Final Research Paper for Megan Dempsey

Measles, also known as rubeola, is a highly contagious, airborne disease transmitted by infected people. Most people live in parts of the world where vaccinations and immunity are a way of life. In six countries, including the United States, measles deaths are at near zero today (Otten, Okwo-Bele, Kezaala, & Brellick, 2003).

A Continuing Need

The Measles Initiative, A Continuing Need

Measles, also known as rubeola, is a highly contagious, airborne disease transmitted by infected people. Most people live in parts of the world where vaccinations and immunity are a way of life. In six countries, including the United States, measles deaths are at near zero today (Otten, Okwo-Bele, Kezaala, & Brellick, 2003). Still, many people around the world do not have access to these vaccinations, and are therefore susceptible to many diseases that have nearly been eradicated in first world countries, such as the United States. The World Health Organization recognized a need to create a new vaccination program to immunize African children and adults against the number one killer of preventable disease in their country, measles. As a united front, the World Health Organization, The American Red Cross, The United Nations Foundation, The Bill Gates Foundation, and The United States Center for Disease Control and Prevention created The Measles Initiative, as a solution for the measles epidemic in effected regions of the world. The Measles Initiative was put in motion to prevent unnecessary deaths of innocent children and adults by the simple use of a $1.00 vaccination. In addition to saving lives, this global vaccination program will help stop the spread of a highly contagious disease, in hopes of eradicating the measles virus for good.
The measles vaccine has been in use for forty years, but it was not until 1974 that global measles vaccination programs were put into effect (Wolfson, 2007). These programs have since been categorized into three phases. The first phase began in 1974, with high hopes of introducing routine measles vaccinations to almost every country in the world. UNICEF then led a universal childhood vaccination program that started the second phase. The second phase started in the 1990’s and continued to 1999 with the administration of one vaccination at 9 months old to children in 47 countries (Elliman & Bedford, 2007). The second phase found failure when school age children were found to contract the disease, due to not responding well to the vaccination at 9 months old. It was in 1999, when the WHO, UNICEF, The Bill Gates Foundation, and The American Red Cross united to create The Measles Initiative to vaccinate children age 9 months to 14 years old. The third phase would involve two vaccinations, at least three years apart, with scientific research showing that two vaccines are more effective than one (Elliman & Bedford, 2007).
The partnership of each group involved in The Measles Initiative is crucial because each group bears a different responsibility. The WHO designs the policies and health guidelines for each country to ensure proper, safe steps are taken during immunization campaigns. UNICEF is the only organization allowed to import the vaccine into most developing countries and has a sophisticated logistics capacity as well as great stature in the country. The CDC provides funding and the technical and scientific information to the campaign. The UN Foundation provides a substantial amount of funding as well as the financial mechanisms necessary to move funds between agencies and to countries. The American Red Cross provides funding and has the network of Red Cross volunteers to do the work, ensuring each child has a chance to be vaccinated. The Bill Gates Foundation provides funding (Measles Initiative, 2006).
With all of these groups coming together, the vaccination of over 80 million children started in Sub-Saharan Africa, an area of the world that was responsible for over half of the worlds measles deaths, causing 45% of vaccine preventable deaths (Otten, Okwo-Bele, Kezaala, & Brellik, 2003). The Measles Initiative would continue all over the world and wherever there was a need, there would be a vaccine against measles. The Measles Initiative set a goal to cut global measles deaths by 90% by 2010 (Measles Initiative, 2006).
