Measles probably another health crisis in Ebola-hit West Africa: study

The West African countries hardest hit by the worst-ever outbreak of Ebola could face a second health crisis brought by measles that could, at its worst, kill thousands more people than Ebola has unless programs to vaccinate children are quickly resumed, scientists warned Thursday.

Healthcare services in Liberia, Sierra Leone, and Guinea have been disrupted by the ongoing Ebola outbreak, and efforts to vaccinate children against measles, an infection that often follows such humanitarian crises, have been suspended.

As a result, a team of researchers from the U.S. and Britain predicted in the U.S. journal Science that a large measles outbreak could occur soon in the region, with an impact that may exceed that of Ebola, which has caused over 24,000 cases and nearly 10,000 deaths since early 2014.

"The secondary effects of Ebola -- both in childhood infections and other health outcomes -- are potentially as devastating in terms of loss of life as the disease itself," said study leader Justin Lessler, an assistant professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health.

Using computer simulations, Lessler and colleagues estimated that measles immunization in the three countries has fallen by 75 percent because of Ebola, leading to an increase in unvaccinated children of about 400,000 from nearly 800,000 prior to the crisis.

In the event of a large outbreak, the number of estimated measles cases will jump from 127,000 before the Ebola outbreak, to 227,000 after 18 months of interruption, resulting in 2,000 to 16, 000 additional deaths, according to the researchers.

At the high end, the death toll could exceed the nearly 10,000 killed by Ebola to date.

"Our primary scenario of a 75 percent reduction in vaccination rates may have been too pessimistic, but even a reduction in vaccination rates of 25 percent would be expected to result in tens of thousands of additional cases and 500 to 4,000 additional deaths," Lessler said.

In order to thwart a second public health disaster, the researchers suggested that public health programs aggressively resume vaccinations for children as soon as it is safe to do so.

The three main Ebola affected countries had seen a marked fall in cases in recent years due to vaccination efforts. Between 1994 and 2003, together they reported over 93,000 cases, but this fell to just under 7,000 in the decade from 2004.

Measles is highly contagious and causes a red rash over the body, from which most people fully recover with two or three weeks. It can be prevented with a vaccine.

While Lessler and his colleagues only looked at the potential for a measles outbreak, he said the Ebola epidemic has also slowed delivery of the oral polio vaccine, a tuberculosis vaccine and the pentavalent vaccine, which protects against Haemophilus influenza type b, whooping cough, tetanus, hepatitis B and diphtheria.

Similarly, there has been a negative impact on interventions against malaria and HIV.

"These setbacks have the potential to erode the substantial gains in the control of these diseases over recent decades," Lessler said. "It could be a long time before the health care systems in the region recover from this." Endite