Measles resurgent in China as migrant children miss vaccinations

by Michael Woodhead
China looked like it was on track to eliminate measles until two years ago, but now the infection is making a comeback among unvaccinated young children, the World Health Organisation has warned.
In a report of the progress towards measles elimination in China a WHO surveillance study notes that China has seen dramatic reductions in rates of measles since it implemented and expanded childhood vaccination campaigns in the 1980s  and 1990s. Rates of the infection fell from 572 per 100,000 in the 1960s to below 10 per 100,000 since the 1990s. Since then, further reductions in measles have been seen as children have been given two doses of measles vaccine with uptake rates of more than 90%. There have also been additional 'catch up' measles vaccination campaigns in provinces where continuing outbreaks of measles have occurred. This resulted in the annual number of cases coming down from 140,000 per year in 2008 to under 10,000 in 2012. However, as the WHO Bulletin report notes, there has been a resurgence in 2013, with the number of cases bouncing back to around 24,000 in that year. The report says most of the measles cases occurred in young children who had missed one or all of their scheduled vaccination doses, although a few also occurred in adults. It says the resurgence is disappointing, especially as it follows intensive 'catch up' campaigns. In their report, the WHO researchers say it is likely that many of the unvaccinated children spreading measles will belong to migrant worker families who have left their hometown and thus drop out of the measles vaccination and reporting programs based in schools and local health centres.
"The resurgence of measles seen among young unvaccinated Chinese children in 2013 indicates a weakness in routine immunisation that allows some children to miss one or both of their scheduled doses of measles vaccine. Such weakness must be eliminated if a further resurgence in the next few years is to be avoided and measles is ever to be eliminated in China," they conclude.
"Improvements in the identification and location of children who are new to an area may permit marked improvements in vaccine coverage" they note.

News in brief: clinical studies from China

Measles is now rare in Guangzhou thanks to vaccination, but complete eradication will require vaccination of transient populations who now account for more than half of cases.

People who have a heart attack in China delay going to hospital for more than two hours, often because they don’t recognise the symptoms or their importance.

Chinese people consume dangerously high amounts of salt, with a Yantai study showing that 97% of men and 87% of women had intakes of over 6 g salt per day (mostly from added salt and soy sauce). Salt intake was related to high systolic blood pressure.

More than one in four new mothers in Guangzhou experience post-partum depression.

Compulsory routine infant vaccination with pneumococcal conjugate heptavalent vaccine would reduce pneumococcal disease in China by at least 32%, would prevent 2,682 deaths in the first five years of life and would save $1,190 million.

In rural China epilepsy goes untreated or undertreated in two out of three people with the condition, a Sichuan study has found. One third of people with epilepsy did not know about the disease and had not sought medical help.

The cultural pressure for gay men in China to marry means that their wives face a high risk of HIV and syphilis, researchers from Ningbo say. They found that only one in four gay men always used condoms with their wives, which explained HIV rates of more than 8% in women married to gay men.

Low vitamin A levels are linked to eye cysts (chalazia) in south west China

Weather has an important influence on measles transmission in China, with infection more likely after cold spells and during dry weather.

Stop fudging measles figures, health authorities told

Local health authorities have been given a stern warning to improve their reporting of measles cases and to ensure they do not under-report or ignore measles outbrekas.
 The National Health and Family Planning Commission has issued the warning in an effort to contain what is says is an increasingly worrying resurgence in measles in China.
The NHFPC says all local health departments must take active steps to ensure that measles monitoring and reporting system are in place and are operating effectively. It warns against under-reporting or  cases or of failing to report outbreaks of the infectious disease.
It is increasingly clear that the resurgence of measles is a very grim situation. Infection prevention, monitoring and control networks must be implemented, the NHFPC said.