By Sara Jerving
Garnering less international attention is an even deadlier outbreak of measles. Over 2,700 deaths have been reported this year, mostly children under the age of 5, with more than 145,000 suspected cases. It is one of the largest outbreaks of the infection globally.
While there are cases across the country, the outbreak has also hit areas impacted by the Ebola crisis. Dealing with the two outbreaks simultaneously has complicated the response, with issues including community mistrust and misdiagnoses.
“It’s taking a bad situation and making it even more challenging in those areas,” said Dr. Mary Agόcs, Measles & Rubella Initiative senior adviser at the American Red Cross.
Last month, a measles vaccination campaign was carried out in an area with active Ebola transmission for the first time.
While measles outbreaks are routine in DRC, the number of suspected cases is six times larger than it was at this time last year. Globally, there have been nearly three times as many measles cases reported this year compared to the same time last year — the highest number of cases the world has seen since 2006, with DRC, Madagascar, and Ukraine at the top of the list.
Early symptoms of Ebola and measles are similar, including fever, red eyes, and diarrhea, proving an obstacle to early diagnosis. Because of resource restraints, not all measles cases are laboratory-tested in DRC, Agόcs said. After a few days, it becomes clear if a person has measles because they develop white spots in their mouth. But those two to three days of waiting can be significant.
“You want to make sure you are appropriately identifying people with Ebola at an early stage and doing the necessary isolation,” she said. “Two or three days may not sound like a lot, but if it’s a child with Ebola, they could be in contact with many other people, and the disease could be spreading.”
The root cause of the outbreak is that the national routine vaccination system is very weak in DRC, leaving many children without measles vaccination, Agόcs said. The strain of dealing with Ebola has further weakened the system.
A study of the West Africa Ebola outbreak found that disruption to routine immunization services led to a 25-75% reduction in vaccination rates in West African nations. This was attributed to the diversion of resources to respond to Ebola, the deaths of health workers, and a sense of reluctance to go to health facilities.
Last month, the United Nations Children’s Fund and DRC’s Ministry of Health began a measles vaccination campaign in the Ebola-affected Ituri Province, in northeastern DRC. The campaign targeted four displacement camps, vaccinating about 40,600 children.
Because of the added complexity of the Ebola outbreak, health workers took extra measures to prevent contact with bodily fluids, including wearing gowns. The vaccination teams also included a worker to check temperatures and refer expected Ebola cases to treatment centers.
One of the main criticisms of the Ebola response over the past year is that humanitarian responders have not made enough effort to engage with communities, which has led to widespread distrust. Many have linked this to the inability of responders to effectively contain the virus.
Now, measles responders are also working to overcome that mistrust in these areas and debunk rumors about vaccine safety, said Dr. Xavier Crespin, chief of health at UNICEF in DRC.
UNICEF has been working with community leaders on communication efforts to convince families to immunize their children against measles.
Since July, the community has been more receptive to the vaccination efforts, he said, and some members have even called for the expansion of the vaccination campaign to other areas, including North Kivu. The agency and government expect to launch another phase of vaccinations in Ituri Province this month, targeting 72,000 children.