Milestones :: Perspectives :: Research
UNICEF delivers over 260,000 vaccines and medical supplies to fight measles outbreaks in Samoa, Fiji and Tonga
Delivers 115,500 doses of measles vaccines to worst-affected Samoa
SUVA, 28 November 2019: UNICEF is supporting the Governments of Samoa, Fiji and the Kingdom of Tonga to respond to the current measles outbreak in the Pacific region. As of 28 November, almost 300,000 vaccines and medical supplies have been delivered to reach those populations most at-risk in Samoa, Fiji, the Kingdom of Tonga, Vanuatu, Cook Islands, Nauru, Niue, Tokelau and Tuvalu.
UNICEF is responding to the outbreak together with the World Health Organisation (WHO) and other partners. UNICEF’s response is being conducted with the support of the Australian Department of Foreign Affairs and Trade (DFAT) and New Zealand’s Ministry of Foreign Affairs and Trade (MFAT).
The Government of Samoa officially declared a state of emergency on 15 November 2019. UNICEF has delivered a total of 115,500 doses of measles vaccines to Samoa since 1 October, including the required diluent, syringes and safety boxes, as well as sufficient supplies of Vitamin A.
The national Measles Vaccination Campaign began on 20 November 2019 with mobile outreach vaccination sites and teams, and special vaccine booths. Since the launch of the campaign, the Ministry of Health has successfully vaccinated more than 33,500 individuals in both Upolu and Savai’i.
UNICEF has delivered six 42 sqm tents, which will be used as vaccination sites or isolation wards for patients with measles. Six specially designed refrigerators and three emergency trolleys will also be provided to the Ministry of Health, to ensure the cold chain is maintained and vaccines are effective when given at vaccination sites.
Fiji declared a measles outbreak on 7 November 2019. Since 1 October, UNICEF has delivered a total of 135,000 doses of measles vaccines with required diluent, syringes and safety boxes. An additional 200,000 vaccines are en route to Fiji.
KINGDOM OF TONGA
A measles outbreak was also declared in the Kingdom of Tonga on 24 October 2019. Since 1 October, UNICEF has delivered a total of 12,000 measles vaccines including required diluent, syringes and safety boxes, to Tonga. Two refrigerators, for the vaccine cold chain, will also be provided along with an additional 6,000 doses of vaccines.
UNICEF and WHO have jointly prepared a communication toolkit and resources to be used for measles prevention, which has been shared with all Pacific Island governments, including Samoa, Fiji and the Kingdom of Tonga. The toolkit is a regional resource, which countries can use and adapt to their country’s needs. It includes a range of communication products targeting three main audiences: travellers, general public and health workers.
4,500 children under the age of five died from measles in the Democratic Republic of the Congo so far this year
Statement by UNICEF Representative in the DRC Edouard Beigbeder
KINSHASA, 27 November 2019 – “Since the beginning of the year, more than 5,000 people have died due to measles, over 90 per cent of them children under the age of five.
“While the Ebola outbreak, which has claimed more than 2,000 lives in the Eastern DRC, has commanded sustained international attention, measles, which has claimed more than twice as many lives, continues to be underreported.
“Violence and insecurity, lack of access to healthcare and shortages of vaccines and medical kits in the worst-affected areas have meant that thousands of children have missed out on vaccinations, with potentially deadly consequences. Cultural beliefs and traditional healthcare practices also often get in the way of vaccinating children against measles and treating those with symptoms.
“Despite the many challenges, we have the tools and the knowledge to prevent measles with a safe, effective and affordable vaccine. The key is to reach every single child, no matter where they are.
“UNICEF and partners are conducting measles vaccination campaigns in the worst-affected areas and supplying clinics with medicine to treat symptoms. So far, we have distributed 1,317 medical measles kits – containing antibiotics, rehydration salts, Vitamin A and other medicines – to affected health zones to treat children with complications.
“Yet these measures can only ever be a short-term solution, as significant investment in strengthening DRC’s national vaccination programme and wider health care systems is crucial to guarantee the health and wellbeing of the country’s children.”
Measles – Global situation
Disease outbreak news = WHO
27 November 2019
Many countries around the world are experiencing measles outbreaks. As of 5 November 2019, there have been 440,263 confirmed cases reported to WHO through official monthly reporting by 187 Member States in 2019.
The following is a brief update on the global measles situation based on information shared by Member States with WHO. Note that this is an evolving situation and data is constantly updated. Data below are based on the latest information available to WHO.
Large measles outbreaks are being reported in several countries in the region. Outbreaks are ongoing in Madagascar and Nigeria ; although the rate of new cases is decreasing, cases are still being reported weekly. As of 17 November 2019, a total of 250,270 suspected cases with 5,110 associated deaths have been reported by the Democratic Republic of the Congo, an increase in more than 8,000 cases compared to the previous week. All provinces are affected, and a national outbreak response vaccination campaign is ongoing in phases and should be completed by the end of the year. As of 13 November, Guinea had 4,690 suspected measles cases, 1,091 of which were confirmed. Outbreak vaccination response activities are underway. As of 17 November 2019, Chad had reported 25,596 suspected cases in 94% of their districts; outbreak response vaccination is planned.
Eastern Mediterranean Region
From 1 January through 17 November 2019, Lebanon reported 1,060 confirmed cases of measles1 (For more information, please see Disease Outbreak News (DON) published on measles in Lebanon on 22 October 2019). As of 8 November 2019, current outbreaks of concern include Yemen with 5,847 confirmed cases, Sudan with 3,659 confirmed cases, Somalia with 2,795 cases, Pakistan with 1,978 confirmed cases, Tunisia with 1,367 cases, and Iraq with 1,222 cases of measles.
