DEMOCRATIC REPUBLIC OF CONGO 2016 © Diana Zeyneb Alhindawi
Measles remains a leading killer of young children in parts of the world, even though an effective, low-cost vaccine has been available for decades.
In 2019, 207,500 people, mostly children under five, died from measles—a 50 percent increase from 2016, and a tragedy for an easily preventable disease. Weak public immunization systems in some conflict-affected countries and record-high numbers of displaced people living in close quarters continue to fuel outbreaks. Since 2006, Doctors Without Borders/Médecins Sans Frontières (MSF) has vaccinated nearly 26 million children against measles.
is the cost
to vaccinate one child against measles
deaths prevented
by vaccination from 2020-2021 (CDC)
people vaccinated
during outbreaks by MSF in 2023
Measles is caused by a virus which is so contagious that 90 percent of non-immune people who live with an infected person will catch it. It is transmitted via droplets from the nose, mouth, or throat of infected people, by coughing, sneezing, and breathing.
Malnourished children under five years of age are more likely to get severe measles. Those without enough vitamin A in their diets, such as in areas where rice is a main food staple, or those whose immune systems are weakened by HIV/AIDS or other diseases, are also especially vulnerable.
Symptoms appear between 10 and- 14 days after exposure to the virus and include runny nose, cough, eye infection, rash, and high fever. A few days after symptoms appear, tiny white spots called Koplik spots may appear inside the mouth.
In some cases, measles causes serious and even fatal complications, including severe diarrhea, ear infection, pneumonia, blindness, and encephalitis.
Routine measles vaccination for children, combined with mass immunization campaigns in countries with high infection rates and in response to outbreaks, are the linchpin of public health strategies to reduce measles deaths globally. Full immunity requires two vaccinations, with the timing of these doses dependent on where the child lives. Infants at high risk for catching measles—for example, those living in displaced person camps, living with HIV or exposed to an outbreak— should be given their first dose as early as 6 months of age.
Although the measles vaccine is safe and affordable, coverage remains low in countries with weak or disrupted health systems. The vaccine needs to be refrigerated until use and then delivered by injection, and it requires two doses—factors that make it difficult to provide in low-resource settings with hot climates and few trained health workers. Yet preventing outbreaks requires that at least 95% of the population is immune. And babies cannot be vaccinated until they are at least six months old, so every population has vulnerable people without immunity. Most people who survive measles or are vaccinated have lifelong immunity.
Clinical diagnosis of measles requires a history of fever lasting at least three days, plus at least one of the "three Cs:" cough, catarrh (build-up of mucus in the nose or throat), conjunctivitis. Clusters of tiny white spots on the inside of the mouth, known as Koplik spots, are also a sign of measles.
To declare an outbreak, laboratory confirmation of diagnosis is required. In overcrowded or closed settings such as refugee and displaced person camps or orphanages, a single confirmed case of measles is considered an outbreak since the disease spreads so easily and quickly.
There is no specific antiviral treatment for measles. Care involves isolating patients and treating them for complications, including a lack of vitamin A, eye-related problems, stomatitis (mouth ulcers), dehydration through diarrhea, protein deficiencies, and respiratory tract infections. Most people recover within two to three weeks, but up to 30 percent of people infected with measles in low-resource settings die from one or more of these complications.
Vaccination is the best protection against measles. Even after the disease has started to spread, immunizing at-risk populations can still reduce the number of infections and deaths. MSF responds to the threat of measles epidemics by conducting mass vaccination campaigns for vulnerable children (about 80 percent of our measles vaccination activity) and providing routine vaccination as part of pediatric care, both in emergency settings and in areas where government immunization systems do not function. During outbreaks we also provide supportive care for infected children, to prevent complications from becoming fatal.
Once there is a single case of measles in refugee settings, an outbreak is declared, and our teams swing into action to prepare a vaccination campaign. To keep vaccines cold for up to a day, often in sweltering temperatures, logistics workers fill coolers with ice packs and load them onto trucks, along with all the supplies necessary for vaccinating thousands of children each day. While community health workers spread the word with local leaders, nurses set up vaccination stations under trees or near schools. Any children already sick will be given treatment and, if necessary, transferred to a hospital. In the past ten years, MSF has done over 30 vaccination campaigns, the majority of them in Democratic Republic of Congo, Central African Republic, Sudan, Niger, Chad, and Nigeria—many of them among populations displaced by conflict.
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