Measles scares again in Brazil: After experiencing evidence of virus eradication, the country is experiencing a continuing spread of the disease

Coverage of measles vaccinations in Brazil is insufficient. (Photo: Claudio Fachel / Palácio Piratini / Archive)

From a measles-free country to the stage of new outbreaks: this scenario has been repeated since 2018, when the virus was re-introduced in Brazil. Four years later, the risk still exists. Data from the Ministry of Health show that in the first quarter of 2022, there were 14 infections – 12 in Amapá and two in SĂŁo Paulo – without deaths. However, the number could be eight times higher, as there were still 98 suspected cases during the period.

Almost half (48) of the number still under investigation is in the state of São Paulo. Another 13 are in Pará and eight in Bahia. Of the 668 cases registered in 2021, Amapá focused on 527 cases, or 78.8%. Pará, on the other hand, reported 115 (17.2%). Between 2018 and 2022, Brazil reported 39,356 diagnoses and 40 deaths. More than half focused on the peak year of 2019: 20,901 registrations and 16 deaths.

As cases begin to scare the country again, vaccination rates will drop. Experts point to a number of reasons for this movement, which vary from locality to locality. These include a possible lack of vaccinations, misinformation, opening hours of health centers that conflict with older work routines, and even an anti-vaccination movement. However, the main assessment is that Brazil itself has become a victim of successful vaccinations:

“Today, the success of vaccines paradoxically prevents people from taking vaccinations. Young parents have not heard, do not live with the disease. The perception of risks is decreasing and this need for vaccination is decreasing, ”said Renato Kfouri, president of the immunization department of the Brazilian Pediatric Association (SBP) and director of the Brazilian Immunization Association (SBIm).

portability

The measles virus is the most contagious of the known infectious agents, surpassing even the Omicron variant of the coronavirus. In this sense, a patient can infect 15 to 18 people, which increases the risk if compliance with the vaccine is low. Data from the Ministry of Health’s National Vaccination Program Information System (SI-PNI) show that MMR vaccine coverage for measles, mumps and rubella has declined since 2019, when it last crossed the border. 90%.

However, the index considered ideal by the Ministry is 95% – achieved by 2016. Last year’s figures combine coverage of 71.63%, the second lowest since the beginning of the historic series in 1994. 2022 has not yet been published and is being analyzed by the Department of Health (SVS).

“In recent years, we have accumulated low vaccination coverage there. With the pandemic, the situation has worsened. It is a very high risk (again an epidemic). Homogeneity in coverage is crucial: there are municipalities where 66% (of the population) have two doses and 80% one, but others have a vaccination rate of less than 40%, 50%. There are pockets with low coverage, where the risk of spreading the disease is very high, ”continues the pediatric infectious disease specialist.

Brazil lost its measles-free country certificate in 2019, three years after it received it from the Pan American Health Organization (PAHO). The recurrence of the disease in 2018, when migrants arrived from Venezuela in the north of the country, led to a continuous spread – as the virus circulates and contaminates freely – the following year.

With that, the achievement of 14 years after the implementation of the national measles eradication plan in 1992 came to an end. To get a certificate again, the effort is to invest and progress to vaccinations.

Campaign

Doctors and researchers agree that the most important way to prevent the disease is to take two doses of the vaccine, which are available for free on the Unified Health System (SUS). At the beginning of the month, the ministry launched a vaccination campaign involving 6-month-old babies up to 5 years old. In addition, healthcare professionals can also update the vaccination booklet. According to the folder, 22 million doses are available for the initiative.

Children deserve more attention in the fight against the disease. In 2022, there were eight cases in infants under 1 year of age. The number of records for 1-4 year olds was four. The other two infected were 20-29 years old. The situation is repeated compared to the previous year, when 255 diagnoses were made in children under 1 year of age and 186 in those aged 1–4 years. In 2021, two died among infants under 1 year of age.