Measles has killed 210 children in Pakistan’s Sindh Province over the past year, and health officials and experts say further deaths are likely.
A World Health Organization (WHO) report handed to the Pakistan government this week, but not made public, says the death toll in 2012 was more than 300 nationwide.
Reports of measles deaths have been increasing in the last quarter of 2012 with around 50 children in Sindh dying of the disease in December, particularly in the Kandhkot and Shikarpur districts.
“The intensity of the outbreak as well the cases of measles have been five times more this year compared to 2011 and it is very much under-reported,” said Iqbal Memon, president of Pakistan Paediatricians’ Association. He said he had warned the government last March about the risks of an outbreak given the low levels of vaccination in the province.
“About 70 percent of children who died of measles in the affected districts were not vaccinated,” he added.
“There has been an outbreak of the measles in upper Sindh [Province] where eight of its districts are affected badly,” Sagheer Ahmed, the provincial health minister, told IRIN by phone.
The minister said some 2,500 cases of measles were reported in the last two months in government hospitals in the districts of Sukkur, Shikarpur, Ghotki, Larkana, Qambar Shahdad Kot, Jacobabad, Salehpat and Kashmor.
But official statistics do not tell the whole story.
“I have visited the government hospital and there are no cases of measles there,” said Tashkeer Muqeem Osto, a Jacobabad-based journalist.
“In the cities they [sick families] are consulting the private medical practitioners whereas in the sub-districts of the city there was no vaccination at all and people have not been informed about the disease,” Osto said.
Immunization drive
Sindh provincial health minister Ahmed said an aggressive immunization campaign has been launched in the affected areas and the age ranges of children targeted for vaccinations would be enlarged.
“We began our vaccination from Saulehpat where it broke out; “2.9 million children ranging from nine months to 10 years would be covered under the current immunization campaign,” he told IRIN.
Pakistan is one of the priority countries targeted by WHO and the UN Children’s Fund (UNICEF) for accelerated sustainable measles mortality reduction.
“Most of the immunization programme staff are engaged in the polio campaign so measles get a secondary priority,” said Memon.
The WHO report handed to the government said the primary reason for the outbreak was a failure to complete the immunization programme. It said 53 percent of children in the province had not received the vaccine.
An initial dose of the vaccine provides 60-70 percent immunity, though a second dose is required to reach 95 percent immunity levels.
Other causes
Health officials attribute the epidemic to socioeconomic conditions in the province, though other sources linked the outbreak to a third year of severe monsoon flooding.
WHO says the “huge difference of Routine Immunization coverage between provinces, districts and cities is at the root of the current measles outbreaks.”
“Malnutrition as well as under-nutrition severely affect children’s immune systems rendering them highly vulnerable to the measles,” said provincial health minister Ahmed.
Illiteracy, lack of awareness, and inefficient vaccination facilities in government hospitals were also key reasons for the outbreak, said Memom, adding: “From January till April the epidemic could turn very dangerous as those months are very crucial as measles become more contagious in such weather.”
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