Containing measles in conflict-driven humanitarian settings

Pediatric Infectious Diseases Encountered During Wartime—Part 1: Experiences and Lessons Learned From Armed Conflict in the Modern Era

“…Recent experiences have shown that certain infectious diseases commonly, and almost predictably, emerge in regions of conflict, especially those of larger scale or prolonged duration [ 3 , 25 , 33 , 34 , 35 •]. For this discussion, it may be most convenient to categorize them by the factors that lead to outbreaks during conflict, summarized in Table 2 .…”

“…In regions with high birth rates, it only takes months for a population group without routine immunizations to decrease the percentage of people with protective immunity below the threshold needed to ensure herd immunity. This is well-described by a recent review, which discusses the risks presented by the dangerously low rates of first vaccine coverage (well below the ideal high 80%) in many regions of conflict [ 34 ]. Afghanistan, the Central African Republic, South Sudan, Somalia, and portions of Syria and Yemen are well below 70%.…”

“…Additionally, the observed measles vaccine failure was high (66%), which the authors proposed it might be related to the well-known difficulties in vaccine handling, administration, and keeping the vaccine stable (cold chain), all of which are more challenging when public health infrastructure is under the duress of conflict. A recent update shows a rebound in coverage up to 83% for 2018, indicating that such problems, once identified, can be addressed quickly [ 34 ]. To further highlight this threat, on September 20, 2021, the USA confirmed 16 cases of measles and 4 cases of mumps in Afghan nationals and US citizens being resettled from Afghanistan.…”