300 deaths and more than 20,000 people infected in Madagascar: measles outbreak

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Three of Hasina Raharimandimby's children died of measles. "We can not always prevent death," she says, "but mothers should do everything in their power to protect their children.

Antananarivo, Madagascar (CNN) – Measles has found Hasina Raharimandimby and her family. At the end of January, three heartbreaking days, three of his young children died as a result of the virus.

"I miss taking candy and snacks every time I come home from work," she says. "We used to play and feed the birds near us."

Madagascar, the island nation off the coast of East Africa, has been hit by the worst measles epidemic it has seen in decades. The Secretary General of the Ministry of Health told CNN that more than 50,000 people had contracted the disease since October 2018 and that there had been more than 300 deaths, mostly children.

Hasina took her youngest surviving child to this clinic located on a hill in central Antananarivo because it coughs.

After the deaths of his brothers and sisters, he was vaccinated in one of four planned phases of a mbadive campaign orchestrated by the government, UNICEF and the World Health Organization.

The doctor tells him that cough is not a problem. It's just a cold.

Due to its relative scarcity in developed countries, measles is sometimes wrongly considered a mild virus with limited impact. But it can set in quickly and cause encephalitis, deafness and, in extreme cases, death, especially in a malnourished or weakened immune patient.

Hasina's children were sick for only a few days before worsening rapidly and dying. She says they were not able to get measles vaccines at the clinic whenever they wanted.

"It's hard and I'm bitter," she says. "We can not always prevent death, but mothers should do everything in their power to protect their children."

An entirely preventable tragedy

When Lon Kightlinger retired from his post of state epidemiologist in South Dakota, he did not think his past life would catch him quite that way.

"We heard a measles outbreak in the capital between December and January and I knew we were going to be affected," he said in a small clinic in Madagascar, about three hours' drive from the capital.

Kightlinger worked in public health here in his youth. Now in his sixties, he returned as a volunteer to Peace Corp.

"Most of the other volunteers are young, idealistic and full of energy," he smiles, "but I bring a little perspective, I think."

This prospect has helped to recognize the warning signs of a larger epidemic. "Our only doctor, practicing for 12 years, had never seen a case of measles a month ago. And then boom, boom, boom, they started to go through the door. And it did not stop, he said.

In South Dakota, Kightlinger has been dealing with a measles epidemic, but health workers have managed to limit it to an extended family.

In Madagascar, the epidemic has affected all regions of the country and all major cities.

The measles virus is highly contagious – it spreads by coughing and sneezing and can live in the air where an infected person coughs or sneezes for two hours. If someone who is not immune to the virus is breathing or touching an infected surface, they may become infected. Symptoms include high fever, cough, runny nose and pink eye, as well as red rashes all over the body.

Now, while several areas in the United States are battling measles outbreaks, mainly due to non-medical exemptions for vaccinations, Kightlinger and other experts point to Madagascar as a dangerous omen.

Across the country, private tragedies occur due to lack of immunization coverage.

Health officials estimate that immunization coverage was below 50% at the beginning of the epidemic, due to the weak health system and lack of funding and the failure of routine immunization.

For herd immunity to work – when enough people are vaccinated and the disease can no longer withstand the disease – coverage should be around 95%.

And for many Malagasy, it's not for lack of trying.

"We Americans have concocted all these excuses and reasons for being complacent about measles. The inhabitants of Madagascar also have a busy life. But when they have immunization campaigns, most of them will come out, travel long distances and sit in the sun for their turn, "says Kightlinger, who cycles several kilometers a week to deliver vaccines to people. neighboring villages.

A stubborn threat

Ironically, self-satisfaction in developed countries stems from the very success of the public health response.

The first effective measles vaccine was developed in the early 1960s. According to estimates by the World Health Organization, the virus has caused 2.6 million deaths a year before. In 2017, about 110,000 people died of measles, mostly children under five, said the WHO.

But the lack of understanding of measles and the rise of anti-vaccination ideas based on fake sciences and conspiracy theories fueled by social media has put a flaw in the armor of otherwise well-protected countries, such as than the United States and France.

In a country like Madagascar, where they are still struggling against a deadly epidemic, doctors are furious.

"It's a matter of mentality because we have to convince these people. Maybe they do not know why we should be vaccinated. In poor countries, it's not just people with little education, "says Andosoa Rakotoarimanana, director of the Ambohimiandra Children's Hospital, in the Malagasy capital.

As the vaccination campaign continues, he hopes immunization coverage will reach much higher levels. But routine vaccination remains the rule of thumb and there are still pockets of epidemics.

This fight is not over yet.

Jean Claude Nambinintsoa traveled for 24 hours in a mini-taxi to take Pierrot, his 15-month-old son, to the hospital.

"I was hoping to vaccinate him," he said as Pierrot clung to his neck gently stroking his ear. "When I arrived here, they said that my son already had measles. .

Pierrot is dangerously malnourished, his arms lost in the sleeve of his dusty striped shirt. Almost another victim of an illness that humanity could defeat, but who seems unable to manage.

"This should be an awakening for not only for every person, for every health center in Madagascar, but for the whole world. These diseases come back and clog us if we are not protected, "Kightlinger said. "These are living viruses that are very intelligent, and they will find us."

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