In May, we posted a story about the rapid and devastating spread of measles in Bangladesh. The headline: More than 500 children have died in an outbreak that the world is virtually ignoring. We asked the reporter who covered the story to tell us what has transpired since then.
There was optimism early on about bringing the measles outbreak in Bangladesh under control.
In April, the country's health minister, Sardar Md. Sakhawat Husain, offered this assessment: "Measles outbreak has somewhat decreased in the country. Once the nationwide vaccination campaign begins on April 20, the situation will improve further."
The goal was to vaccinate 18 million children ages 6 months to 5 years, even if records indicated they'd already been vaccinated. That goal was met and then some, with 18.4 million vaccinations.
Five months later, the outbreak continues apace.
In August, the Centers for Disease Control and Prevention reported that Bangladesh has had more measles cases than any other country from January to June of this year: 57,561.
On the day of Aug. 31, authorities recorded 1,162 suspected cases and 94 confirmed cases in 24 hours.
On September 9, the toll for children who have died from suspected or confirmed measles cases since March 15 passed 1,000, according to the Directorate General of Health Services of Bangladesh.
Why has the virus not been conquered?
It turns out that 18 million vaccinations wasn't enough to reach all the unvaccinated children. Health experts in the country now say that 22.6 million is the true target.
This persistent immunization gap has given the highly contagious virus a continued chance to spread.
"Many children have still not received the measles vaccine, so we cannot go into a relaxed mode," Tajul Abdul Bari told NPR. He is a vaccine expert and former program manager of the government's Expanded Programme on Immunization. "We need to start a new vaccination campaign, potentially covering children from 6 months up to under 10 years of age. We did something similar in 2014."
Dr. Javid Abdelmoneim, president of Médecins Sans Frontières International, told NPR, "The management of a measles outbreak is vaccinating. Vaccinate, vaccinate, vaccinate."
"Measles has a very specific biology. It is highly transmissible. One case of measles can affect 100 others," he added.
Dr Jahangir Alam, the World Health Organization's divisional coordinator for the capital city of Dhaka, said: "Even small gaps in immunization coverage can trigger outbreaks. Every missed child increases the risk."
Indeed, a UNICEF situation report says that 72% of cases are among those with no doses of the two-dose vaccine and 16% of the patients are partially vaccinated.
The toll has been worsened because of the country's widespread malnutrition, which increases the risk of severe illness and death from a measles infection. "Children who are underweight or have two or more medical conditions at the same time suffer more, and their condition worsens," says Colonel Latifa Rahman, director of Mohakhali DNCC Hospital, the hospital in the capital that is now doing nothing but measles care.
Malnutrition can also lessen the immunity conferred by a vaccine.
Next steps
On Aug. 18, Bangladesh announced it will vaccinate another 1.6 million children against measles.
Former Health Services Division Secretary Md Kamruzzaman Chowdhury said official data shows that in some pockets of the country, there are children between 6 months and 5 years who missed out on vaccination. in pockets of the country.
"In light of that, we will administer the 1.6 million vaccines we currently have," he said.
The government is also moving to procure another 2.5 million doses to guard against future shortages, according to Kamruzzaman.
"We will give 1.6 million now and are procuring 2.5 million vaccines for the future. We have spoken with UNICEF about purchasing these vaccines," he added.
So the early forecast of a quick end to the outbreak has been tempered by the reality in Bangladesh.
"There is no scope for unrealistic assurances. Even if the pace of vaccination were doubled, it would still take another two to three months to bring the measles outbreak fully under control," State Minister for Health Dr. M.A. Muhit said on Aug. 19.
The toll on families
As the outbreak continues, thousands of families are being driven into financial distress. Nearly 9 in 10 affected households have borrowed money for treatment and 6 in 10 have exhausted their savings, according to a joint assessment in May and June by the Bangladesh Red Crescent Society and the International Federation of Red Cross and Red Crescent Societies (IFRC).
The assessment covered 2,746 measles-affected households receiving care at 12 government medical colleges and district hospitals.
Sonakshi Dey of the IFRC in Bangladesh said economic hardships continue even if a child has recovered: "Beyond direct medical expenses, caregivers often lose income when they need to stay home to care for a sick child or travel repeatedly to health facilities. For low-income households that depend on daily wages, even a short interruption to work can have serious consequences for household wellbeing and food security."
Families who have lost a child face the heaviest toll of all. Toriqul Islam, whose 10-month-old boy died due to measles on May 9, said in a heavy tone:
"When fate turns against you, this is what happens. I don't know if there is any greater pain in this world.
"Let the government do whatever they want, but all I want is for no one to die."
Ali Asif Shawon is the chief reporter at Dhaka Tribune in Bangladesh, where he covers politics, security, climate change, migration and global health. He can be reached on LinkedIn.
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