Measles Epidemic: Another Stain in an Already Terrible Public Health Track Record

PAHO alerts on the resurgence of measles in the Americas, Venezuela leads the way with over 800 cases and becomes a public health threat for the whole region.

Photo: Correo del Caroní

On March 9, the Pan-American Health Organization (PAHO) released its newest Epidemiologic Alert regarding the increasing number of measles cases in the American continent. Just like it happened with malaria and diphtheria last year, Venezuela stands out… for all the wrong reasons.

With 886 confirmed cases (including two deaths) since June 2017, Venezuela is once again leading in poor control of perfectly preventable diseases. 82% of these cases come from the Bolívar state (a monument to the failure of the Venezuelan public health system), specifically from the Caroní municipality, or Ciudad Guayana, the biggest city in the region. Cases have been registered in Apure, Anzoátegui, Delta Amacuro, Caracas, Miranda, Monagas, Vargas and Zulia, mostly linked with workers from the illegal mines of Bolívar. If it rings a bell, that’s because it should.

Measles is an airborne disease, transmitted through cough, sneezes and any form of contact with saliva from infected patients. Initially characterized by high fever and runny nose, clinical diagnosis is difficult until the typical red, flat rash spreads across the body. Complications like severe diarrhea, encephalitis and pneumonia can occur in a third of infected patients, being particularly dangerous in malnourished children, where up to 10% of cases can be lethal. This is an important concern in Venezuela, where some 15% of all kids are malnourished. While not as lethal as other diseases recently found in headlines, measles is much, much more contagious, with up to 90% of unvaccinated people in contact with patients developing the disease.

Venezuela is once again leading in poor control of perfectly preventable diseases. 82% of these cases come from the Bolívar state.

While the number of cases in Venezuela is small compared to that of European countries like Italy, Romania and Ukraine (over 70% of the 21,315 cases registered last year in that continent), measles was a long forgotten problem in our country. The last national epidemic occurred in 1993, with an important outbreak in 2002 and a few imported cases in 2012. But by December 2017, Venezuela had registered 71,83% of all confirmed cases of measles in America, and since January 1, 159 more cases have been diagnosed in the country. The United States follows us with 11 (eleven!) confirmed cases since January, all of them imported from other countries.

The Venezuelan situation is particularly alarming for neighboring countries like Brazil, which has confirmed eight cases of measles since January, all of them unvaccinated Venezuelan children who recently arrived to the border city of Boa Vista, where up to 40,000 Venezuelan refugees are living in inhuman conditions. Another 25 suspicious cases wait for confirmation, all of them from towns near the Venezuelan border. A 4- year-old Venezuelan girl showing measles symptoms died last week in a local hospital, propelling a regional vaccination campaign, aiming to cover some 400,000 susceptible people.

In response to the national epidemic, the Venezuelan Health Ministry, with support from PAHO, launched a national vaccination campaign, buying over 6 million vaccines between the second half of 2017 and 2018. The measure, however, might have been taken too late; UNICEF reports show that by 2016, only 88% of all kids at risk had received one dose of the MMR (measles, mumps, rubella) vaccine. When evaluating coverage of the complete scheme for full immunity, the percentage reduced to an alarming 53%.

The Venezuelan Health Ministry expects to stop the current epidemic before it turns one year old (next June). Considering the precarious economic situation, and the government’s shameful track record when dealing with infectious diseases, it’s unlikely that’ll happen. Expect measles to join diphtheria, malaria and HIV as part of Chavez’s terrible public health legacy.