Many countries in Europe experienced large outbreaks in 2019. From 1 January through 5 November 2019, Ukraine has reported 56,802 cases, followed by Kazakhstan with 10,126 cases, Georgia with 3,904 cases, Russian Federation with 3,521 cases, Turkey with 2,666 cases, and Kyrgyzstan with 2,228 cases of measles. Some of these outbreaks (e.g. Georgia, Russian Federation, Turkey) have resolved.
Region of the Americas
From 1 January through 9 November 2019, Brazil reported 11,887 confirmed cases of measles, with the majority of cases in Sao Paulo. A vaccination response is underway.
During the same time, Venezuela reported 520 measles cases with no new case being reported in the last 14 weeks. Colombia has reported 215 cases which were likely acquired in Venezuela. In the United States, two large sustained outbreaks in New York State have also been declared over; however, small outbreaks are still occurring in other states within the United States. 2
South-East Asia Region
From 1 January through 18 November, Bangladesh has reported 4,181 confirmed cases of measles. Much of the current, growing outbreak is centered in Rohingya refugee camps in Cox’s Bazaar; vaccination efforts continue. Myanmar has had 5,286 cases though their outbreak appears to be resolving after two rounds of outbreak response immunization. A nationwide vaccination campaign for children aged 9-65 months is ongoing. There is a need to also vaccinate previously unreached adults to stop the current ongoing transmission.
During the same time, Thailand reported 4,852 cases, and a vaccination campaign targeting children between 1-12 years of age is ongoing; however, there is a need to conduct vaccination campaigns for susceptible populations born between 1984 to 2000 as well as migrant populations in industrial areas, people participating in travel and tours company and such other establishments.
Western Pacific Region
Outbreaks in the Philippines and Viet Nam earlier in 2019 drove the increase in cases in the Region, but new cases are decreasing in these countries. As of 20 November 2019, current outbreaks include New Zealand with 2,084 confirmed cases, of which 80% are in the Auckland region 3 ; Cambodia has 490 cases with cases occurring in all provinces.
From 1 January through 23 November 2019, multiple countries in the Pacific Islands are experiencing outbreaks including Tonga (310 cases), Fiji (10 cases)4 , and American Samoa (2 cases). As of 26 November, the Samoa Ministry of Health confirmed a total of 2,437 cases and 32 associated deaths, with 243 new cases reported within the last 24 hours 5 . These islands are conducting outbreak response activities and mitigation measures, including vaccination campaigns.
Public health response
WHO and partners coordinate their support to Member States for the following activities:
:: Enhancing preparedness for measles outbreak response
:: Strengthening public trust in vaccines
:: Strengthening surveillance, risk assessment and outbreak investigations
:: Improving clinical management of measles cases
:: Implementing outbreak response immunization activities
:: Evaluating outbreak response activities
WHO has established a measles outbreaks Incident Management Support system to coordinate its support to affected countries.
WHO risk assessment
Measles is a highly contagious viral disease which affects susceptible individuals of all ages and remains one of the leading causes of death among young children globally, despite the availability of safe and effective measles-containing vaccines. It is transmitted via droplets from the nose, mouth, or throat of infected persons. Initial symptoms, which usually appear 10–12 days after infection, include high fever, usually accompanied by one or several of the following: runny nose, conjunctivitis, cough and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreads downwards. A patient is infectious four days before the start of the rash to four days after the appearance of the rash. Most people recover within 2–3 weeks.
Even with implementation of routine immunization, measles continues to circulate globally due to suboptimal vaccination coverage and population immunity gaps. Any community with less than 95% population immunity is at risk for an outbreak. If an outbreak response is not timely and comprehensive, the virus will find its way into more pockets of vulnerable individuals and potentially spread within and beyond the affected countries.
The impact on public health will persist until the ongoing outbreaks are controlled, routine immunization coverage is continuously high (≥ 95%) and immunity gaps in the population are closed. As long as measles continues to circulate anywhere in the world, no country can be assured to avoid importation. However, countries can protect their populations through high vaccine coverage achieved primarily through routine immunization programmes, and where necessary through supplemental immunization activities designed to assure that susceptible individuals are vaccinated.
Immunization is the most effective preventive measure against measles. Two doses of measles-containing-vaccine are recommended to ensure immunity.
While there is no specific antiviral treatment for measles,prompt provision of vitamin A is recommended by WHO for all children infected with measles. It is critical to quickly recognize and treat complications of measles in order to reduce mortality and severity of disease.
WHO urges all Member States to do the following:
:: Maintain high measles vaccination coverage (≥ 95%) with two doses of measles-containing-vaccine, in every district;
:: Offer vaccination to individuals who do not have proof of vaccination or immunity against measles, and who are at risk of infection and transmission of the virus, such as healthcare workers, people working in tourism and transportation, and international travelers;
:: Strengthen epidemiological surveillance for cases of ‘fever with rash’ for timely detection of all suspected cases of measles in public and private healthcare facilities;
:: Ensure that collected blood samples from suspect measles cases appropriately tested by laboratories within five days;
:: All countries need to provide a rapid response to imported measles cases to prevent the establishment or re-establishment of endemic transmission;
:: Recognize complications early and provide comprehensive treatment to reduce the severity of disease and avoid unnecessary deaths.
:: Administer vitamin A supplementation to all children diagnosed with measles to reduce the complications and mortality (two doses of 50, 000 IU for a child less than 6 month of age, 1,00,000 IU for children between 6 and12 months of age or 2,00,000 IU for children 12-59 months, immediately upon diagnosis and on the following day.
:: Ensure health care workers are vaccinated in order to avoid infections acquired in a health care setting.