Severe measles outbreaks are likely to occur in 2021 as an unexpected consequence of the COVID-19 Pandemic, according to a new scientific article.
The article, published in The lancetUrges international action to prevent potentially devastating measles epidemics in the years to come.
Lead author Professor Kim Mulholland of the Murdoch Children’s Research Institute and chair of the World Health Organization’s SAGE Working Group on Measles and Rubella Vaccines said many children have missed the measles vaccination this year, making future measles outbreaks inevitable.
Professor Mulholland said while 2020 had been a quiet year for measles, in part due to travel cuts and national COVID-19 control measures, the economic impact would lead to many cases of child malnutrition.
Malnutrition worsens the severity of measles and leads to worse outcomes and more deaths, especially in low and middle income countries.
“Children who die of measles are often malnourished, but acute measles causes many surviving children to become malnourished,” he said. “Malnutrition, together with measles-associated immunosuppression, leads to delayed mortality, while a simultaneous vitamin A deficiency can also lead to measles-associated blindness.
“In the coming months, there will likely be an increasing number of unimmunized children who are susceptible to measles. Many live in poor, remote communities where health systems are less resilient and malnutrition and vitamin A deficiencies are already increasing. ”
Professor Mulholland said the COVID-19 pandemic has also had a profound impact on the fight against vaccine-preventable diseases, as vaccination campaigns were suspended in the first few months of 2020 and routine vaccination services were severely disrupted in many countries.
WHO estimates that delayed vaccination campaigns in 26 countries by the end of October 2020 resulted in 94 million children missing scheduled measles vaccination doses.
“All of these factors create the environment for severe measles outbreaks in 2021, accompanied by increased mortality rates and the severe consequences of measles that were common decades ago,” said Professor Mulholland. “This is despite the fact that we have an extremely inexpensive way to prevent this disease with measles vaccination.”
In 2019, before the pandemic began, the world saw a dramatic return of measles, more than it had ever done in the past 20 years. According to WHO data, there were 9.8 million measles cases and 207,000 deaths in 2019, 50 percent more than in 2016.
Most of the deaths from measles in 2019 were in Africa, many of them related to major outbreaks in Madagascar and the Democratic Republic of the Congo. Measles also re-emerged in South America, particularly among indigenous communities.
“The inadequate vaccination that led to the measles outbreaks in 2019 has still not been adequately addressed, and the situation is now exacerbated by operational disruptions during the COVID-19 pandemic, causing high-risk children at risk to unite in unreached communities “said Professor Mulholland.
The article identified three pillars for immediate action:
- Help countries reach unimmunized children through catch-up vaccinations and campaigns
- Better prepare countries for expected outbreaks. WHO and its partners have developed a strategic response plan to support measles outbreak prevention, preparedness and response
- Keep the measles and rubella elimination goals in place. WHO’s new Strategic Framework for Measles Rubella 2021–2030, aligned with the 2030 Immunization Agenda, includes a plan to strengthen routine immunization and surveillance.
Professor Mulholland said the solutions would help end the cycle of insufficient immunization and outbreaks of the past decade.
“Without a concerted effort, measles and its serious, often fatal complications are likely to increase in the years to come,” he said.
Reference: “Measures are now needed to prevent further increases in measles and measles mortality in the coming years” by Kim Mulholland, Katrina Kretsinger, Liya Wondwossen and Natasha Crowcroft, November 12, 2020, The lancet.
DOI: 10.1016 / S0140-6736 (20) 32394-1