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November 2015, Volume 65, Issue 11

Letter to the Editor

Increased incidence of measles in vaccinated population of Pakistan

Noman Ahmed Jang Khan  ( Dow Medical College, Karachi, Pakistan. )
Ehsan Faquih  ( Dow Medical College, Karachi, Pakistan. )
Syed Mojizul Hasan  ( Sindh Medical College, Karachi, Pakistan. )

Madam, It is a matter of great concern that measles has become one of the major contributor to the mortality and morbidity of children all over the world including Pakistan.1 Measles is caused by RNA virus called as paramyxovirus. It is a highly contagious disease spread mainly through airborne particles in cough and sneeze .The incubation period is 10 -14 days.2 The symptoms are usually followed by a typical maculopapular rash starting from face spreading downwards.
Unfortunately due to lack of proper surveillance infrastructure, the demographic statistics of measles including age of the patient are unknown.According to World Health Organization, 4386 cases in 2011 8046 in 2012 and 8749 cases were reported in 2013 from Pakistan.3
Even though the risk of contracting measles is high in un-vaccinated population, the increased outbreaks in vaccinated populations raises a big question on our vaccination programme. The cause of measles outbreaks despite extensive immunization demands serious attention .According to a senior doctor in Pakistan Institute Of Medical Sciences, Islamabad, out of 550 reported cases of measles, 305 cases were from Urban areas and more than 50 % were vaccinated.4 This is further supported by a study conducted in Lasbella Karachi which showed the rate of vaccination failure to be over 50%.5 Another study conducted in Karachi showed the coverage of measles to be 90 % but measles antibodies were only found in 55 % of children.6
According to another study poor immunization, corruption in health system, destabilized immunization programmes, negligence among parents and malnutrition are some major causes of immunization failure in Pakistan.7
The causes of vaccination failure should be sorted out. Seminars and awareness workshops should be organized to increase awareness about measles. CME and Training programmes should be introduced for health care personnels responsible for vaccinations in order to make immunization more effective. Isolation units should be present in all centres to cut down the spread of measles in close contacts. The EPI programme should be reviewed according to the international standards set by World Health Organization. The cold chain maintainance should be given pivotal importance. The corruption in health system should be highlighted and fixed. New techniques to test the specimen should be introduced and access to vaccination be made easy for everyone including those in rural areas. All these measures can help eradicate measles from Pakistan and decrease the mortality associated with measles epidemics.


References

1. Mehnaz A. Infectious diseases in children-still leads. J Pak Med Assoc 2009; 59: 425-6.
2. Goodall EW. Incubation period of measles. Br Med J 1931; 1: 73-4.
3. World Health Organization. Measles reported cases. (Online) Cited 2015 July 4). Available from URL: http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tsincidencemeasles.html/July 2015.
4. Wasif S. Measles outbreaks: city hospitals continue to receive new cases. The Express Tribune. April 27, 2013. (Online) Cited 2015 July 4). Available from URL: http://tribune.com.pk/story/541062/measles-outbreak-city-hospitals-continue-to-receive-new-cases/.
5. Ledogar RJ, Fleming J, Andersson N. Knowledge synthesis of benefits and adverse effects of measles vaccination: the Lasbela balance sheet. BMC Int Health Hum Rights2009; 9(Suppl 1): S6. doi:10.1186/1472-698X-9-S1-S6.
6. Sheikh S, Ali A, Zaidi AK, Agha A, Khowaja A, Allana S, et al. Measles susceptibility in children in Karachi, Pakistan. Vaccine 2011; 29: 3419-23. doi:10.1016/j.vaccine.2011.02.087.
7. Khan T, Qazi J. Measles outbreaks in Pakistan: causes of the tragedy and future implications. Epidemiol Rep2014; 2: 1.

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