A measles epidemic killed 1,200 people in Madagascar, where parents want to vaccinate but lack resources

April 14, 2019, 13:41 GMT

By Associated press

AMBALAVAO, Madagascar – Babies lament while a nurse tries to reassure mothers who have come to vaccinate their children. They fear a measles epidemic that has killed more than 1,200 people in this island nation where many are desperately poor.

While Madagascar faces the largest measles epidemic in its history and the number of cases far exceeds 115,000, resistance to childhood immunization is not the driving force.

Measles cases are on the rise in the United States and in other parts of the world, partly because of the misinformation that some parents are reluctant to see a crucial vaccine. New York City is now trying to end a measles epidemic by ordering mandatory vaccinations in a Brooklyn neighborhood.

In Madagascar, many parents want to protect their children but face huge challenges, including lack of resources.

Only 58% of the inhabitants of the main island of Madagascar have been vaccinated against measles, a major factor in the spread of the epidemic. Since measles is one of the most infectious diseases, vaccination rates must be 90-95% or more to prevent epidemics.

Recently, the waiting room at the Iarintsena Health Center was full, with mothers sitting on the floor and others waiting outside in the oppressive heat. Two volunteer nurses and a midwife tried to respond to the request.

Nifaliana Razaijafisoa had walked 15 kilometers with her 6-month-old baby in her arms.

"He has a fever," she says. "I think it's measles because there are those little pimples that have appeared on his face." The nurse quickly confirmed it. "I'm so scared for him because in the village everyone says it kills babies," Razaijafisoa said.

The measles outbreak has killed most children under the age of 15 since its debut in September, according to the World Health Organization.

"The epidemic unfortunately continues to spread," said Dr. Dossou Vincent Sodjinou, an epidemiologist at WHO in Madagascar. By mid-March, 117,075 cases had been reported by the Ministry of Health, affecting all regions of the country.

Some cases of resistance to vaccination exist because of the influence of religion or traditional health practitioners, but they are isolated, he said.

This epidemic is complicated by the fact that nearly 50% of Malagasy children are malnourished.

"Malnutrition is the bed of measles," said Sodjinou.

Razaijafisoa's baby weighs only 11 pounds.

"This is the case for almost all children with measles who have come here," said Lantonirina Rasolofoniaina, a health center volunteer.

It can be difficult to contact a help center for help. Many people in Madagascar can not afford to see a doctor or buy drugs, and health centers often lack staff or have low-skilled workers.

As a result, information on health issues may not be reliable. Some parents do not know that vaccines are free, at least in public health centers.

Four of the five children of Erika Hantriniaina had measles. She had mistakenly thought that people could not be vaccinated after the age of nine months.

"It's my 6-year-old daughter who had measles first, she had a lot of fever," she said. "I called the doctor but it was Friday.He had been to town before, I went to see another doctor who told me that my daughter had an allergy … This error diagnosis was almost fatal. "

The girl had diarrhea and vomiting and could not eat, Hantriniaina said, adding that she had survived shortly.

Measles, a highly infectious disease transmitted by coughing, sneezing, close contact or infected surfaces, is not the subject of any specific treatment. The symptoms are treated instead.

"Vitamin A is given to children to boost their immunity, we try to reduce fever, and if we get cough, we give antibiotics," said Dr. Boniface Maronko, who was sent by the WHO to Madagascar to oversee efforts to contain the epidemic. If the disease is not treated early enough, complications appear, such as diarrhea, bronchitis, pneumonia and convulsions.

The Madagascar Ministry of Health has sent free medicines to the areas most affected by the epidemic. Maronko reminded health center officials in the Ambalavao region not to charge parents, claiming that he had seen doctors asking for money. He told AP that he feared that the drugs were not enough.

The country's capital, Antananarivo, a city of about 1.3 million inhabitants, has not been spared by the epidemic.

Lalatiana Ravonjisoa, a vegetable seller in a poor neighborhood, cries for her 5-month-old baby.

"I had five children, they all had measles, and last I did not go to the doctor because I did not have money," she said. . "I gave my baby the leftover medicine from his big brother to bring down the fever."

For a few days she did not worry, "I felt cured." But one morning, she noticed that he was having trouble breathing. Later, she found that he was cold feet.

"Look at my baby," she said to her mother.

"She hugged her for a long time and she did not say anything, then she asked me to be strong, he was gone."

Ravonjisoa said that she was angry, "but I did not imagine for one moment that he was going to die." At the hospital, a doctor confirmed that his baby had died of respiratory complications related to measles.

At the end of last month, WHO launched a third mass measles immunization campaign in Madagascar, aimed at reaching 7.2 million children from 6 months to 9 years of age.

"But immunization is not the only response strategy to this epidemic.We still need resources for care, monitoring and social mobilization," said Sodjinou, a WHO epidemiologist.