surrounding areas to contain the outbreak. 

'What we are experiencing is the down side of the ineffective measles campaign conducted in 2011, and the states affected now recorded low quality campaigns.' 

'But to avert further cases, we will conduct a massive immunization campaign in June or August to vaccinate all missed children. It would take that long because we need to train health workers to administer the vaccines correctly since it is not administered orally. 

In his contribution, the President, Nigerian Medical Association (NMA), Dr Osahon Enabulele, said to substantially prevent measles, the following are important: 

Promotion and implementation of Routine measles vaccination of children. To maximize the benefits from routine measles vaccination, great efforts on public enlightenment and education on the immense benefits of routine measles vaccination need to be undertaken to overcome religious, cultural and educational barriers to routine immunization; 

He said, 'It is also important to ensure that only potent measles vaccines are used to vaccinate children. In this regard, the essence of uninterrupted power supply to ensure effectiveness of the cold chain storage cannot be over-emphasized. However, it is important to note that even when an individual has been vaccinated with measles vaccine, the immunity developed against measles in the individual is not absolute, as there is a 4-5% chance of the individual still developing measles. This is attributable to some other factors.' 

He also emphasized the urgent need for revitalization and rehabilitation of primary healthcare centres in Nigeria to facilitate delivery of routine immunization. 

Similarly, Enabulele said, efforts at public-private partnership in the delivery of routine immunization should be strengthened. 

'Also critical is the need for the Nigerian government and private entrepreneurs to massively invest in the construction of vaccine manufacturing firms/industries in Nigeria so as to guarantee all-year supply of vaccines' 

' In cases of outbreaks, individuals infected with the measles virus should be appropriately managed with emphasis on barrier nursing so as to limit the spread of the measles virus to potential contacts.' 

'Supportive measures that can help in the prevention of measles or limitation of its spread include: good nutrition to boost the immunity of individuals; adequate housing for the people; implementation of effective travel medicine policies backed by cross border surveillance; vitamin supplementation for children, particularly vitamin A supplementation.' 

On what can be done to forestall future outbreaks, the NMA president pointed out that there is need to sustain and improve the current level of routine measles vaccination in Nigeria. 

His words: 'There is need to guarantee the security and safety of vaccinators and health workers who are very critical to the delivery of vaccines to children' 

'There is also need for intensification of public enlightenment and health education on the immense benefits of routine immunization, while demystifying some misconceptions about vaccines and vaccination.' 

'The place of sustained surveillance, monitoring and evaluation to enable prompt identification and management of cases, cannot be over-emphasized.' 

Also, Idris, who was the immediate past president of the NMA, said giving vulnerable children under five years of age especially at the age of nine months, potent vaccine, is the sure and reliable way to prevent measles infection, outbreak and death. 

The Nigerian Voice

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