Five and a half months into Bangladesh’s measles outbreak, children continue to die despite a nationwide vaccination campaign, with public health experts warning that the battle is being lost not only in immunisation but also in early detection, community-level control and timely treatment.
More than 1,000 children have died from measles or measles-like symptoms since the outbreak began in mid-March.
Yet experts say many critically ill children are reaching hospitals only at the final stages of the disease, when opportunities to prevent death have already narrowed considerably.
The continued fatalities expose another dimension of the measles crisis: vaccination can prevent infections, but once an outbreak is widespread, identifying cases early, isolating patients and ensuring rapid treatment of complications become equally critical.
Public health expert Dr Mohammad Mushtuq Husain said Bangladesh’s response needed to move beyond a hospital- and intensive care-centred approach.
“Measles control strategy should be at community level and not hospital or ICU centric,” he told Deutsche Welle.
Effective identification, prevention and isolation cannot be achieved without community involvement, he argued, adding that opportunities to reduce mortality become limited once a critically ill child reaches intensive care.
Children arriving too late
The pressure is already visible at Bangladesh Children’s Hospital and Institute in Dhaka, where patients have been arriving from across the country since the outbreak began.
Hospital Director Professor Dr Mirza Md Ziaul Islam said capacity remained a constraint.
“We are trying to treat the patients as much as possible. But we also have limitations. We cannot admit all the patients even if we want to,” he told Deutsche Welle.
Patients in more serious condition are admitted, while others receive initial counselling.
He said many children were being brought to hospital only after their condition had deteriorated significantly.
“In most cases, we have seen that when the child’s condition becomes very bad, they are taken to the hospital. Most of the children who come here are not vaccinated against measles. As a result, immunity has not developed in their body. That is why the death toll is high.”
Dr Md Atiqul Islam, who is in charge of the hospital’s measles ward, also said severe complications were frequently seen among patients arriving from outside Dhaka.
Some deteriorate rapidly and eventually die, he told BBC Bangla.
The experience of one three-year-old girl illustrates the importance of timing.
Her father, Rafiqul Islam, brought her to Bangladesh Children’s Hospital after fever was followed by a rash.
Doctors diagnosed measles and admitted her immediately. Her condition subsequently improved.
Rafiqul said doctors told the family that arriving quickly had prevented her condition from worsening and that a delay of another day or two could have made the illness more severe.
Measles opens door to complications
The virus itself is only part of the danger.
Public health and vaccination specialist Dr Tajul Islam said measles can severely weaken the body’s immune response, leaving infected children vulnerable to other illnesses.
Complications including pneumonia and diarrhoea can then become life-threatening without rapid treatment, he said.
“The children who are dying are dying because of other diseases besides measles,” Tajul said.
That makes early detection particularly important, experts say, especially for children already weakened by malnutrition or other health problems.
Outbreak showing no sign of ending
Professor Mahmudur Rahman, chairman of the National Measles and Rubella Eradication Committee and an epidemiologist, said there were still no meaningful signs that the outbreak was subsiding.
Infections are now appearing among children across different age groups, including those aged six to nine months, nine months to one year and one to five years.
Even where infections have declined slightly, the reduction has not been significant, he said.
The continuing spread has also renewed questions about the effectiveness of the emergency vaccination campaign conducted from April 20 to May 20.
Authorities had hoped the campaign would build sufficient population immunity to bring the outbreak under control by July.
Instead, after cases declined during June and July, doctors reported another increase in recent weeks.
The government reported vaccination coverage exceeding 100% of its campaign target, but experts say the figure does not necessarily mean all vulnerable children were reached.
Public health expert Dr Mushtuq said proper EPI microplanning requires health workers to identify individual children, determine who needs vaccination and direct families to appropriate vaccination centres.
Door-to-door vaccination may work as an emergency intervention, he said, but cannot replace that system over the longer term.
‘Should have declared emergency’
Some public health experts are now questioning whether Bangladesh responded aggressively enough when the outbreak first emerged.
They argue that declaring an epidemic or public health emergency early could have triggered a more coordinated response involving surveillance, vaccination, treatment and local health facilities simultaneously.
Public health expert Dr Be-Nazir Ahmed said specialists had called for such action from the beginning.
“We had been saying from the very beginning that it was necessary to declare an epidemic or a public health emergency,” he told BBC Bangla.
“Had a concerted battle against measles been launched on all fronts simultaneously, the outbreak would not have dragged on for so long.”
The government, however, says it is treating the outbreak with the highest priority.
Prime Minister’s Special Assistant on Health Ziauddin Hyder said many children without immunity were arriving at hospitals at a very advanced stage, contributing to the continuing deaths.
He said vaccines had been stocked in every upazila and blood samples were being collected from vaccinated children to examine questions surrounding vaccine efficacy.
For experts, however, the continuing deaths show that vaccination alone cannot end the crisis.
