After three years of relative quiet, measles has reemerged with vengeance in Vietnam. Since January 2014, an outbreak that has spread through twenty-four cities and provinces, including major metropolises such as Hanoi and Ho Chi Minh City, has caused 7 deaths and over 993 cases of measles in the country. The disease has reemerged despite a joint UNICEF and WHO vaccination campaign carried out in 2010, which aimed to vaccinate 7.5 million children and to eliminate measles in Vietnam by 2012. The latest outbreak seems to have begun around May 2013, with Vietnam reporting 1,048 cases of measles by the end of December.
Measles, a common childhood viral illness of the paramyxovirus family, carries symptoms of high fever, a runny nose, white spots in the mouth, and a hallmark rash. Deaths related to measles are usually a result of complications from the disease. According to the WHO, measles remains one of the leading causes of deaths among children, particularly in developing countries. However, the disease has been combated over the years through the availability of a safe and effective vaccine and Vietnam reports a particularly high measles vaccination rate of 96 percent — so, how could an outbreak of this magnitude happen?
There remains speculation as to how and why measles has reemerged with such tenacity. In particular, is the claim that over the last year, parents have been reluctant to vaccinate their children due to the publicized stories of adverse vaccination effects. One such story from 2012, the Quinvaxem vaccine incident, describes nine deaths reported after receiving the pentavalent vaccine and resulted in Vietnam suspending the vaccine as a precautionary measure. Nevertheless, after thorough review of the cases, the vaccine was again declared as safe and the suspension was lifted. While Quinvaxem does not contain measles vaccination (rather, the vaccine protects against diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenza B infections), the theory holds that coverage of the deaths may have swayed parents from vaccinating their children. Whether or not this incident had major impact on measles vaccination rates remains to be seen – the most recent WHO country health profile on Vietnam’s measles vaccination rates was just released in May 2013, and no update has been announced.
Another theory behind the outbreak, claims that incompletion of the measles vaccination series has contributed to the outbreak. For full and effective prevention, the entire course of vaccination needs to be completed. Currently, the measles vaccination measures used in Vietnam contains two doses – one taken at nine to twelve months of age, the other at eighteen months of age.
As of February 23, 2014, Vietnam’s Ministry of Health has decided to respond to the outbreaks with a plan for a measles immunization campaign that would cover approximately 200,000 children.