Why measles is still headache for Kenya

Measles-rubella

A school boy waits to be vaccinated during a measles-rubella vaccine drive in Nakuru.

Photo credit: File | Nation Media Group

What you need to know:

  • Following a nationwide risk assessment conducted by the Ministry 22 counties were identified for a vaccination campaign
  • The campaign targets to reach children of between nine and 59 months and is expected to cost Sh800 million
  • Measles-rubella infects both children and adults
  • It is spread through sneezing and coughing

As Kenya was coming to terms with Covid-19 last year, a “worrisome” measles outbreak was happening.

“Immunisation coverage dropped due to Covid-19. If nothing is done now we will have an outbreak like in the DRC,” Dr Collins Tabu, the head of Kenya’s National Vaccines and Immunization Program told HealthyNation.

In the last one-and-a-half years, the cases of measles, the world’s fastest spreading virus, has increased by more than 700 per cent in the country, said the Health ministry.

Dr Tabu termed the trend worrisome, prompting the government to launch a vaccination campaign targeting 3.9 million.

The expert observed that within the country, there has been a gradual rise in the number of cases, which would lead to about 2.1 million children being susceptible to the disease.

Following a nationwide risk assessment conducted by the Ministry 22 counties were identified for a vaccination campaign.

Dr Peter Okoth, a health specialist at Unicef, which is helping the ministry procure the vaccines, said these counties were selected for being “high risk”.

The counties are Kilifi, Mandera, Wajir, Garissa, Baringo, West Pokot, Turkana, Tana River, Trans Nzoia and Elgeyo Marakwet.
Others are Busia, Homa Bay, Migori, Kisii, Kajiado, Nairobi, Bomet, Bungoma, Kakamega, Narok and Vihiga.

“From October 2019 to date we have registered 786 cases and two deaths .There is an active outbreak in West Pokot after Mandera and a gradual rise in the number of cases,” said Dr Tabu.

Dr Mercy Mwangangi, the Chief Administrative Secretary at the Health ministry, said last week that Kenya remains at constant threat of measles outbreaks.

“The ministry, through the National Vaccines and Immunization Program, plans to conduct the campaign that started on June 25 to July 5,” she said.

The campaign targets to reach children of between nine and 59 months and is expected to cost Sh800 million. 

Reduce measles

The World Health Organization ranks the measles virus as the most infectious virus on the planet. The virus’ reproduction number — that is the number of people infected from one case — is between 12 and 18. This is higher than most viral diseases. For instance, Sars-Cov-2 which causes Covid-19 has a reproduction number of between 2.5 and 3.5.

Measles-rubella infects both children and adults. It is spread through sneezing and coughing.

Once it gets to the body of the child, it can cause damage to the lungs, the brain, the ears and even to the stomach and intestines, and eventually death,” said Dr Okoth.

Dr Stephen Mutwiwa, Kenya’s country director for Jhpiego, told HealthyNation that death or sickness from both viruses are preventable by vaccines.

“Vaccination remains one of the most cost-effective ways of preventing infection and due to this Kenya has seen a tremendous decline in deaths or disease caused by measles over the years,” said Dr Mutwiwa.

He added that Kenya’s goal is to reduce measles cases by 90 per cent and deaths by 95 per cent. “We should support the government in this endeavour by all means, including helping mothers and caregivers take their children to the facilities, and be available should the health workers visit them at home to administer vaccines,” he added.

The campaign will involve more than 16,000 health workers who are currently undergoing training and will offer the vaccines free of charge through 5,061 vaccination posts that will be set up in public places.

On October 20, 2019, a total of 281 cases with nine positives for measles and two for rubella with one death were first reported in Pokot North Sub-County, West Pokot County.

“The outbreak in Tana River County has affected two sub counties: Bura and Galole. A total of seven confirmed cases have been reported. The outbreak is still on. In Wajir County, the outbreak has affected Wajir East, while in Garissa four sub-counties have been affected. The Kilifi County outbreak is from Ganze,” the health ministry said in 2019.

In 2020 the number of counties affected increased to five. “An outbreak of measles is active in five counties - West Pokot, Garissa, Wajir, Tana River and Kilifi. The total number of cases reported are 382, confirmed 48 with two deaths,” said the ministry then.

Rubella, like measles, is a highly infectious viral disease that can cause serious health complications to newborns such as birth defects, including heart problems, loss of hearing and eyesight, and brain damage.

Covid-19 disruptions

Due to Covid-19 and other health system related issues, many parents did not take their children to the hospital for vaccines for fear of contracting the coronavirus.

There were also interruptions in service delivery, such as health workers’ strikes.

These health challenges started even before the pandemic.

In a paper published in the journal Nature, the Local Burden of Disease Vaccine Coverage Collaborators — a group of researchers from reputable scientific institutions including the University of Nairobi and African Population and Health Research Center — mapped vaccination for measles and the results were saddening: measles vaccinations are under threat due to inequities in coverage and the poor coverage of routine first-dose measles vaccines between 2010 and 2019.

WHO notes that before the introduction of the measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately every two to three years and measles caused an estimated 2.6 million deaths each year.

The global health body recorded more than 140,000 deaths from measles in 2018 – mostly children under the age of five years despite the availability of a safe and effective vaccine.

WHO said accelerated immunisation activities have had a major impact on reducing measles deaths.  “During 2000–2018, measles vaccination prevented an estimated 23.2 million deaths. Global measles deaths have decreased by 73 per cent from an estimated   536,000 in 2000 to 142,000 in 2018,” said WHO.

Measles is caused by a virus in the paramyxovirus family and it is normally passed through direct contact and through the air.
The virus infects the respiratory tract then spreads throughout the body.

On the other hand, rubella is an acute contagious viral infection which causes a mild fever and rash in children and adults. Infection during pregnancy, especially during the first trimester, can result in miscarriage, foetal death, stillbirth, or infants with congenital malformations, known as congenital rubella syndrome.

When a person is infected, the virus spreads throughout the body in about five to seven days. This is followed by the symptoms which usually appear two to three weeks after exposure.

When a woman is infected with the rubella virus early in pregnancy, she has a 90 per cent chance of passing the virus on to her foetus.

According to Dr Rose Jalang’o of the National Vaccines and Immunization Program, in 2000 measles was the leading cause of vaccine preventable paediatric deaths but is now third after pneumococcal virus and rotavirus.

“Ninety-five per cent population immunity is not achievable with only one dose even at a very high vaccination coverage as only 85 per cent of children vaccinated against measles develop immunity from the first dose. So, the accumulation of children without immunity occurs overtime thus the high risk of an outbreak,” Dr Jalang’o told HealthyNation.

He said this was the reason the coverage must be above 95 per cent in the target age group. “Take children aged between nine to 59 months to the nearest health facility or immunisation post for vaccination,” he said.