Poor success rate in eradicating polio has led to administration of polio drops to all travelling out of the country without exception. On top of that, officials fear yet another measles outbreak which we have seen in the past couple of years.
Measles, currently spreading in Sindh, Balochistan and Khyber Pakhtunkhwa (KP), has already claimed at least 18 lives. This is the official figure till the last month of 2014. Last year too, major outbreak of measles was reported in these provinces and this year again the measures are said to be not sound enough to prevent the outbreak. The Punjab is believed to have controlled it to a great extent.
Official vaccination campaign to control measles is underway in KP and Sindh for the past few days. In first quarter of this year, more than 200 measles cases were detected in these areas. The figures include majority of cases in KP, and Sindh and a few in the Punjab, Islamabad and tribal areas. The total number of cases in 2013 was around 9,000 across Pakistan despite nationwide drives.
“Pakistan, sadly, is among the top five countries in the world with miserably low immunisation coverage and poor vaccination ration,” says Dr Qamarul Hassan, the focal person of World Health Organisation (WHO) on measles. He says this is because of poor management. “Around six million children under the age of one year need routine vaccination of measles and other diseases other than special campaigns which are launched to cover maximum children under different ages.”
The number of measles cases has multiplied in Pakistan. In 2011, the total number of reported cases was around 4,500, out of which not less than 2,500 were confirmed. In 2012 the figure of suspected cases tripled to 12,354, out of which 2,975 were confirmed. In 2013, once again the number of suspected cases nearly tripled. Out of 33,314 cases, 8,616 were tested positive. From 2012 to 2013, 600 children died of measles in the country, according to studies.
The WHO statistics show more than 310 children died of measles in 2012 as opposed to 64 in 2011.
Measles is considered a highly contagious disease caused by a virus, specifically, paramyxovirus. Till 1980, before the vaccination became widespread, measles caused an estimated 2.6 million deaths each year. The WHO considers it one of the most readily transmitted communicable diseases. A dose of measles vaccine, given by the intramuscular or subcutaneous route, with opportunity for second dose at least a month after, may prevent a child from this disease.
The WHO recommends every child must receive two doses of measles vaccine. In Pakistan’s apparently extended campaigns, Vitamin A doses are being provided to all vulnerable children during vaccination campaigns and education is also being imparted at operational sites.
The EPI started work in 1978, initially covering six diseases, but it has since grown to cover nine (poliomyelitis, tetanus, measles, diphtheria, pertussis, hepatitis-B, pneumonia, meningitis and tuberculosis). Measles spreads rapidly among un-immunised children and adults.
EPI National Manager Dr Ejaz Khan says the number of reported cases is gradually rising, adding to the worries of an outbreak. “There is chance of an outbreak, if not controlled well in time.”
He says the number of cases in Balochistan and Sindh is going up. “Special campaigns are being run this year in June and October with the financial and technical cooperation of international donors including the Japan International Cooperation Agency. If the campaign goes successful, there are chances of decline in number of measles cases.”
Insecurity is one of the major factors that have restricted the campaigns in different parts of Pakistan. According to the Pakistan Paediatric Association (PPA), as many as 53 percent children in the country are not vaccinated against any disease because of misconceptions about vaccines, including those linked to fertility, or the fact that vaccines cause fever at times.
“We need an effective strategy to counter such diseases through regular catch up campaigns; follow-ups by specifically improving routine coverage up to three, four years,” says Dr Tariq Bhutta, chairman National Immunisation Technical Advisory Committee WHO, which works independently in Pakistan.
The country has inadequate routine coverage of vaccination campaigns due to multiple reasons. “It is a matter of total care,” he says, giving example of America where routine immunisation coverage is up to 95 percent still they face measles outbreak sometimes. Pakistan is 10 times behind.
“Problem with a country like Pakistan is that here routine campaigns are less emphasised. The focus is on the donor driven special campaigns and projects,” he says, adding, “Primary reason is that routine immunisation is not given importance at all despite the fact that EPI’s nine vaccines are free of cost for public.”
Sri Lanka eradicated polio after four special campaigns with its routine immunisation coverage and Bangladesh eliminated this disease in 17 special campaigns. “We, in Pakistan, have miserably failed even after 150 campaigns,” he says, urging the government to make routine immunisation coverage up to 90 percent at least.
The measles campaign first started in 2008, while there was a half campaign in 2010-11. The measles vaccination coverage in Pakistan is up to 50 percent, and even among those who have been immunised about 20 percent is likely not to develop immunity against measles. “This means that every second year there is risk of measles outbreak in Pakistan.”