Prossy Namuwulya
Measles, a highly contagious viral disease, remains a significant global health concern, especially among young children. Despite the availability of a safe and effective vaccine, measles continues to be a leading cause of death in low-income countries with limited healthcare systems.
According to the World Health Organisation (WHO), measles was responsible for the deaths of more than 700,000 people in the year 2000 alone while afflicting more than 36 million others worldwide. While vaccination efforts have prevented about 500,000 deaths between 2000 and 2022, measles still claims more than 136,000 lives each year, primarily in Africa and Asia.
Between 2020 and 2023, the UVRI WHO, RRL (Uganda Virus Research Institute, World Health Organisation, and Regional Reference Laboratory) reported a total of 144 measles outbreaks across 29 districts in Uganda. Lamwo District, which shares a border with South Sudan, confirmed 28 cases of measles during this period. The situation in Lamwo emphasizes the urgency of addressing measles outbreaks effectively, especially considering the region’s challenges.
Uganda declared a measles outbreak in February, with cases spreading between Lake Albert and the Rift Valley. Lamwo’s situation is exacerbated by cross-border movements from South Sudan, where political instability leads to unregulated migration into Uganda. Despite measures by Uganda’s Ministry of Health to vaccinate and monitor these individuals, unsupervised entries facilitate community spread.
The Centers for Disease Control and Prevention (CDC) describes the signs and symptoms of measles as unmistakable, characterised by a rash that starts on the face and spreads, coupled with fever. Additional symptoms include coughing, coryza (runny nose) and conjunctivitis (red eyes). Everyone is at risk of contracting measles if unvaccinated, but children under five years are particularly more vulnerable. This is because their immune systems are still developing and they are more likely to experience complications from the disease.
Measles transmission is mainly through respiratory droplets when an infected person coughs or sneezes, or through direct contact with contaminated surfaces. Prevention hinges on vaccination, with two doses recommended in endemic areas: one at nine months and turning two. Limiting the spread requires isolating infected individuals for at least five days after the rash appears.
Measles persists as a concern due to suboptimal vaccination coverage. WHO recommends at least two doses at 95 percent coverage to achieve population immunity. However, disruptions in surveillance and routine immunisation during the Covid-19 pandemic have left many children unvaccinated, making them susceptible. Global mobility further complicates containment, as infected individuals can easily spread the virus across borders.
To build trust and enhance vaccination rates, Uganda has engaged various stakeholders, including cultural, political, religious, and civic leaders in maternal and child health interventions. Uganda’s policies support routine immunisation drives, as detailed in the national Expanded Programme on Immunisation (EPI) policy. Continuous efforts to involve community leaders and conduct media campaigns are critical to improving immunisation coverage.
Additionally, government and regional stakeholders must conduct regular population-level studies to monitor viral activity and develop cost-effective diagnostic assays. Enhancing vaccination coverage to establish population immunity against all vaccine-preventable diseases is essential.
In conclusion, addressing the measles outbreak in Uganda requires a multifaceted approach. First, by strengthening vaccination campaigns, improving cross-border health measures, and fostering community trust.
Ms Namuwulya is a laboratory scientist at the Uganda Virus Research Institute.
