Measles outbreak shows no signs of easing; actual vaccination coverage, effectiveness questioned

Highlights

• Around 46 lakh children left out of measles vaccination
• IEDCR to test vaccine effectiveness
• Measles deaths reach 867
• There's been measles-related death every day in past 6 months
• Around 1,000 children hospitalised daily
• 4-6 children dying daily

Nearly six months after Bangladesh's measles outbreak began, infections and deaths continue at a high level, raising questions over the actual coverage and effectiveness of the government's vaccination programme.

Around 1,000 children are still being hospitalised every day with measles or measles-like symptoms on average, while 4-6 children are dying daily, according to health officials. There has not been a single day without a measles-related death in the past six months.

Infographics: TBS

In the past 24 hours until 8am yesterday, another four children died from measles and related symptoms, taking the total number of deaths from measles and measles-like illnesses to 867.

Public health experts say the continued spread is closely linked to gaps in vaccination coverage. They argue that an error in determining the target population for the national measles vaccination campaign left millions of children outside the programme.

Public health expert Dr M Mushtuq Husain told The Business Standard that around 46 lakh children were left out of the measles vaccination campaign because of an error in setting the target.

The issue of vaccination coverage has become more prominent following a comparison between the targets of the measles vaccination and vitamin A campaigns.

The government launched a phased measles vaccination campaign from 5 April after the outbreak began in March. The campaign targeted 1 crore 80 lakh and 15,064 children aged between six months and five years. Government figures say the campaign achieved 103% of its target.

However, a vitamin A campaign conducted in June covered 2 crore 26 lakh children in the same age group. The difference of around 46 lakh children has raised questions over whether the measles campaign target was set too low.

"Because vaccination coverage did not reach 95%, herd immunity was not achieved, and that is why transmission is not declining," Mushtuq said.

"If 95% of children can now be brought under vaccination coverage, infections will start to decline," he said.

Public health specialist and vaccinologist Dr Tajul Islam A Bari told The Business Standard that although authorities have reported 100% vaccination coverage, actual coverage was around 81%.

"Since 95% of children have not been brought under vaccination, infections are not declining. As infections are not declining, deaths are not declining either," he said.

He also noted that measles is being detected among children older than five. He recommended expanding vaccination campaigns to include children up to 10 or even 15 years old, with at least all children up to age 10 brought under vaccination coverage.

Dr Tajul also said the government should take immediate action if testing shows that vaccinated children have failed to develop sufficient antibodies.

The government has acknowledged the target-setting problem.

Health and Family Welfare Minister Sardar Md Sakhawat Husain told TBS that the government realised there had been an error in setting the target for the measles vaccination campaign after the vitamin A campaign.

"Although the national measles vaccination campaign ended on 20 May, health workers have continued visiting homes since the following day to identify children who were missed and vaccinate them," the minister said.

Dr Mushtuq Husain, however, stressed that vaccination alone will not be enough to reduce deaths.

"Healthcare services need to be decentralised to reduce deaths," he said, adding that critically ill children need to receive appropriate treatment at the grassroots level before their conditions deteriorate to the point where ICU care is required.

IEDCR to assess whether vaccinated children developed immunity

The government is preparing to test whether children who received measles vaccines developed adequate protective antibodies.

The Institute of Epidemiology, Disease Control and Research (IEDCR) is expected to begin the testing this month.

Dr Quazi Ahmed Zaki, director of IEDCR, told TBS that preparations are underway to collect samples from vaccinated children to determine whether they have developed protective immunity.

The required testing kits are being imported from abroad, and testing could begin around 10 August after the kits arrive, he said.

"The main objective is to measure whether children have developed immunity at the required level after vaccination," Zaki said.

He described the test as a sensitive and expensive quantitative assessment. As Bangladesh does not currently have the capacity to conduct the test, the necessary kits are being imported.

The initial phase will focus on a cluster in an urban area, followed by sample collection from different rural clusters.

The final sample size has not yet been determined, but IEDCR plans to collect samples from at least 500-600 children. Necessary measures will be taken based on the findings, Zaki said.

Hospitals remain under pressure

Despite the vaccination drive, hospitals continue to face a substantial influx of measles patients.

Dr Asif Ahmed Hawlader, spokesperson for the DNCC Covid Dedicated Hospital, which has been redesignated for measles patients, said the pressure has declined slightly but remains worrying.

Around 300-350 measles patients are currently admitted to the hospital. Yesterday morning, 344 patients were receiving treatment.

The hospital is still admitting around 80-100 new measles patients every day, although the figure had previously reached 120-130.

Asif said critically ill measles patients continue to require ICU treatment, with around 48-52 patients typically occupying ICU beds.

The continuing pressure has also highlighted the need to decentralise treatment facilities.

Yesterday, an eight-month-old child infected with measles died in Sylhet after failing to secure an ICU bed.

Mushtuq Husain said many such deaths could potentially be prevented if critically ill patients received appropriate treatment before reaching the stage where ICU care was required.

According to DGHS data, 1,17,444 patients with suspected measles have been hospitalised nationwide since 15 March, of whom 113,200 have recovered