Colombia is not facing a measles or swine flu (influenza A or H1N1pdm09) pandemic, and probably will not have one in the near future. This is the conclusion when figures of the National Health Institute (INS, for its Spanish acronym) and circumstances of these disease occurrences during this year are compared.
In regards to measles, the Colombian Ministry of Health reports vaccination coverage of 90% or more in the last years, protecting the country from an epidemic. The INS has confirmed that the 11 cases of measles reported up to mid-April (in the Provinces of Antioquia, Bolívar, Norte de Santander, and Risaralda) have all come from Venezuela and are not an autochthonous episode, meaning they have not emerged in the country, suggesting that protection against measles in Colombia is high in all age groups.
Measles is a highly-transmissible disease and preventable only by vaccination and caused by a virus specifically of the Paramyxoviridae family, morbillivirus genre, and is transmitted by contact with breathing secretions, inhaling small droplets expelled from a infected person when talking, coughing or sneezing. One case can produce up to twenty new cases if the person is not vaccinated.
In populations with low immunity to the virus it is disseminated rapidly and impacts almost all not vaccinated people or those who have lost immunity, something which to date has yet to occur.
Meanwhile, the Ministry of Health recommends all the community to be up to date with their MMR vaccines for all infants of one year of age and reinforcement at five. To date, the government has a provision of 350,000 dosages of the vaccine and is expecting another 700,000 additional dosages for almost 2,600 vaccination points across the country.
According to the epidemiological update published by the Pan American Health in March past, in 2017 four countries in America notified confirmed cases of measles: Argentina (3), Canada (45), United States (120), and Venezuela (727 cases). In the first months of 2018, eight countries have notified confirmed cases of measles: Antigua y Barbuda (1), Brazil (14), Canada (4), United States (13), Guatemala (1), Mexico (4), Peru (2), and Venezuela (159).
After an effort of almost 25 years, America is the only region of the world declared free from autochthonous transmission of measles. However, the Venezuelan economic, social, and health crisis is a challenge for the health care services as they need to increase supervision and vaccination activities where need be.
The virus circulates both in the continent as in many regions around the world; for instance in Europe, the World Health Organization (WHO) recorded 21,315 cases of measles and 35 deaths in 2017, 400% more than in 2016, when they reported 5,273 cases. The most affected countries are Rumania, Ukraine, and Italy.
Among the factors that influence propagation in Europe are international flights as the carrier of the virus can carry the virus to another country in less than 24 hours; furthermore, the WHO has stated that the anti-vaccination movements which have emerged with power in the region are producing low immunization coverage. These are two highly relevant aspects if migration movements are taken into consideration.
It is important for the countries to maintain measles vaccination coverage’s above 90% to avoid autochthonous transmission from cases coming from other countries.
With respect to influenza A, this past April, the Colombian Ministry of Health submitted a report which indicates that during the first quarter of the year there have been 10 fatal cases due to influenza A; additionally, up to the middle of this month, the confirmed cases were up to 61, 3 less than the same period in 2017.
It is important to highlight that since the pandemic of 2009, which left 18,500 deaths around the world, the virus became endemic in humans and swine and therefore it has been around Colombia several times, therefore many people must be total or partially immune to the disease, dramatically reducing the probabilities of an epidemic.
For now, the reports of respiratory disease of the INS show a reduction of cases with respect to the historic average, which also supports the affirmation that currently there is not an influenza pandemic. For 2018 they expect 17 cases per week of unusual severe acute respiratory disease which is an indirect indicator of the influenza virus, and in most weeks occurred up to now there have been fewer cases (between 8 and 16).
The number of yearly cases of influenza depends on three factors: One, if the virus is “new”. The influenza virus infects different species besides human beings which implies transformations in its structure, resulting in different degrees of antigen alterations, resulting in “new” viruses. If the variation is very deep, they will be completely new viruses for the immune system, leading to short-lived pandemics (especially in people with greater vulnerability such as children less than 5 years old and people greater than 65 years of age). Therefore, if the changes are not so extensive, the “new virus” will look fairly similar to the one that has already circulated among the populations.
A second factor is related to the intensity of the rainy season. In tropical countries, the influenza virus circulates most frequently during the rainy season and almost disappears during the dry season. For Colombia, according to the Hydrology, Meteorology and Environmental Studies Institute (IDEAM, for its Spanish acronym), the rainy season began last March and will go until far into June.
A third aspect has to do with the effectiveness of the vaccine, which varies each year between a low 20% and a high 85%. This variation is due that not always the viruses contained in the vaccine are the same that are circulating in Colombia. Vaccine preparation is a very hit and miss process and based on the types of viruses that circulated the year before and not always predictions are accurate.
Although the current analysis has been centered on the measles and influenza A, which cases do not reach the “outbreak” category, it is essential to underscore the relevance of the vaccine as an effective and safe way to prevent and control these diseases. The WHO says that vaccines help to avoid between 2 and 3 million deaths a year by providing protection against diseases such as diphtheria, measles, pneumonia, rotavirus, rubella, tetanus and polio.
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