Ebola Could Cause Thousands More Deaths — By Ushering In Measles

A child ill with measles during a 2009 outbreak in Guinea, one of the countries now hit by Ebola. Julian Harneis, Flickr (CC) A child ill with measles during a 2009 outbreak in Guinea, one of the countries now hit by Ebola. Julian Harneis, Flickr (CC)

Awareness of Ebola is picking up again in the United States: An American volunteer who was working in Sierra Leone has contracted Ebola and been medevac’d to the National Institutes of Health Clinical Center for Ebola treatment, and 10 more volunteers have been brought back to NIH, Omaha and Atlanta, to be examined at three of the four institutions in the US that have safe units to house them.

It’s a reminder that Ebola still persists in West Africa: In the last period the World Health Organization reported on (the 7 days ending March 8), there were 116 new cases. One bit of good news: None of them were in Liberia, for the second week in a row. But Guinea and Sierra Leone, where this volunteer was infected, continue to struggle.

And in a research paper published as that volunteer was being flown back, there’s a reminder that the Ebola outbreak is creating layers of health risks for those countries. In Science , researchers from NIH and four universities warn that Ebola’s interruption of other health services, such as childhood immunizations, threatens to create secondary epidemics of preventable diseases that would dwarf Ebola’s impact. In particular, they warn that there could be 100,000 additional measles cases, and up to 16,000 additional deaths, if health services are not restored.

As front-line Ebola nurse F. Zeela Zaizay of MAP International told me last month, the disease has undermined the entire health care infrastructure in the disease zone — not only in the obvious way of killing health workers, but also in diverting resources from other areas of public health, and in making healthy people afraid to come to clinics.

The team who conducted the analysis in Science predict that strain will make other health problems worse.

“Measles in particular is known to show up during or after humanitarian crises because it’s so infectious,” Justin Lessler, an assistant professor of infectious disease epidemiology at the Johns Hopkins Bloomberg School of Public Health, said in a press briefing last week. “The disruptions (in healthcare and vaccinations) would lead to nearly 400,000 additional unvaccinated children across the three countries. This number of unvaccinated children would be in additional to an already considerable at-risk population and significantly increases the likelihood of a major measles outbreak occurring and the impact of one if it were to occur.”

Measles is already present in West Africa, so the team is not arguing that Ebola will revive an eradicated disease — although, poignantly, hard work in the three countries had recently forced measles incidence way down. “Between 1994 and 2003, the countries reported — and this is just how many they reported, not necessarily how many occurred — about 100,000 cases of measles,” Lessler said. “Whereas in the last decade, they’ve only reported 7,000. So they’ve done an excellent job of controlling the virus compared to the previous (decade).”

Their analysis predicts that immunization programs would be so disrupted that 75 percent of children who otherwise would have received shots will not get them. For every month the disruption continues, they project, 20,000 additional children become vulnerable who otherwise would have been protected.

The WHO has been advising against vaccination campaigns in the hard-hit countries, because the campaigns create mass gatherings where Ebola can spread. (The WHO recommendation is to hold back on vaccination until 42 days after the last recorded Ebola case.) But Lessler and co-authors say the potential risk of measles — and the deaths and severe side effects from the disease — is so serious that campaigns should be started as soon as possible.

“Supplemental immunization campaigns have been successfully performed in all three countries in the past and could virtually eliminate Ebola’s effect on a measles risk in the region — likely making the situation better than it was before the Ebola crisis began,” Lessler said. “Measles is not the only health threat that has been made worse by the Ebola crisis, and it may not even be the worst. But it’s certainly one we can do something about.”