Concern over reported number of measles cases in Yemen

Milestones :: Perspectives

Concern over reported number of measles cases in Yemen
The Lancet | 12 May 2018
Over 3000 suspected measles cases have been reported in 2018 across Yemen, where conflict has plunged the country into the world’s largest humanitarian crisis. Xun Yuan reports.

As of April 20, over 3000 suspected measles cases have been reported across the country, more than 60 of which were fatal, according to data from UNICEF and WHO. According to UNICEF, the highest numbers of cases have been seen in Aden (786 patients), Al Bayda (324 patients), and Sana’a (245 patients). UNICEF Yemen told The Lancet that the exact number has not yet been confirmed due in part to the poor laboratory examination capacity in Yemen at the time.

Despite the uncertainty, the sheer number of suspected cases still raises alarm. From 2013 to 2017, the number of suspected cases has ranged from about 2000 to 4000 per year, according to UNICEF.

“Every 2 or 3 years, there is a spike in measles cases because the number of unvaccinated children accumulates”, WHO told The Lancet. “The last big outbreak of measles was in 2012, at which time the conflict had not yet begun.” According to WHO, the combination of the expected upsurge in cases since the last outbreak and the deterioration of the security situation—whereby reporting of new cases and access to communities is becoming problematic—makes this uptick of reported cases particularly worrisome.

Fouzia Shafique, chief of health and Nutrition of UNICEF Yemen, told The Lancet that reported coverage of the measles vaccine, MCV1, has generally been maintained on a national scale despite the challenges that the Expanded Program on Immunization faces in Yemen. Based on data shared by WHO and UNICEF with The Lancet, the last national campaign was initiated in November, 2014, and reached all 333 districts, covering 93% of the targeted individuals. In the following years, mop-up campaigns, door-to-door immunisations in specific areas where the virus is known or suspected to still be circulating, were done on a yearly basis, with coverage ranging from 41% to 92%.

A nationwide measles vaccination campaign is scheduled to occur at the end of this year, and is expected to target over 13 million children under the age of 15 years, said Shafique.

Some governorates and districts are nevertheless seeing declines in coverage, according to Shafique.

“Due to deterioration of security situation and considerable stress on the health system, with salaries unpaid in most of the country for over 18 months, and operational cost not paid for much longer, the access to quality services became affected”, she told The Lancet.

A risk assessment done by WHO with UNICEF and the local health authorities this year found that “more than 100 districts were identified as very-high-risk for measles and rubella”, said the Emergency Communications lead of WHO Yemen.

“There is certainly an upsurge of measles cases, at least in Aden. We have admitted 11 measles patients in the last 3 days. But, sadly, we do not have enough resources to vaccinate other children at risk”, a doctor based in Aden, who chose to remain anonymous because of safety concerns, told The Lancet. Doctors in the area have been known to be targeted by violent attacks, this doctor reported.

Local residents at Jayshan District in Abyan Governorate also expressed frustration with the near-complete collapse of the information system in Yemen, because of which they did not receive updates about vaccination programmes.

When asked about the past vaccination campaigns, Sadiq Basha, a Jayshan District local resident whose son was diagnosed with measles, seemed surprised and told The Lancet in Arabic, “I have never heard of such things. If I did, why would I let my kid go unvaccinated?”
Apart from the accessibility issue, a doctor based in Aden also raised concern about the inability to maintain the cold chain, which he said was due to lack of fuel to support the generators.

Although the Saudi-led coalition’s blockade on the Al Hudaydah port was officially lifted, sources told The Lancet that the decreased capacity of the port and the delayed clearances for imports continued to pose challenges to the import of fuel. The UN Verification and Inspection Mechanism has reported that the total fuel imports for April were 27% of the monthly national requirements.

UNICEF, however, believes that the break of the cold chain is rare. “UNICEF provides fuel to the national and all governorate-level cold rooms”, Shafique told The Lancet. “We have also helped installed solar panels in over 300 sites so as to not be dependent on electricity and fuel.”
Some local residents have said that concerns about the stability of the vaccines have deterred them from bringing their children to get vaccinated.

“We heard the vaccines distributed by local clinics are no longer effective”, Nawal Hanna, another local resident at Jayshan District, told The Lancet, “we don’t know if there are any harms coming from getting those vaccines, but we’d rather not take that risk.”