AWARENESS OF EBOLA is picking up again
in the United States: An American volunteer who was working in Sierra Leone has
contracted Ebola and
been medevac’dto the National
Institutes of Health Clinical Center for Ebola treatment, and 10 more volunteers have been
brought back to NIH, Omaha and Atlanta, to be examined at three of the four
institutions in the US that have safe units to house them.
It’s a reminder that Ebola still persists in West Africa: In
the last period the World Health Organization reported on (the 7 days ending
March 8), there were 116 new cases. One bit of good news: None of them were in
Liberia, for the second week in a row. But Guinea and Sierra Leone, where this
volunteer was infected, continue to struggle.
And in a research paper published as that volunteer was
being flown back, there’s a reminder that the Ebola outbreak is creating layers
of health risks for those countries. In Science ,
researchers from NIH and four universities warn that Ebola’s interruption of
other health services, such as childhood immunizations, threatens to create
secondary epidemics of preventable diseases that would dwarf Ebola’s impact. In
particular, they warn that there could be 100,000 additional measles cases, and
up to 16,000 additional deaths, if health services are not restored.
As front-line Ebola nurse F. Zeela Zaizay of MAP
International told me last month, the disease has undermined the entire
health care infrastructure in the disease zone — not only in the obvious way of
killing health workers, but also in diverting resources from other areas of
public health, and in making healthy people afraid to come to clinics.
The team who conducted the analysis in Sciencepredict that strain
will make other health problems worse.
“Measles
in particular is known to show up during or after humanitarian crises because
it’s so infectious,” Justin Lessler, an assistant professor of infectious
disease epidemiology at the Johns Hopkins Bloomberg School of Public Health,
said in a press briefing last week. “The disruptions (in healthcare and
vaccinations) would lead to nearly 400,000 additional unvaccinated children
across the three countries. This number of unvaccinated children would be in
additional to an already considerable at-risk population and significantly
increases the likelihood of a major measles outbreak occurring and the impact
of one if it were to occur.”
Measles
is already present in West Africa, so the team is not arguing that Ebola will
revive an eradicated disease — although, poignantly, hard work in the three
countries had recently forced measles incidence way down. “Between 1994 and
2003, the countries reported — and this is just how many they reported, not
necessarily how many occurred — about 100,000 cases of measles,” Lessler said.
“Whereas in the last decade, they’ve only reported 7,000. So they’ve done an
excellent job of controlling the virus compared to the previous (decade).”
Their
analysis predicts that immunization programs would be so disrupted that 75
percent of children who otherwise would have received shots will not get them.
For every month the disruption continues, they project, 20,000 additional
children become vulnerable who otherwise would have been protected.
The WHO has been advising against vaccination campaigns in the
hard-hit countries, because the campaigns create mass gatherings where Ebola
can spread. (The WHO recommendation is to hold back on vaccination until 42
days after the last recorded Ebola case.) But Lessler and co-authors say the
potential risk of measles — and the deaths and severe side effects from the
disease — is so serious that campaigns should be started as soon as possible.
“Supplemental
immunization campaigns have been successfully performed in all three countries
in the past and could virtually eliminate Ebola’s effect on a measles risk in
the region — likely making the situation better than it was before the Ebola
crisis began,” Lessler said. “Measles is not the only health threat that has
been made worse by the Ebola crisis, and it may not even be the worst. But it’s
certainly one we can do something about.”
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