Date: Sun 10 Mar 2019
Source: Medical Xpress [abridged, edited]
<https://medicalxpress.com/news/2019-03-madagascar-killer-measles-outbreak.html>

[F] is aged 2 but weighs no more than a 4 month old, the terrible result of her battle with measles, which is cutting a deadly swathe through Madagascar. Widespread malnutrition and low rates of immunisation on the Indian Ocean island have ramped up the killing power of the highly infectious virus. In the last 6 months, nearly 1000 children have been killed by a resurgent disease that vaccination once appeared to have tamed.

Between last September [2018] and February [2019], there were more than 79,000 cases of measles in Madagascar, 926 of which were fatal, according to the World Health Organization (WHO).

The Anivorano-nord clinic has had 510 patients suffering from "kitrotro" and "kisaosy", the local names for measles. Roughly 100 patients were hospitalised, but only 4 lost their lives, according to official statistics. In Madagascar, where 47% of children under 5 are malnourished, the disease has proved particularly dangerous. "It's often said that malnutrition makes a bed for measles," said Vincent Sodjinou, a WHO representative. "The most serious cases are often reported in malnourished children."

The paediatric ward at Antsiranana's military hospital, north of Anivorano, has been overwhelmed. "Normally we only treat one measles case here every 2 months," said head of medicine Ravohavy Setriny Mahatsangy. "We've had 444 just since December [2018]. The people prefer traditional healers who often advise them to refuse any hospitalisation," said Dr Said Borohany, a health ministry official. "And most villages are hours away from basic medical centres."

The other viable solution, vaccinations, has been complicated by the lack of funds available for such a programme. Until now the nation's vaccination programme has administered only a single dose, when WHO recommends 2. The UN agency estimates that 5.6 million doses would be needed to contain the epidemic. But Madagascar is USD 1.6 million (EUR 1.42 million) short of the USD 11.2 million [EUR 9.96 million] needed to fund such an operation.

Newly elected president, Andry Rajoelina, has promised to vaccinate all children aged between 6 months and 9 years.
Date: Sun, 10 Mar 2019 03:09:02 +0100
By Tsiresena MANJAKAHERY

Antsiranana, Madagascar, March 10, 2019 (AFP) - Frangeline is aged two but weighs no more than a four-month-old -- the terrible result of her battle with measles, which is cutting a deadly swathe through Madagascar.   Widespread malnutrition and low rates of immunisation on the Indian Ocean island have ramped up the killing power of the highly infectious virus.   In the last six months, nearly 1,000 children have been killed by a resurgent disease that vaccination once appeared to have tamed.   Now on a drip, the scrawny infant was only saved because her mother Soa Robertine, 32, made the 25-kilometre (15-mile) trek from her home to the Anivorano-nord health centre, in the island's far north.

Without her timely action, respiratory or neurological complications arising from the virus would have proved fatal, doctors said.   "Frangeline is suffering severe malnutrition and she wasn't vaccinated" against measles," said the clinic's head of medicine, Hollande Robisoa.   "She contracted a complicated form of measles and she would have died if she hadn't been brought here."   Many other children have not been so lucky.   Between last September and February, there were more than 79,000 cases of measles in Madagascar, 926 of which were fatal, according to the World Health Organization (WHO).   The Anivorano-nord clinic has had 510 patients suffering from "kitrotro" and "kisaosy" -- the local names for measles.

Roughly 100 patients were hospitalised but only four lost their lives, according to official statistics.   But many local people dispute the numbers in a community where rumours are common.   "I heard that hundreds of children have already died," said Sylvain Randriamaro, 46, sitting in the hospital waiting room.   "I was alarmed, so I decided to vaccinate my two children," aged five and six, he said.   Measles has hit Madagascar barely a year after it was gripped by an outbreak of plague that claimed 200 lives.   "It's a major epidemic," said doctor Vincent Sodjinou, a WHO representative.   "It's down to the fact that for almost a decade the rate of vaccine coverage was not high enough and, over generations, the numbers of unvaccinated people have increased."

- 'Malnutrition a bed for measles' -
Measles can be relatively benign if symptoms like fever and cough are handled promptly.   If not, there is a risk of "opportunistic" illness such as pneumonia or diarrhoea -- diseases that can fatally attack patients with weak immune systems. 

In Madagascar, where 47 percent of children under five are malnourished, the disease has proved particularly dangerous.   "It's often said that malnutrition makes a bed for measles," said Sodjinou. "The most serious cases are often reported in malnourished children."   The paediatric ward at Antsiranana's military hospital, north of Anivorano, has been overwhelmed.   "Normally we only treat one measles case here every two months," said head of medicine Ravohavy Setriny Mahatsangy. "We've had 444 just since December."   Mahatsangy blamed physical contact between patients, their "reluctance to go to hospital and opposition to vaccinations".

The combination of factors has wrought a tragic toll on his patients.   One example is Marie Lydia Zafisoa, aged eight, whose "mother took her to a witchdoctor... and then a traditional healer who prescribed six baths," according to her aunt Bana Tombo.   When that failed, Zafisoa's father carried her to the clinic.   "It was too late -- she died on the way, on her father's shoulders," said Tombo.   Seven-month-old Adriano Luc Rakototsioharana was more fortunate.   Her grandmother Catherine had also turned to traditional medicine before taking her to hospital.   She barely survived the ordeal -- but even so, Catherine remains adamant that traditional medicine holds the key.   "For measles, you need a cow dung infusion or a tea with bark from the lazalaza tree," she said.

