Malawi on course to eliminate measles
In Malawi, government commitment to eliminate measles
has led to a dramatic reduction in measles cases and deaths. This
achievement has involved support from community volunteers and concerted
efforts to train health workers, improve immunization safety, strengthen
disease reporting systems, and mobilize parents to immunize their
children against measles.
Measles kills more children than any other vaccine-preventable
disease -- most of them in developing countries. The highly contagious
disease accounts for almost one in ten of all deaths among children
under five -- half of them in children less than a year old. In 1998,
there were an estimated 30 million cases of measles worldwide and
about 900 000 deaths. Measles can also lead to lifelong disabilities,
including brain damage, blindness, and deafness, especially in developing
countries. The disease thrives in cities -- especially in deprived
urban areas where overcrowding ensures the continued circulation of
the measles virus.
Yet measles deaths and disability can be prevented.
A vaccine against measles has been available for over three decades.
It is safe, effective, and costs only US$ 0.26 for the single dose
needed to immunize a child. But in 1998, one in five of the world's
children were not immunized against measles during their first year
of life. And in Africa, which accounts for more than half of the
measles cases, less than 50% of children were immunized. Meanwhile,
in six African countries, only one in three -- or less-- were protected
Against this backdrop of low immunization coverage in
Africa, Malawi has succeeded in boosting immunization coverage against
measles from only 50% in 1980 to almost 90% today. As a result, the
number of reported cases and deaths has fallen dramatically. During
1999, only two laboratory-confirmed cases were reported. And, for
the first time ever, no measles deaths. Yet only two years earlier,
almost 7000 measles cases were reported and 267 deaths (although most
cases go unreported and WHO estimates that nine times as many cases
and almost five times as many deaths actually occurred).
This turnaround has been achieved in one of the world's
poorest countries. One in five of the population do not have access
to health services, less than 50% have access to safe water, and only
3% have access to adequate sanitation. In 1998, life expectancy hovered
at just below 40.
The first key step in reducing measles deaths in Malawi
was a sustained increase in routine immunization coverage. This led
to an encouraging sharp drop in measles cases and deaths. However,
while epidemics have become less frequent, they still occur every
3-5 years -- triggered by a build-up in the number of children who
have not been immunized and by the vaccine's inherent 15% failure
rate. In an epidemic in 1992, for example, 11 000 cases were reported.
Then in 1998, Malawi launched a campaign to eliminate
measles. The strategy, developed in the Americas, where measles has
almost been eliminated, involves a 3-pronged attack to halt transmission
of the virus: a nationwide immunization campaign usually targeting
every child from nine months to 14 years ("catch-up"); sustained routine
immunization coverage of at least 95% of children during the first
year of life ("keep-up"); and nationwide campaigns every 2-5 years
usually targeting children born after the initial catch-up campaign
("follow-up"). The aim is to ensure that few if any children slip
through the immunization net.
In June 1998, a nationwide immunization campaign in
Malawi targeting 4.7 million children from 9 months to 14 years succeeded
in reaching over 90% of the target population. In addition, vitamin
A supplements -- which can prevent one in four child deaths from infectious
diseases -- were given to all children aged six months to five years.
The cost of the campaign -- including delivery costs -- was US$ 0.78
for every child vaccinated.
Malawi's success in reducing the death toll from measles
has involved concerted efforts to train health workers, improve immunization
safety (including vaccine quality assurance and injection safety),
and strengthen disease surveillance and monitoring skills. A key factor
has been the success of social mobilization campaigns in encouraging
parents to immunize their children against measles. In some cases,
community volunteers have helped organize door-to-door immunization
or set up vaccination posts nearby to ensure that previously unreached
children could be immunized.
Today, in an effort to prevent epidemics of measles,
Malawi is continuing efforts to ensure that at least 95% of children
are immunized during the first year of life and to identify populations
where children are unimmunized and at high risk of continued transmission
of the measles virus. These children will be targeted in the follow-up
phase of the campaign.