•Sister Racheal Samungole attends to a child during a routine under-five exercise at the Railway Clinic in Ndola. Picture by JESSIE NGOMA–SIMENGWA.

By JESSIE NGOMA-SIMENGWA –
Zambia has extended a measles immunisation campaign to its neighbouring countries as a way of sealing all possible loopholes for infections.
The aim is to ensure that the measles immunisation programme is not undermined.
A special case is the Democratic Republic of Congo (DRC), at the northern end, which has been subject to years of armed conflict.
The influx of refugees from the DRC, particularly into the Copperbelt Province, poses a potential health risk to the population of Zambia, a landlocked country.
In recent years, the Copperbelt has recorded a rise in immigrants from the DRC, Angola, and Somalia, among other countries.
The immigrants have settled in communities around the Copperbelt.
In view of this, the provincial health team has been on high alert, and has gone a step further by engaging officials from some neighbouring countries.
“One mechanism that has been put in place includes joint programmes with neighbouring countries on immunisation coverage.
“That places us on a better side of managing outbreaks with ongoing campaigns,” says Copperbelt Provincial Health Officer, Robert Zulu.
Dr Zulu, in an interview in Ndola, said the aspect of measles being communicable makes it a public health concern.
This, therefore, necessitates the placement of the Copperbelt on high alert as the province is near the DRC where measles cases are still high.
Measles is a highly contagious viral disease transmitted through droplets from the nose, mouth or throat of infected people.
It remains a major cause of death among children globally, despite the availability of a safe and effective vaccine.
Under the Global Vaccine Action Plan, measles is targeted for elimination in five WHO regions by the year 2020.
According to the World Health Organisation (WHO), the DRC is one of the countries in Africa which have not been consistent in immunisation programmes because of social and political upheavals.
The vast central African nation wrestles with regular outbreaks of measles and other contagious diseases that mostly affect children.
According to research, the decades of violence and conflict in the DRC have resulted in a health system marred by widespread inefficiencies, especially in rural areas.
Doctors Without Borders describes the current health situation as a big challenge, since the neighbouring country continues recording recurrent epidemics.
Immunisation has so far proved to be one of the most successful and cost-effective health interventions.
Celebrated in the last week of every April is the World International Week for Immunisation, whose aim is to promote the use of vaccines to protect people of all ages against diseases.
The global health campaign has seen diseases such as polio, tetanus, measles, cholera, and malaria, among many other deadly diseases, reduce.
It is widely acknowledged that countries in the sub-Saharan African region have stepped up their measures in controlling measles.
Zambia has not been an exception, as it has responded positively by running a fairly comprehensive immunisation campaign.
However, with the rising number of immigrants from the DRC and other neighbouring countries, Zambia recognises the need to be alert in order to avert a negative impact on the immunisation exercise.
The WHO has routinely called for an improved vaccination coverage against measles which, if not addressed, could kill or leave a child disabled for life.
According to the global health body, the incidence of measles is significantly higher than the recorded figures because many cases go undocumented.
In the first three months of 2019, the number of measles cases quadrupled, with 112, 000 cases across the globe recorded.
The resurgence of measles has not spared developed countries such as the United States of America, Australia and some parts of Europe, whose health systems are strong.
Dr Zulu said measles mostly affects children with a compromised immunity and those that are not vaccinated.
The virus is transmitted through coughing and sneezing by an infected person, and starts with non-specific symptoms such as fever and sore throat, followed by specific symptoms such as rash and red eyes, known as conjuctivitis.
“This may lead to serious respiratory infections such as pneumonia. At the moment, we have no outbreak of measles in Zambia; an outbreak is declared when there are three to five confirmed cases of measles,” explained Dr Zulu.
He said measles is a public health concern because the complications are fatal, particularly in crowded places and in areas where the level of poverty is high, as these are prime factors that aid transmission.
Measles mostly attacks children below the age of five years.
Therefore, the vaccine is administered to children during their routine visits from nine months of age.
In Zambia, low immunity is usually equated to people living with HIV/AIDS.
However, this is not always the case as low immunity may also be present in pregnant women, malnourished people and alcoholics.
Dr Zulu further explained that measles could lead to miscarriages and premature delivery of babies.
In severe cases, measles could cause blindness and other infections that may lead to bacterial pneumonia, meningitis, and death of young ones.
The proportion of measles outbreak observed in 2016 led to a shift in the vaccination exercise on the Copperbelt, targeting children from nine months to 15 years.
“Today, measles cases are being found in older children and young adults who are not immunised or in whom primary immunisation has failed due to factors such as low immunity,” Dr Zulu said.
Arising from the heightened awareness and sensitisation programme, the Copperbelt Province has recorded positive response from many community members.
“Copperbelt has hit 80-85 per cent, above the national target of immunisation for measles, which is 80 per cent,” says Copperbelt Province Disease Surveillance Officer Albert Mweemba.
Despite its success rate, the immunisation campaign has not been without hiccups.
Mr Mweemba said in an interview that it was difficult to monitor the movement of people, especially those using the porous border points.
He also cited religious beliefs in some communities as one of the barriers which health teams face in immunisation campaigns.
Overall, Zambia has performed well in accordance with the vision of achieving a world without measles.
The multi-pronged strategy that includes running joint programmes with neighbouring countries should be sustained in order to attain the global goal of eliminating measles through increased immunisation.