Civil conflicts and unrest often occur hand in hand with disease outbreaks — disruption to travel and national and local economies can lead to interruption of routine immunization activities, leaving children and others vulnerable to infection. Such is the case with significant increases in measles incidence in Venezuela, where civil unrest and an unstable economy are affecting all aspects of life. Domestic immunization activities have been affected in some areas, and young cohorts of children are under-unvaccinated and thus vulnerable to measles, one of the most highly communicable of the vaccine-preventable diseases.
The first measles case of this current outbreak was reported in 2017, and the Venezuelan health system has confirmed 2,154 cases of measles as of June 3 2018, including 35 measles deaths. Now the disease has bled across man-made borders into Brazil, with devastating effects on indigenous people.
More than 1,000 suspected and confirmed cases of measles have occurred in indigenous Yanomami people, who live in the Amazon on both sides of the Brazil-Venezuela border. It is likely that refugees or miners from Venezuela brought in cases of measles, while at the same time vaccination coverage in the Yanomami has fallen from almost 100% in 2002 to 84% today.
A Venezuelan nongovernmental organization that works with the Yanomami notes with concern that in one area affected by the outbreak, about 52% of Yanomami individuals with measles were men older than age 25. In this case, they point out, supplementary and routine immunization activities focusing on infants and and young children will not protect all of those who are vulnerable to infection. Moreover, the risk of complications from measles is high in adults, and lack of access to medical care and poor nutrition can increase the chance of poor outcomes. In the 1960s, a measles epidemic in the Yanomami killed 9% of those infected.
In Venezuela, health officials have devised plans to address the crisis with rapid response teams, vaccination activities, surveillance, investigation of cases, contact tracing. Similarly in Brazil, medical teams with hundreds of thousands of doses of vaccines have been sent to the area. Reaching isolated populations will like prove to be a challenge to the Brazilian health ministry’s efforts.
@manodelsur. Alerta en Venezuela. 7/14/2018.
Brazil: measles outbreak that infected 500 may devastate indigenous people. July 3, 2018. The Guardian
Ministério da Saude da Brasil. Surto de sarampo no Amazonas reforça importância de vacinação. 6/2/2018.
Pan American Health Organization / World Health Organization. Epidemiological
Update: Measles. 8 June 2018, Washington, D.C.: PAHO/WHO; 2018
Wataniba.org. Situation summary: El pueblo yanomami amenazado por brote de sarampión. 6/15/2018.