Measles, one of the world’s most contagious diseases, has resurfaced in Zimbabwe and is killing children in Manicaland and Masvingo provinces.

The last outbreak hit Manicaland ten years ago and was attributed to apostolic sects whose religious beliefs abhor vaccinating children or seeking any medical treatment.

The long lull was broken on April 10 this year when the first cases of measles were recorded in Mutasa District in Manicaland Province before the disease spread to Masvingo province. More than 50% of the registered cases are from unvaccinated children.

According to data shared by the Government through the weekly Disease Surveillance System on 5 September, a total of 6034 suspected cases, 4266 recoveries and 685 deaths have so far been recorded since the onset of the outbreak.

Manicaland Province has the highest burden (52.5%) and highest case fatality rate (9.8%).

The government, with other partners, launched a massive vaccination blitz to contain the disease.

UNICEF, which is helping government to address vaccine hesitancy in communities and respond to misinformation and rumors circulating within communities, said it ‘is deeply concerned with the numbers of cases and deaths among children’ due to the outbreak.

The World Health Organization (WHO) had already warned in April about the increase in measles in vulnerable countries as a result of a disruption of services due to COVID-19.

What is Measles?

Measles, also called Rubeola, is a highly contagious respiratory tract viral infection commonly found in children.

According to the Center for Disease Control and Prevention, Measles symptoms appear 7-14 days after contact with the virus and typically include high fever (which may spike to more than 104°), cough, runny nose and watery eyes. Measles rash appears three to five days after the first symptoms.

Two to three days after symptoms begin, tiny white spots (Koplik spots) may appear in the mouth. The spots may appear on the face at the hairline and spread downward to the neck, trunk, arms, legs and feet.

Who is at risk?

Unvaccinated young children are at the highest risk of measles and its complications, including death. Unvaccinated pregnant women are also at risk. Any non-immune person (who has not been vaccinated or was vaccinated but did not develop immunity) can become infected.

According to a WHO fact sheet on measles, the overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.

“Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection.”

“Serious complications are more common in children under the age of 5, or adults over the age of 30. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases,” noted the WHO in its fact sheet on measles.

Outbreaks

Measles outbreaks can result in epidemics that cause many deaths, especially among young, malnourished children. In countries where measles has been largely eliminated, cases imported from other countries remain an important source of infection.

Treatment

WHO notes that no specific antiviral treatment exists for the measles virus. Severe complications from measles can be reduced through supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral re-hydration solution. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.

All children diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This treatment restores low vitamin A levels during measles that occur even in well-nourished children and can help prevent eye damage and

blindness. Vitamin A supplements have also been shown to reduce the number of measles deaths.

Prevention

Measles can be prevented through mass routine measles vaccination for children, immunization campaigns in countries with high case and death rates.

Vaccine costs a dollar

WHO further notes that the measles vaccine has been in use for nearly 60 years. “It is safe, effective and inexpensive. It costs approximately one US dollar to immunize a child against measles.

“Two doses of the vaccine are recommended to ensure immunity and prevent outbreaks, as about 15% of vaccinated children fail to develop immunity from the first dose.”