Since the beginning of this year, measles outbreaks have occurred in 61 of 63 provinces and cities, killing at least 127 people. As the country mobilises its resources to fight the disease, Viet Nam News talks with experts about the situation and measles prevention efforts in the country.
What do you think are the main reasons behind the current measles outbreaks in Viet Nam?
Tran Dac Phu, Director, Preventive Medicine Department, Ministry of Health
|Tran Dac Phu
Measles used to occur every year with a high infection rate in the country, especially before the national expanded programme for immunisation was introduced in 1985. The rate of measles infections has actually decreased dramatically because of the immunisation programme (EPI). This year, for instance, there have been fewer measles infections than in 2009-2010.
The vaccination rate of Viet Nam is currently at a little more than 90 per cent, meaning that around 10 per cent of children haven't been vaccinated against diseases yet. This is why there are measles outbreaks every 3-5 years.
However, this year, scattered measles outbreaks have occurred in 61 of 63 provinces and cities nationwide.
Infections were reported in most districts of Ha Noi and HCM City, and in some areas of Yen Bai, Lao Cai and Tuyen Quang provinces.
One problem we must care about is the high fatality rate in the north, especially at the National Paediatrics Hospital in Ha Noi, while no fatality has been reported in the south. This should be investigated in depth.
The National Paediatrics Hospital has been overloaded with measles patients, especially in serious condition. The high fatality rate is due to many patients going directly to central hospitals in the city instead of district or provincial hospitals for early examination and treatment.
The overloading of hospitals has caused difficulties in patient classification, quarantine and treatment.
The overload also causes cross infections between measles patients and those having other diseases. Many children died because they contracted both measles and other conditions including acute breathing difficulties, heart failure and blood abnormalities.
Brian McNaull, medical director of Family Health Medical Practice, Ha Noi
I am not surprised by the current epidemic since the level of vaccination against this particular disease (measles) has been low in the Vietnamese community. Hence the level of ‘herd' or community immunity is also low. The news of the measles epidemic in Ha Noi has caused a significantly heightened concerns among the expat community with many mothers bringing in vaccination schedules (records) of their children for us to check, to ensure that their children are fully covered against measles. In addition, the vaccination schedule can vary from country to country so this can generate additional questions as to the adequacy of their vaccinations.
About 500,000 plus people, mainly children, die from this disease each year around the world. The sad fact is that it is largely a vaccine preventable disease. Some diseases such as polio have been practically wiped out because of well co-ordinated, well financed vaccine campaigns run by international organisations such as the UN agencies and WHO.
This demonstrates that when there is a unified and determined response by governments to act (the political will) and funds that have been prioritised against certain diseases, then the goal of eradication of a particular vaccine preventable disease such as measles can be achieved. In many developing countries, the level of vaccination is not high enough amongst the community so we see small epidemics erupting, as it did in Ha Noi.
The only positive outcome from this current situation is that awareness has been raised dramatically about the necessity of vaccination and that there appears to be support both from the populace and the health agencies to mount a comprehensive vaccine campaign to protect the community.
However that will require the vaccine being widely available and the population strongly encouraged to participate. Sadly, in some of the more developed countries, vaccination rates have fallen, especially for measles, and small localized outbreaks have occurred in parts of North America and Europe in recent years. I think many people fail to realise that around the world measles and measles associated complications have a mortality of between 1 and 3 per cent of those infected with measles because they are not immune.
What would you say are the shortcomings in measles prevention and treatment in Viet Nam?
Phu: Hospital overload has been a pressing problem in Viet Nam. Measles outbreaks and fatalities have been pushed to a higher level due to concentration of many other patients having serious respiratory and lung diseases at the National Paediatrics Hospital. The overload occurs because most patients prefer to go to central hospitals for treatment.
Communication programmes haven't succeeded in improving by much people's knowledge of disease prevention, personal hygiene practices and other examination and treatment regulations. The number of patients admitted to the National Paediatrics Hospital has decreased to one-third, thanks to recent efforts of the health sector and mass media. That's why stronger measures must be taken for preventing contagious diseases.
What are the measures that have been taken and what are those that must be further implemented to control measles?
Phu: The whole political system has been mobilised for measles prevention. Drastic measures have been taken to conrol the disease by increasing vaccination rates nation-wide. Medical units have implemented measures for improving treatment, preventing cross-infections and minimising fatalities by expanding treatment areas. Infection prevention measures have been tightened at hospitals. More satellite branches of central hospitals have been established for reducing patient overload.
