A study has found that 59.4% of children hospitalised with measles in Chittagong, Comilla and Cox’s Bazar contracted the virus at healthcare facilities, highlighting significant gaps in infection prevention and control measures at hospitals.
The findings were presented in the conference room of Chittagong Medical College on Wednesday.
The study, titled “Measles Outbreak in Southern Bangladesh: Disease Spread, Symptoms, Genetic Analysis, and Maternal-Child Antibody Status,” was conducted by the Asperia Health Research and Development Foundation (AHRDF).
The study showed that of 200 children hospitalised with measles in Chittagong, Comilla and Cox’s Bazar, 167 had not been vaccinated against the disease.
However, 91 of the unvaccinated children had not yet reached the age for routine measles vaccination.
Genome sequencing of samples from 17 infected children identified the B3 genotype in all cases, a strain that can be controlled through vaccination.
Malnutrition emerged as a major underlying factor in severe illness, with 31% of the affected children suffering from severe malnutrition.
Researchers collected data from 200 children treated for measles and 100 of their mothers at Chittagong Medical College Hospital, Mother and Child Hospital, Comilla Medical College Hospital and Cox’s Bazar Medical College Hospital.
Kamrun Nahar, associate professor of child health at Chittagong Medical College, was the principal investigator.
Children from poor rural families most affected
Among the 200 children, 46% were under nine months old, meaning they contracted measles before reaching the routine vaccination age.
Of the infected children, 148 (75.5%) were from rural areas, while 127 (64.8%) belonged to low-income families.
“A significant portion of the outbreak is linked to rural areas, demonstrating that poor and marginalised populations are at extreme risk from this virus,” Kamrun Nahar said.
The study found that malnutrition was a major factor contributing to severe disease and measles-related complications.
About 31% of the children were suffering from severe malnutrition. The study also found that 18.9% were fed foods other than breast milk, which the researchers said could compromise their immune systems.
The report noted that Vitamin A can help prevent severe complications from measles. However, only 63 children (32%) had received Vitamin A capsules during the previous six months, indicating a significant gap in coverage.
“Among the children who did not receive Vitamin A, 59% developed severe and acute complications,” Kamrun Nahar said.
She added that exclusive breastfeeding alone was insufficient to reduce the severity of measles and that other medical interventions and proper nutrition were essential.
The study found that moderate to severe malnutrition, living in rural areas or slums, poverty, overcrowded housing and Vitamin A deficiency were associated with a higher risk of severe complications.
Among children whose mothers had no history of measles vaccination, 55% suffered severe complications after contracting the disease.
Many infected before vaccination age
Of the 200 measles patients, 167 had not been vaccinated. However, 91 of them had not yet reached the eligible age for routine vaccination.
Overall, the patients ranged in age from two months to 11 years, with 46% under nine months old.
In Bangladesh, the first routine measles vaccination is administered at nine months, meaning many of these children contracted the disease before becoming eligible for vaccination.
Among unvaccinated children, 52% missed vaccination because of a lack of awareness or forgetting the date, 30% because of illness, 8% because of their mother’s illness, 4% because of fear of vaccination and 4% because they had lost their vaccination cards.
Hospitals emerge as major source of transmission
The study found that 59.4% of the infected children contracted measles at healthcare centres or hospitals, highlighting weaknesses in infection prevention and control measures.
“Measles transmission is occurring because multiple children share the same bed due to a shortage of hospital beds,” Kamrun Nahar said.
Professor Dr Mohammad Musa Mia, head of the Department of Paediatrics at Chittagong Medical College Hospital, said patients often remain in general wards while showing symptoms before being diagnosed.
“Transmission occurs among other patients through contact with them. Other patients recover and go home, only to return to the hospital later with measles,” he said.
“If a separate hospital were established for measles, transmission would decrease, and providing treatment would become easier,” he added.
Professor Dr M A Hasan Chowdhury, former head of the Department of Medicine at Chittagong Medical College, said measles was highly contagious and that one patient could infect 12 to 15 others.
“Therefore, isolation is crucial. If infected individuals are not kept separate, the infection spreads rapidly. Health protocols must be strictly followed to prevent transmission,” he said.
The study also found that 32 children, or 16%, had previously come into contact with a measles patient.
According to Kamrun Nahar, 86% of the children who participated in the study recovered and returned home.
No new genotype detected
The research team conducted genome sequencing on samples from 17 patients and identified the B3 genotype in every case.
Kamrun Nahar said there had been concerns that a new genotype might be circulating because of the presence of Rohingya populations in the region.
“However, the study did not detect any new imported infection,” she said.
She said the B3 genotype had also been identified in tests conducted by the Institute of Epidemiology, Disease Control and Research (IEDCR) and icddr,b.
“This confirms that the current measles outbreak is due to a decline in overall vaccination coverage. Achieving 95% vaccination coverage would make it possible to control the disease,” she said.
Researchers call for vaccination and isolation
Kamrun Nahar said unvaccinated children were nearly twice as likely to develop severe complications as vaccinated children.
“The most reassuring and significant finding is that not a single vaccinated child died,” she said.
The research team recommended regular vaccination campaigns to reach 95% of children, door-to-door vaccination for children who missed their doses, Vitamin A supplementation, improved child nutrition, rapid detection and isolation of children below the eligible vaccination age, and adequate isolation facilities and proper ventilation in hospitals.
Brigadier General Mohammad Taslim Uddin, director of Chittagong Medical College Hospital, said the level of isolation used during the Covid-19 pandemic was not being maintained for measles patients.
“If strict isolation is implemented and 95% of children are vaccinated, control will be possible,” he said.
He said 193 measles patients were currently admitted to the hospital and the number was continuing to rise.
“Transmission is also occurring within the hospital from infected patients to others,” he said.
Speaking at the event, Chittagong City Corporation Mayor Shahadat Hossain attributed the situation to the failure to hold the 2024 vaccination campaign and shortcomings over the past few years.
“Both vaccination and isolation must be ensured. Why are there so many patients despite vaccinating more children than the target?” he said.
“Since measles is highly contagious, isolation is the primary priority now. The nutritional needs of the children’s mothers must also be ensured,” he added.
Recommendations were also made at the event to maintain year-round vaccination programs, strictly enforce isolation protocols and consider establishing a dedicated measles treatment facility in Chittagong to help curb transmission.
