More than five and a half months after measles spread in an epidemic form across Bangladesh, the situation has not seen significant improvement. Instead, reports of new infections and deaths are coming in daily. According to the Directorate General of Health Services, at least three children died in Khulna, Cumilla, and Moulvibazar over the last 24 hours due to measles and its symptoms. With this, the death toll from measles and its complications over the past five and a half months has reached 994.
During the same period, from March 15 onwards, more than 164,000 children have been infected with measles and its symptoms across the country. Due to severe complications developing among the infected, many are being admitted to hospitals. This year, reports indicate that along with children, adults are also being infected with measles in various areas.
Although vaccination programs were intensified to control the infection after the outbreak began, expected results have not been achieved. Following the special vaccination campaign launched last April, it was expected that a strong herd immunity barrier would be created in the country within a few months. However, as infections have continued after several months, questions have arisen over whether that target has been met.
According to public health experts, effective vaccine coverage cannot be ensured merely by the number of vaccines administered. Without identifying left-out children, bringing them under vaccination, and conducting regular monitoring at the field level, it is difficult to bring the infection under complete control.
Patient Pressure Rises Again in Hospitals
Ever since measles spread, guardians have been bringing infected children from various regions of the country to the Bangladesh Shishu Hospital and Institute in Dhaka. Due to the increasing pressure of patients, the number of hospital beds was at one point more than doubled.
Following the start of the vaccination campaign in April, the number of patients decreased somewhat in June and July. However, patient numbers have begun to rise again over the recent weeks.
According to physicians' observations, complications are appearing relatively more frequently among children whose treatment started late. Especially for many children coming from outside Dhaka, conditions are deteriorating due to various complications including pneumonia.
A seven-month-old infant from Keraniganj was taken to the hospital after suffering from a high fever for several days followed by a rash all over the body. Although dengue was initially suspected, doctors later identified it as measles.
Claim of 100 Percent Coverage in Vaccination, Yet Questions Remain
About three weeks after measles spread nationwide, emergency vaccination activities were launched in 30 high-risk upazilas. Later, from April 20 to May 20, a nationwide mass vaccination program was conducted for children aged six months to five years.
At the beginning of the program, a target was set to bring approximately 18 million 15 thousand children under vaccination. According to information from the Directorate General of Health Services, more than 19 million 661 thousand children were vaccinated during that April and May program. This means the number of children who received the vaccine exceeded 100 percent of the set target.
However, many experts have questioned these vaccination figures from the beginning. According to them, if the set target itself is lower than the actual population, then even if more children are vaccinated than the target, the true coverage may not be 100 percent.
An indication of this can also be found in the data from the Vitamin 'A' capsule program conducted for children of the same age group. In that program conducted last June, about 24 million children received Vitamin 'A' capsules. Consequently, a fresh discussion has started regarding what percentage of children were actually brought under vaccination in the measles immunization program.
Public health experts opine that while it was necessary to start rapid vaccination based on old demographic data during an emergency situation, it was subsequently necessary to go door-to-door and collect information on missed children. If such 'micro-planning' had been done through grassroots health workers, it would have been easier to identify unvaccinated children and bring them under immunization.
Why Were Emergency Measures Not Taken, Experts Ask
Public health experts believe that more comprehensive and coordinated steps were needed right at the beginning to control the measles situation. According to them, if an epidemic or health emergency had been declared, it would have been possible to work in a coordinated manner across all areas—vaccination, treatment, monitoring, and public awareness.
Experts have expressed the opinion that the situation has prolonged due to a failure to take necessary measures at the onset of the outbreak and to ensure adequate treatment for measles-infected children at the district level.
According to them, just vaccination programs are not enough to combat measles. Simultaneously, activities must be continued for the prompt treatment of the infected, monitoring of infected children, identification of unvaccinated children, and raising awareness among parents.