Awareness campaigns have been launched to encourage people to get children vaccinated against measles as also go to local hospitals for measles treatment in order to avoid cross infections.
The community, especially parents, have been asked to practise measles prevention measures and given advice on caring for measles patients as well as those with respiratory problems.
Dr. McNaull: I think when we have disease outbreaks as we do at this present time with many deaths, awareness is already raised and people want to respond by doing their best for themselves and their children by being vaccinated. Education is key. By demonstrating that vaccines are effective and safe and that vaccination can prevent serious negative outcomes (disability and death) then we can achieve much higher levels of community immunity.
Promotion of vaccination by health authorities and government agencies through the media, is critical. Again, where there is political will, we can achieve high levels of immunity against disease through vaccination. We have seen this in many parts of the world where successful disease eradication has occurred.
Free vaccination ensures that the most financially disadvantaged (and most disease vulnerable) in society can also be protected.
What are the lessons Viet Nam has to learn from this episode?
Phu: Vaccination is the only way to eliminate measles. Some parents did not get their children vaccinated against measles because of some adverse reactions to certain vaccines. However, they will change their mind after this measles outbreak.
Awareness campaigns should encourage people to take their children to healthcare facilities for vaccinations. Measures are also necessary to overcome shortcomings in treatment. Comprehensive research on measles is needed in order to take effective disease prevention measures in the coming time.
Some measles patients are under nine months old. They haven't been vaccinated against measles yet. So more research is required to adjust vaccination schedules.
More than 11 per cent of measles patients are children who haven't been vaccinated against measles or have had no vaccination records. So a vaccination campaign should be carried out for children aged between 9-24 months who haven't been vaccinated against measles.
Dr. McNaull: Since deaths from infectious diseases have been dramatically reduced in many developed countries, there has been a laxity about the necessity to vaccinate. People focus on potential rare side effects of vaccine but have forgotten or have not experienced first hand the ravages of diseases such as measles.
In the West, measles is combined with Mumps and Rubella into a triple vaccine (MMR). Because of a supposed association between the MMR vaccine and the development of autism in children, a small but significant number of mothers have elected not to vaccinate against measles. This is unfortunate because they assume the disease will remain controlled. However as community vaccination rates drop, the disease will be resurrected. Unfortunately we are seeing this already in developed countries.
The number one issue at this time is to encourage vaccination against measles. We know that after the first MMR (or measles vaccine itself) about 95 per cent of individuals achieve immunity. The second dose seeks to boost immunity to high levels and hopes to stimulate immunity in the 5 per cent who did not respond to the first dose. Follow the Ministry of Health's recommendations for vaccination.
Dr. Takeshi Kasai, WHO Viet Nam Representative
In order to prevent the spread of measles, a country needs to have at least 95 per cent of its children immunised with two doses of the measles vaccine. Viet Nam provides access to routine immunisation to 1.7 million Vietnamese infants against 10 important childhood diseases, including measles. Parents have an important role in understanding the risks associated with childhood diseases and ensuring that their children are up-to-date with all their vaccinations.
Immunisation is critical to reducing child deaths in Viet Nam. Before the introduction of the measles vaccine in 1980, more than 100,000 measles cases were reported yearly in Viet Nam. By 1988, measles vaccination was at 90 per cent, which significantly reduced outbreaks to less than 10,000 per year, but not enough towards complete elimination. Several measles outbreaks continued to occur periodically.
In 2011 a routine second dose of measles vaccine was introduced for children at 18 months of age in an effort to ensure complete immunity and to reduce the numbers of measles infections. Even though the vast majority of children in Viet Nam are immunised, measles will spread quickly through groups of those children who have not been fully vaccinated against the disease.
For this reason Viet Nam's health sector is focusing its efforts to ensure that as many children as possible are vaccinated with two doses in order to control further spread of the measles virus. However, for a national vaccination programme to be effective, it also needs the full co-operation of every individual to understand the dangers of these childhood diseases and to make certain that their children are immunised.
In the last 20 years of Viet Nam's national immunisation programme, there has been a well-documented decline in deadly childhood diseases such as polio, diphtheria, pertussis and tetanus. As a result, child mortality rates have been halved. High vaccination coverage for major childhood diseases, including measles, will ensure that these gains can be maintained over the long-term. — VNS