Science
13 March 2015 vol 347, issue 6227, pages 1169-1284
http://www.sciencemag.org/current.dtl

In Depth
Infectious Diseases
As Ebola fades, a new threat
Leslie Roberts
A second, often overlooked, public health crisis is brewing in the countries hardest hit by Ebola, epidemiologists warn. The Ebola epidemic has devastated already weak public health systems and disrupted childhood vaccinations in Liberia, Guinea, and Sierra Leone. As a result, unless action is taken quickly, preventable childhood diseases will likely soar. Measles, in particular, is considered a sentinel of a broken health system, often hitting early and hard in the aftermath of a disaster. In a paper in this week’s issue of Science, researchers put some sobering numbers on the size of a potential measles outbreak in the region post-Ebola. In the worst case, they warn, a measles outbreak could kill thousands more people than Ebola has.

Report
Reduced vaccination and the risk of measles and other childhood infections post-Ebola
Saki Takahashi1, C. Jessica E. Metcalf1,2, Matthew J. Ferrari3, William J. Moss4, Shaun A. Truelove4, Andrew J. Tatem5,6,7, Bryan T. Grenfell1,6, Justin Lessler4,*
Author Affiliations
1Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08544, USA.
2Woodrow Wilson School, Princeton University, Princeton, NJ 08544, USA.
3Centre for Infectious Disease Dynamics, Pennsylvania State University, State College, PA 16801, USA.
4Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
5Department of Geography and Environment, University of Southampton, Southampton SO17 1BJ, UK.
6Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA.
7Flowminder Foundation, 17177 Stockholm, Sweden.
Abstract
The Ebola epidemic in West Africa has caused substantial morbidity and mortality. The outbreak has also disrupted health care services, including childhood vaccinations, creating a second public health crisis. We project that after 6 to 18 months of disruptions, a large connected cluster of children unvaccinated for measles will accumulate across Guinea, Liberia, and Sierra Leone. This pool of susceptibility increases the expected size of a regional measles outbreak from 127,000 to 227,000 cases after 18 months, resulting in 2000 to 16,000 additional deaths (comparable to the numbers of Ebola deaths reported thus far). There is a clear path to avoiding outbreaks of childhood vaccine-preventable diseases once the threat of Ebola begins to recede: an aggressive regional vaccination campaign aimed at age groups left unprotected because of health care disruptions.