Daily Times

Karachi: Health official of Sindh have stressed for increasing Expanded Programme on Immunization (EPI) coverage upto 85 percent to prevent any outbreak of measles.

Currently Sindh lags far behind in terms of EPI coverage while officials are holding District Health Officers DHOs responsible for any untoward incident of measles in the province.

According to Pakistan Social and Living Standards Measurement Survey (PSLM) 2015, Sindh’s EPI coverage hovers around 45 percent. This shows increase of Sindh’s performance from 35 per cent of EPI coverage, according to MICS 2014.

EPI coverage in Punjab is around 85 percent while its remains above 50 percent in Khyber Pakhtunkhwa.

“The situation has relatively improved in Sindh. Each district should have coverage area more than 85 percent”, said Dr Agha Muhammad Ashfaq, Project Director, Expanded Programme on Immunization (EPI) Cell Sindh.

Measles is a highly contagious infection caused by the measles virus. Measles is an airborne disease which spreads easily through the coughs and sneezes of those infected. It may also be spread through contact with saliva or nasal secretions.

Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.

According to World Health Organisation (WHO), unvaccinated young children are at highest risk of measles and its complications, including death. Unvaccinated pregnant women are also at risk. Any non-immune person (who has not been vaccinated or was vaccinated but did not develop immunity) can become infected.

Severe complications from measles can be avoided through supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhoea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.

Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection.

“Good or poor management makes the real difference. Yes we do have management issues on some districts of Sindh. If there is competent DHO working in any district, the cases would be less in terms of measles cases,” Dr Agha stated.

“DHO should make contingency plan for prevention of measles which is part of World Health Organization (WHO) protocol,” he added.

Giving the example, Dr Agha said there were some districts which were performing well, while some are performing under par. “Well performing districts are Hyderabad, Sukkur, Larkana and Shikarpur. Similarly situation is comparatively better in Dadu with previous years. In Karachi, areas like Shah Faisal Town, Orangi town are better whereas Baldiya, SITE, Landhi, Gaddap are poor performer,” he added.

The first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure to the virus, and lasts 4 to 7 days. A runny nose, a cough, red and watery eyes, and small white spots inside the cheeks can develop in the initial stage. After several days, a rash erupts, usually on the face and upper neck. Over about 3 days, the rash spreads, eventually reaching the hands and feet. The rash lasts for 5 to 6 days, and then fades. On average, the rash occurs 14 days after exposure to the virus.

Director Health Services, Karachi & Director General (DG) Health, Sindh, Dr Mohammad Taufiq, seems satisfied with the performance of Sindh against measles.

“Migration of unvaccinated children is main reason behind frequent cases. Influx from Afghanistan and migration from Balochistan and other parts of the country towards Karachi is the main reason,” he noted.

Dr Taufiq said it is not Sindh, but even Punjab measles cases are reported on frequent basis even after having better EPI coverage.

Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths. In Pakistan, Measles has been part of EPI for last 35 years.

According to PD EPI, there was no shortage of vaccine. “Global Alliance for Vaccines and Immunizations (GAVI) is providing Rs. 37 billion vaccine support all over Pakistan for five years. Sindh government is also providing Rs. 6.4 billion for five years,” Dr Agha informed.

Another expert, Dr Asad Ali, Associate Professor Pediatric Infectious Diseases, Aga Khan University said in order to control measles, better health governance, accountability from top to bottom and public awareness were necessary.

“Take the example of Punjab, where Chief Minister holds regular health meetings. Not only this on the spot, he orders punishment awards for those staff who lack behind in performance,” Dr Asad added.

Special Supplementary Immunization Activity (SIA) for measles is planned next year. The campaign is done after every three years throughout country with the support of Global Alliance for Vaccines and Immunizations (GAVI).

“We have cold storage centers at division and district level. We have recently opened new cold storages at Shaheed Benazir Abad Division and Mirpurkhas divisions,” Dr Agha added.