– Public Health Ministry moves to protect border and residents

RECOGNISING the threat of imported cases of measles into Guyana from bordering countries, the Public Health Ministry along with the PAHO/WHO had crafted a response plan in April 2018 to protect its borders and residents.

The response includes mop-up and catch-up vaccination campaigns to target the vulnerable areas, vaccination of health staff, armed forces, miners, teachers and tourism industry personnel. The education of public health staff across the country on signs and symptoms of measles, procurement of additional vaccines, syringes and cold storage equipment and national coordination activities with the armed forces, immigration authorities, non-governmental organisations (NGOs) and other international organisations, also buttress the Public Health Ministry’s counter-measures.

Acting Maternal and Child Health (MCH) Officer, Dr Oneka Scott said “this response plan continues to include further preparation of local health facilities, for the management of any suspected case of measles presenting with rash and fever and either cough, conjunctivitis or runny nose.”

The Ministry of Public Health is therefore reminding all mothers and parents to ensure that their children get their Measles, Mumps and Rubella (MMR) vaccination urgently, since the threat from the 2018 measles outbreak in neighbouring Venezuela is an ongoing threat. This has therefore placed the health of our children and others at great risk.
Adults as well are urged to be vaccinated, Dr Scott encouraged.

The ministry, through the MCH programme, has “stepped up” its vaccination programme in Barima/Waini (Region One); Pomeroon/Supenaam (Region Two); Cuyuni/Mazaruni (Region Seven); Potaro/Siparuni (Region Eight) and Upper Takutu/Upper Essequibo (Region Nine), Dr Scott said.

There are some 2,000 Venezuelan migrants currently living in the five vulnerable areas.
In a New Year’s message earlier this month, Dr Karen Lewis-Bell, Decentralised Regional Advisor, Immunisation, Caribbean Sub-Region, PAHO/WHO, Jamaica Representative counselled health officials to be on the lookout for travellers afflicted with cough, coryza (runny nose) and conjunctivitis (‘red eye’) since these are some symptoms of measles.

Other symptoms include high fever, watery eyes, and small white spots in cheek. Ignoring the signs and symptoms can result in infection of middle ears which can lead to hearing loss, pneumonia (infection of lungs) diarrhoea leading to dehydration, inflammation of the brain leading to seizures, mental retardation, blindness and death.

STRENGTHEN SURVEILLANCE
“I therefore urge each and every island/country to strengthen surveillance at this time for suspected cases of measles in our sub-region. Anyone presenting with fever and any of the three Cs i.e. cough, coryza or conjunctivitis with a history of travel from or recently to the UK or any other country in Europe, should heighten the suspicion of measles even before the onset of a rash. This is because such persons would be infectious during this prodromal phase, four days before the onset of the typical generalised maculopapular rash,” Lewis-Bell counselled.

Continuing, Lewis-Bell observed that “of note is the fact that passengers from flights from the UK into the Caribbean islands usually continue their vacation or journey onto other Caribbean islands, either by flights on Caribbean Airlines or LIAT or by yacht or boat charters”.

Anyone with the three Cs is kept under surveillance for the development of a rash and if this happens s/he will be isolated and investigated, Lewis-Bell reminded.
Officials should follow the cue and collect samples of serum, naso-pharyngeal swab and urine for submission to the Caribbean Public Health Agency (CARPHA) as well as completion of the measles investigation form, she said.

While measles is highly contagious, it is nevertheless a preventable disease and can be eliminated by vaccination, a WHO document explained. It said between 2000 and 2015, the global incidence of measles slumped by 75 per cent, declining from 146 to 35 per million population.

“In 2015, there were an estimated 134,200 measles deaths globally representing a 79 per cent decline since 200,” the WHO position paper said.

Eradication of measles is biologically, technically and operationally feasible by strengthening immunisation services according to a WHO panel.

AMBITIOUS GOAL
The World Health Assembly (WHA), an arm of the global health body, has targeted measles elimination in at least five of the six WHO regions by 2020.

“This is an ambitious goal, since measles control requires the highest immunisation coverage of any vaccine preventable disease, which means that the health system must be able to reach every community” according to an online article.

Measles occurs predominantly in areas with low vaccination rates, particularly in the developing world. Guyana’s vaccination rate is some 95 per cent, which explains why the disease is absent among nationals in all 10 regions of the independent, South American country.

The WHO Global Vaccine Action Plan for 2012–2020 has established the target of measles and rubella elimination in at least five WHO regions by 2020, and member states in all six regions have established goals to eliminate measles by 2020 or before.
The WHO defines elimination as the absence of endemic measles transmission in a defined geographical area, in this case, all countries in a WHO region, for up to 12 months “in the presence of a well-performing surveillance system”.

To confirm elimination, there are three essential criteria: interruption of endemic measles virus transmission for a period of at least 36 months (three years) from the last known endemic case; in the presence of a high-quality surveillance system that is sensitive and specific enough to detect imported and import-related cases; and genotyping evidence should support interruption

Guyana is geographically located in the region of the Americas, which has achieved the elimination of endemic measles transmission in 2002, and like other countries in the region, has withstood outbreaks for more than a decade and a half notwithstanding challenges in other parts of the world. The elimination of measles brings additional benefits through strengthening health systems and better delivery of other vaccines including rubella.

“Measles will tell us quickly if we are off track, direct our efforts towards elimination and confirm our arrival if we allow its epidemiology to be our teacher,” an online article advises.
Measles like any other vaccine-preventable diseasee is a national notifiable condition and should be reported to Dr Shamdeo Persaud, Chief Medical Officer (CMO) within 24 hours of suspicion.

All public and private physicians, medex and nurses are urged to be on the alert for the symptoms, and be advised that all suspected cases are to be investigated immediately and followed up for 30 days.

“The MCH unit is prepared to give support whereever needed,” Dr Scott assured.