- 'It's the culture' -
Doctors say that such beliefs are frustrating their efforts to roll back the disease.   "It's the culture," Ravohavy said, with a resigned smile.   "Changing people's mentality is far more difficult than treating measles."   The profession also complains that the situation is worsening despite the state paying for most measles treatment.    "But the people prefer traditional healers who often advise them to refuse any hospitalisation," said a health ministry official, doctor Said Borohany.   "And most villages are hours away from basic medical centres."   The other viable solution, vaccinations, has been complicated by the lack of funds available for such a programme.

Until now the nation's vaccination programme has administered only a single dose when the WHO recommends two. The UN agency estimates that 5.6 million doses would be needed to contain the epidemic.   But Madagascar is $1.6 million (1.42 million euros) short of the $11.2 million needed to fund such an operation.   Newly-elected President Andry Rajoelina has promised to vaccinate all children aged between six months and nine years.   "Our goal is to eradicate measles," he said.   But the fight will be long and difficult.   "Madagascar put in place a routine vaccination programme," said the WHO envoy, Sodjinou. "But it remains inadequate to reach the furthest reaches of the country."
Date: Mon, 28 Jan 2019 17:06:04 +0100

Antananarivo, Jan 28, 2019 (AFP) - Six people from the same family were "killed on the spot" by a lightning strike in Madagascar over the weekend while sheltering from a storm, officials said Monday.   The relatives -- including a three-year-old child -- were killed in the central village of Bakaro on Saturday. Another person suffered superficial burns.   "Twenty-five farmers sheltering from rain under a thatched cottage after leaving their rice field were hit by a lightning bolt," said medical inspector William Patrick Rakotondralambo of the Fitsinjovana commune.

"Six people from the same family were killed on the spot, including a three-year-old child," he added.   Eight survivors were treated for shock, Rakotondralambo said.   Lightning strikes are relatively common in Madagascar, an Indian Ocean island famed for its unique wildlife and well-known for its vanilla and precious redwood.
Date: Sun, 20 Jan 2019 19:59:57 +0100

Antananarivo, Jan 20, 2019 (AFP) - Heavy rains and flooding swept away houses in Madagascar's capital of Antanarivo have killed nine people, an official report said Sunday.   "During an emergency operation in the district of Tsimialonjafy, we found five dead bodies," said a report from the city's fire brigade .   "On Sunday, by 5:00 pm (1400 GMT) four other dead bodies were discovered under the rubble," it added.   Emergency services were alerted by locals to the sudden flooding that happened on Saturday evening.   According to officials in the district, at least five houses collapsed and were washed away in the deluge.
Date: Thu 13 Dec 2018
Source: Midi Madagasikara [online translation, abridged, edited]
<http://www.midi-madagasikara.mg/a-la-une/2018/12/13/epidemies-plus-de-10-000-cas-de-rougeole-dans-20-regions-tana-egalement-en-epidemie-de-rubeole/>

With 44 districts, 20 regions and 10,294 affected people, the measles epidemic has reached its peak. The districts of Antananarivo Renivohitra and Ambato Boeny are the most affected. As the stock of vaccine is exhausted except vaccines for infants up to 9 months old already scheduled to be vaccinated in health facilities according to the vaccination schedule, the importation of new vaccine doses is under way.

A milestone of 10 000 cases in all age groups has now been crossed. The measles epidemic affecting children, adolescents and adults hit a large part of the Antananarivo district, with 5971 cases, and that of Ambato Boeny, where 782 cases were recorded. In total, 44 districts in Madagascar are affected by this epidemic, which started about 3 months ago. With 20 affected regions out of 22, the epidemic has spread across the island; the exceptions are the 2 regions of Ihorombe and Anosy.

The resurgence of measles cases is explained by gaps in vaccination. Indeed, the number of children vaccinated at 9 months (the age indicated for vaccination against measles in Madagascar) has been steadily decreasing.

As the number of vulnerable or unvaccinated people is high, so too is the risk of people developing the disease. Since the beginning of the current epidemic, nearly 70% of measles cases are children and adolescents aged 1-14 years, with a clear predominance of unvaccinated people in the age group of less than one year.

Similarly, 55% of all cases are unvaccinated or of unknown vaccination status. "It's only in the face of this growing epidemic that people are realizing the importance of immunization. And yet routine vaccination has for years included that against measles from 9 months. Similarly, Mother and Child Health Week (MSM) is an opportunity to carry out catch-up vaccination," says Dr Manitra Rakotoarivony. Completely free vaccines in public health facilities are accessible to every child from 9-11 months.

Currently, in the face of the epidemic situation, measles vaccines are out of stock for older subjects. According to the Ministry of Public Health, the doses still available are intended only for children who will soon reach the age of 9 months and who are scheduled, according to the appointments already set during their last immunization session, to be soon vaccinated against measles. The health authorities had to use the safety stock to meet the growing needs of the growing epidemic in Antananarivo. However, an import of new batches of vaccines is under way.

Measles is not the only epidemic currently affecting Antananarivo. The current epidemiological situation indicates that the district of Antananarivo Renivohitra is also in a rubella epidemic, as well as 2 other districts, namely Ambanja and Amboasary South, with at least 5 cases per district confirmed in one month.
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