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Increasing cases of measles in Pakistan… who is responsible?

Measles is a highly contagious and serious disease caused by virus in the paramyxovirus family,which is characterized by fever,runny nose,cough,red eyes and spreading rash.

The bacteria normally grows in cells that lie the back of throat and lungs and complications from it can occur in almost every organ system.

It is mentioned in journal of infectious diseases volume 189 that:

“Pneumonia, croup and encephalitis are common causes of death due to measles. Measles remain a common cause of blindness in developing countries .Croup and otitis media are more common in those less than 2 years old and encephalitis in older children and adults.”

Licensed vaccine to prevent measles became available in 1963.

It was between 1985-1988,researchers found that many measles cases had occurred in children who had been vaccinated with measles vaccine.

This was particularly noticed in children who received only one dose. This led to recommendation of second dose for children between 5 and 19 years of age.

The booster dose significantly increased the protection and children who did not develop immunity at first dose develop it with second dose.

Burden of measles is increasing continuously in Pakistan.

According to a W.H.O report,

“Cases of measles reported in Pakistan in 2015 were 386,in 2016 were 2703 and in 2017 were 9175.”

According to a news report published in an English daily on May 29, 2018:

“Punjab is at potential risk of measles outbreak.31 children died in province of Punjab due to measles.Most cases were reported from Lahore followed by Rawalpindi and Gujranwala.”

According to EPI performance indicator, a total of 5178 suspected and 258 confirmed cases have been reported in Pakistan.Moreover EPI director confirmed that number of deaths reported during first five months of 2018 due to measles were double compared to that of last year.

According to research article published in Journal of Pakistan Medical Association: “In Islamabad, out of 550 reported cases of measles 305 were from urban areas and more than 50% were vaccinated.This is further supported by study conducted in Lasbella,Karachi which showed the rate of vaccination failure to be 50%.another study conducted in Karachi showed the coverage of measles to be 90% but measles antibodies were found only in 55% of children.”

This puts a big question mark on our vaccination program.

Is it only our vaccination program which is not effective or are there some other factors which are also contributing to the spread of this disease?

Pakistan is among the five nations where almost a million children did not receive their first dose of measles vaccination.So it remains a leading cause of death among children.

But the question is why they do not get vaccinated?

Is it only the government and our health system who is responsible or are we also equally contributing to it? There may be number of answers to this question.It may be due to corruption in health system, poor health infrastructure,lower immunization coverage,lesser awareness among population, socio –economic status,distance to the facility,some people who are not taking the booster dose because they might think that just one dose is enough but actually its not.

Another most important reason for increasing incidence of measles is malnutrition.Vitamin A deficiency is one of the leading causes of measles.

According to an article published in HOAJ:

“Negligence among parents is one of the main reason of lower vaccination coverage among children. This may be due to many reasons but the most worrisome situation arose when parents from some religious communities in Sindh refuse to vaccinate their children stating that it is not a disease and is a test of faith as some religious goddess has entered the children and will abstain after sometime”

In May 2015,Journal of Medicine published a report stating that measles infection can leave apopulation at increased risk for mortality from other diseases for 2-3 years.

All this indicates that the government should take serious steps to strengthen our routine immunization programs.

Awareness should be raised among population by arranging seminars and through different awareness campaigns. Serious steps should be taken against corruption in health system.

Special units should be formed in different hospitals with proper facilities to prevent the spread while vaccination process should be carefully carried out to eradicate the disease

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