In 2005 Otten, Kezaala, Fall, Maresha, Caimes, & Eggers (2005) found that between December, 2000- June of 2003, the average decline in the number of reported cases was 91%. The total estimated deaths averted in 2003 were 90,043. The initiative has been wildly successful and is still in progress. In 2005 the number of reported measles-related deaths around the world was at 345,000, which is a 60% decrease from 1999’s reported number of deaths of 873,000 (Irby, 2005). In continuing with this success, The Red Cross wants to ensure that The Measles Initiative steadily moves across the globe to vulnerable regions like Asia, where measles deaths are the highest outside of Sub-Saharan Africa and to smaller countries such as Pakistan, and Uzbekistan. With theses programs, health workers provide not only measles vaccines, but also insecticide-treated nets for malaria prevention, vitamin A, de-worming medication and polio vaccines (Irby, 2005).
The follow up campaigns have proven to be successful all over the world. And it has even been suggested that receiving the measles vaccine could act as a non-specific immune boost to give added protection against other diseases, but further research is needed to confirm this (Salama, Mcfarland, & Mulholland, 2003). There is still a need to continue with vaccination campaigns in Africa. Between 2003-2005, citizens of Mozambique were ravaged with a measles outbreak. There were 1,676 confirmed cases in just three years (Nshimirimana, et all, 2006). This was from failure to vaccinate enough of the population to prevent the endemic proving the absolute importance that even those in remote areas of the world must be vaccinated due to the virus’s airborne ability to infect. In 2004 and 2005, there were several large outbreaks in the European Region. The outbreaks in Romania and the Ukraine were the source of measles outbreaks in a number of EU countries, countries in which the government had reported that measles were under control (Spika, 2006). This exemplifies that measles can still effect vulnerable and non-vulnerable populations alike.
The necessity to eradicate vaccine-preventable diseases is overwhelming. Many of these diseases are highly contagious and there are no walls to protect us from the infected. Everyday people travel from region to region carrying unknown diseases. Diseases, such as measles, are capable of wiping out at-risk populations where treatment and medications are remote. We are fortunate to have access to vaccines that our bodies respond to with immunity. The measles vaccine, when given in two doses, is nearly 100% effective against the virus, but whether we can totally eradicate the virus with global vaccination is debatable. Eradication is possible due to the fact the virus in monotypic and unable to mutate (Spika, 2006). The lack of an animal reservoir and the fact that this is an acute, not chronic, illness makes eradication possible. The problem still remains that measles is a highly contagious disease, making it necessary to vaccinate every child, including those in remote areas of the world (Spika, 2006).
With continuing measles vaccination programs and with the united support of major health organizations such as UNICEF, the WHO, The American Red Cross, and the CDC, eradicating measles becomes more of a possibility every time a child is vaccinated. The measles vaccination has been shown to save tens of thousands of lives and the need to vaccinate against measles will continue until the final goal of measles eradication is met.
a. Intervention 1 Immunize every child in Africa against Measles
i. Disadvantage 1 It is extremely unlikely that every child in Sub-Saharan Africa will be found by members of the Measles Initiative due to the topography of the country
1. Sub-Saharan Africa’s climate and topography make it extremely difficult to account for its total population. “Despite colonialism, African remains powerfully itself, moulded by its hard environment” (Otten,2003). The problems of finding those in need of medical care are usually compounded by a collapse in basic infrastructure; broken roads and bridges, and continued insecurity (Otten, 2003).. It is difficult to maneuver through the terrain to find tribal groups that are “hidden” from society. The measles initiative would like to vaccinate every child in Africa, but this seems unlikely due to the fact that there are people unaccounted for in a country that is divided by desert, mountains, vast forest and war.

