The number of children who have died from measles and measles-like symptoms in Bangladesh has crossed 900, with eight more deaths reported in the 24 hours to yesterday morning.
A total of 902 children have died from measles or symptoms of the disease since March 15, according to the latest data from the Directorate General of Health Services (DGHS).
Of the deaths, 803 were among children with measles-like symptoms, while 99 were confirmed measles cases.
The DGHS disclosed the figures in its latest measles situation report yesterday afternoon.
No death among confirmed measles patients was reported in the last 24 hours. During the period, 70 new confirmed cases were detected, while 728 children developed measles-like symptoms.
Another 700 children were admitted to hospitals, while 549 were discharged after treatment.
Between March 15 and Saturday, Bangladesh recorded 141,776 suspected measles cases and 17,800 confirmed cases. A total of 123,494 patients were hospitalized, of whom 119,089 have since been discharged.
Why is measles not coming under control?
The continued deaths despite an ongoing vaccination campaign have raised questions about the government’s measures to contain the outbreak.
Public health experts say many children in the target age group remain outside vaccination coverage. The absence of adequate guidelines and coordinated instructions has also complicated the situation.
They believe the outbreak could have been brought under control sooner had appropriate decisions been taken at the initial stage and effectively implemented at the grassroots level.
Experts also said it is important to determine whether vaccinated children have developed sufficient antibodies to protect them against measles.
However, DGHS Director General Prabhat Chandra Biswas said infections have declined somewhat and are expected to fall further.
He said awareness campaigns are being conducted alongside vaccination drives.
The DGHS has also launched an initiative to determine the actual causes of death among children who died after developing measles. Divisional directors have been instructed to review whether the deaths were caused by measles or pneumonia.
Biswas said pneumonia deaths following the measles outbreak have not emerged as a significant separate issue, although pneumonia naturally causes many child deaths in Bangladesh.
Concerns over vaccination coverage
Former IEDCR director Professor Mahmudur Rahman said controlling infections is essential to reducing deaths and that ensuring proper vaccination coverage should be the first priority.
Public health and vaccine expert Tajul Islam A Bari also questioned the government’s vaccination coverage figures, saying they do not reflect the actual situation.
He said the vaccination programme’s target was around 18 million in 2010. Despite the population increase since then, a similar target has been set for measles-rubella vaccination, which he said is inappropriate.
A Bari said measles cannot be controlled without vaccinating children who have been left out of the programme. At least 95% of a population must be vaccinated to effectively control transmission, he said.
EPI Deputy Director Sabbir Ahmed said the Expanded Programme on Immunization is conducting initiatives to vaccinate children aged six to 59 months who have not yet received vaccines.
Health workers have been instructed to go door to door to identify unvaccinated children and administer vaccines, he said.
Sabbir said children below six months and those above five years are currently being affected by measles at higher rates, meaning children outside the routine vaccination age are also at risk.
He expressed hope that improved vaccination coverage would reduce both infections and deaths.
Asked whether children outside the specified age range would be included in the vaccination program, he said there was no such plan for now.
Healthcare system weaknesses
Public health expert Mushtaq Hossain said weaknesses in the healthcare system, alongside vaccination gaps, are contributing to child deaths.
Some deaths could have been prevented if the healthcare system had been more effective, he said, adding that public awareness also remains inadequate.
Mushtaq advised parents to keep children with fever separated from others and seek treatment at a local health centre if the fever persists.
He called for stronger primary healthcare facilities, particularly centres providing care between intensive care units and home-based treatment. Such facilities could help save critically ill patients while reducing pressure on major hospitals, he said.
Experts accuse government of negligence
Professor Benazir Ahmed, former chief scientific officer of the IEDCR, said the government had not taken sufficient action to tackle the outbreak.
He pointed to the health minister’s announcement that another 100,000 children would be brought under vaccination coverage, saying this indicates coverage remains below the desired level.
At least 95% of children in the target age group must be vaccinated, he said. Otherwise, transmission will continue among unvaccinated children.
Benazir acknowledged that identifying unvaccinated children is difficult but said it is possible with adequate funding and planned initiatives. He recommended village- and neighbourhood-based campaigns to raise awareness among parents.
Experts call for coordinated plan
Professor Mahmudur Rahman, former IEDCR director and chairperson of the National Verification Committee on measles-rubella vaccination, called for coordinated decision-making involving multiple experts.
He said children below six months are also being infected, requiring a separate strategy.
Given the continued transmission, authorities should also consider vaccinating children outside the routine age range, he said.
Rahman said several technical issues also need to be addressed to bring the outbreak under control. Sustainable improvement will not be possible unless those issues are identified and addressed based on expert recommendations, he added.