Measles: Pará will be the epicenter of the disease in Brazil in 2020; understand why – 11/23/2020

In a year marked by the covid-19 pandemic, little is said about another infectious disease that continues to increase in Brazil and worldwide: measles.

In its most recent epidemiological bulletin, the Department of Health estimates that there were 8,217 cases and seven deaths from the disease in the country in 2020 alone. The data refers to the period from December 29, 2019 to October 17, 2020.

In addition to the extremely high number for a vaccine-preventable disease, there is another fact that draws attention in the report: Pará is experiencing a real measles outbreak.

The state has 5,294 confirmed cases (64% of the country’s total) and has already reported five deaths (71% of which were recorded in the national territory).

But how did Pará become the epicenter of the disease in the country?

Failure of immigration and vaccination

To fully understand this story, it is necessary to go back in time: in 2016, Brazil received a measles elimination certificate from the World Health Organization. In practice, this meant that the virus that caused the disease was no longer circulating within our borders.

In less than two years, the conquest was lost: In 2018, the disease broke out in the country because it had not suffered for almost two decades. That year, Amazonas and Roraima states were the most affected, with nearly 10,000 individuals infected.

But what exactly explains this revival in this region of Brazil? “There was a reintroduction of the virus from Venezuela, with the arrival of refugees crossing the border of these states,” said infectologist Tânia Chaves, a professor at the Faculty of Medicine at the Federal University of Pará.

Let it be clear: the blame for the outbreak cannot be placed on the Venezuelans. After all, if the entire Brazilian population were vaccinated against measles, the infectious agent would not be able to move freely between us.

“Unfortunately, we relaxed our surveillance and left much of the population unprotected,” complains Chaves, who also represents the Brazilian Association of Infectious Diseases.

In 2019, the situation deteriorated further, with 15,000 measles cases confirmed. The most affected states were São Paulo, Paraná and Rio de Janeiro.

Then we arrived at the current outbreak in Pará. Experts agree that the measles from the Amazon seems to have “jumped” and found a very vulnerable population in the neighboring state. In a context of low immunization, the proximity of two states that have had high rates of measles cases in recent years has made Pará extremely vulnerable to the disease.

“The large number of cases is due to a pocket of susceptible people that has arisen from the low vaccination coverage of the past few years,” analyzes sanitarian Bruno Pinheiro, director of the Epidemiology Department of the State Secretariat of Public Health in Pará.

It’s worth noting that measles is one of the most contagious illnesses to affect humans: a single infected person transmits the virus to 18 other people. In comparison, in Covid-19, this number is estimated to vary between 2 and 3.

So what to do?

To control the problem, the Ministry of Health and state departments have been conducting extensive measles vaccination campaigns in recent years.

The immunizer, known as triple viral for protection against measles, mumps and rubella viruses, has been available to all Brazilians for decades in the Brazilian Unified Health System.

The recommendation is to take two doses. The first is given when the newborn is 12 months old. The second can be applied up to 29 years.

The outbreaks that started in Brazil from 2018 have prompted some changes to this vaccination schedule: currently, specialists are offering a “zero dose” in babies between 6 and 11 months. “This is an emergency measure to provide more protection at this point, but the other two doses from the first year of life are still essential,” said Chaves.

Another strategy has been to strengthen adult protection. The idea is that people ages 20 to 49 who do not have a vaccination card or do not know if they have taken the triple virus in the past will receive a dose of the vaccine or complete the immunization schedule to be protected.

However, the campaigns show frustrating results. Pará aimed to vaccinate 3.4 million people by 2020. By the beginning of November, only 26% of the target group, or about 900 thousand adults, had received their doses.

The situation is even worse when we look at the country as a whole. Between the start of the national measles mobilization (which began on March 16) to October 29, 11.7 million Brazilians between the ages of 20 and 49 were vaccinated. This corresponds to 13% of the target.

Reasons for low demand

With the success of vaccination programs over the decades, the population has stopped seeing narrow cases of measles and other infectious diseases. “There was a perception that these problems were under control and that you didn’t have to worry about them anymore,” says Chaves.

This lower risk perception caused many parents to stop taking their children to health centers to fill out their vaccination cards.

At the same time, there is grave concern about anti-vaccine movements, which share untrue information about immunizers and discourage people from taking their doses. But experts believe that this factor is less important in Brazilian reality.

Finally, in this context, we cannot ignore the impact of the pandemic. “Many non-essential services were phased out by Covid-19 and people were afraid to go to the health center to get vaccinated,” says the infectologist.

From a strategic action point of view, the coronavirus also greatly divided health managers’ attention and required professional teams to focus on the most pressing issue. This, of course, has led to a mistake and uncontrolled other infectious diseases.

Through a note, the Department of Health press service answered the questions posed by the BBC News Brasil report and highlighted the importance of measles vaccination:

The ministry says it has expanded public awareness strategies, as well as actions with health professionals, with the aim of maintaining a high and homogeneous vaccination coverage and, consequently, reducing the risks of introduction and transmission of vaccine-preventable diseases in the country. “

Global Challenge

Measles has become a concern not only in Brazil. In a recent statement, the World Health Organization and the United States Center for Disease Control and Prevention warned that the disease killed 207,000 people in the past year. That number has increased by 50% between 2016 and 2019.

According to the report, the number of cases exceeded the 869 thousand mark, a record for the past 23 years. The organizations are asking countries to strengthen their campaigns and develop strategies to contain local outbreaks.

Measles is a disease that is transmitted by droplets of saliva coming from the mouth and nose through speech, coughing, sneezing, or by breathing itself.

It is a highly contagious disease that can lead to serious complications and even death, especially in children under the age of five, malnutrition or those with immune deficiency.

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