Otten, J. The suffering of millions. (2003, June). New African,(419), 59. Retrieved February 4, 2008, from Platinum Full Text Periodicals database.


ii. Disadvantage 2 There is knowledge deficit amongst some of Africa’s population that the immunization is necessary.
1. Many people In Africa are more concerned with short-term survival than minded to take risks for long-term development. Tribal people in the Congo region live in a warring county, their primary concern is to survive the day. These people have more eminent concerns such as what they are going to eat and drink for the day rather than the need for vaccinations. Knowledge deficit is a problem because they are surviving, but their children are dying from diseases like measles, that could have been prevented from a simple vaccine. It is important to teach the need of vaccinations, not only individually, but also globally, as measles cannot be eradicated unless every individual is immune (Culligan & Welsh, 2001).

Tim Cullinan, James Welsh. (2001). The problems of medical relief agencies. The Lancet, 357(9257), 713-4. Retrieved February 4, 2008, from Platinum Full Text Periodicals database

Intervention 2 Give a booster shot of the measles vaccine to the same children at least three years apart from the time it was first given,
i. Disadvantage 1 Record keeping if Africa is modest due to the socioeconomic status of certain rural parts of the country.
1. Immunization records have been lost or never documented due to the fact that there is little access to computers where most records are stored safely. Paper charting has been lost. especially in tribes where travel is a way of life. This problem has led to errors in documentation of school age children who have or have not received a second booster shot to discourage a measles outbreak during early education. The booster shot is necessary to prevent further outbreaks and spread of such a highly contagious disease. As the child gets older, vaccination records have become more and more obscure (Alan,Lifton,Thai,Kaying, & Hang, 2001), This potentiates the need to vaccinate school age children against measles and other threatening diseased where there are either no documents of incorrect document of the child’s past medical history. In Sub-Saharan Africa, there are few computers and even fewer dollars to provide accurate accounts of medical history (Alan et all, 2001).

.Alan R. Lifson, Dzung Thai, Kaying Hang. (2001). Lack of Immunization Documentation in Minnesota Refugees: Challenges for Refugee Preventive Health Care. Journal of Immigrant Health,3(1), 47-52. Retrieved February 4, 2008, from Research Library database..


ii. Disadvantage 2 African tribes travel due to political unrest, making it difficult to find the children who are in need of a booster shot.
1. Political unrest and a warring state have caused people to leave their homes and communities. . Some of these people go into hiding to escape the consequences of war. This makes it extremely difficult to find those children in need of a second measles shot as well as other vaccinations. The reality of this has shown that the measles epidemic is still a problem in Africa because school age children need a booster to keep them immune from the disease. Aid workers cannot find these displaced children to give them the immunization that are necessary
(Dowden,2005).


Richard Dowden (2005, March). To save Africa we must listen to it. New Statesman, 18 (850), 18-20. Retrieved February 4, 2008, from Platinum Full Text Periodicals database.






























References



Alan R. Lifson, Dzung Thai, Kaying Hang. (2001). Lack of Immunization Documentation in Minnesota Refugees: Challenges for Refugee Preventive Health Care. Journal of Immigrant Health, 3(1), 47-52. Retrieved February 4, 2008, from Research Library database. (Document ID: 352546391)
Carlson, L. (2007, March). Immunization update: neonates to adolescents. Nurse Practitioner, 32(3), 49-57.

Fitzpatrick, M. (2007, May 24). An End to the MMR guilt trip for blameless parents. Community Care, Community Care 1674, 23.


Nshimirimana, D., Masresha, B.G., & Maumbe, T. . (2006, September 22). Effects of measles-control activities--African region, 1999-2005 MMWR: Morbidity & Mortality Weekly Reportt
55, 1017-1021.


Otten, M. W., Okwo-Bele, J. M., & Kazaala, R. (2003, May 15). Impact of Alternative Approaches to Accelerated Measles Control: Experience in the African Region. Journal of Infectious Diseases 187, 36-43.
.Richard Dowden (2005, March). To save Africa we must listen to it. New Statesman, 18(850), 18-20. Retrieved February 4, 2008, from Platinum Full Text Periodicals database. (Document ID: 810330381).
Tim Cullinan, James Welsh. (2001). The problems of medical relief agencies. The Lancet, 357(9257), 713-4. Retrieved February 4, 2008, from Platinum Full Text Periodicals database. (Document ID: 69559122).

The suffering of millions. (2003, June). New African,(419), 59. Retrieved February 4, 2008, from Platinum Full Text Periodicals database. (Document ID: 349264441).