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Ebola's Hidden Risk: Measles

Children haven't been getting their shots in countries where the health care system was burdened by Ebola and it's putting them at risk of a new outbreak.

Just as regions of West Africa ​affected by Ebola are slowly starting to recover from the devastating outbreak, a new study suggests another deadly disease could be lurking on its heels: measles.

Ebola has killed nearly 10,000 people in West Africa since the middle of last year, according to the World He​alth Organization, with the heaviest impact in Liberia, Sierra Leone, and Guinea. The outbreak has overburdened the medical systems in these countries, according to a study published today in the journal Science. According to the study, routine health care, like making sure kids gets their shots on time, has been swept to the side as resources are funnelled into fighting the epidemic.

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This has put children at risk of a second outbreak, this time of vaccine-preventable diseases like measles, pertussis, diphtheria, and tuberculosis—all of which can be deadly in small children and babies.

"Measles epidemics often follow humanitarian crises," reads the study, which was lead by Saki Takahashi, a Princeton University PhD candidate. "Measles is one of the most transmissible infections, and immunization rates tend to be lower than for other [recommended] vaccines, in part because of the older age at which measles vaccine must be administered. For this reason, explosive measles outbreaks are often an early result of health system failure."

To assess the risk of a measles outbreak, the researchers analyzed data on the number of unvaccinated children before the Ebola outbreak and the reduction in routine vaccination rates, then extrapolated to make projections on how deadly a measles outbreak would be. They estimated that after 18 months of a disrupted health care system, more than 1 million children in Liberia, Sierra Leone, and Guinea will be unvaccinated. If those populations were hit with a measles outbreak, it would be devastating.

"If vaccination had continued at pre-Ebola rates, a generalized measles outbreak would have caused 126,868 cases. However, the projected outbreak size increases to 227,484 cases after 18 months of disruptions, resulting in a projected 5209 additional deaths from measles," the study reads. "Measles mortality could be at the high end of this range because of the limited health care services and increased prevalence of malnutrition and vitamin A deficiency associated with the Ebola outbreak."

Global health efforts like the WHO's expanded programme on immunization have been working to eradicate these childhood diseases throughout the world, including West Africa, and they'd been finding success. The number of reported measles cases in Liberia, Sierra Leone, and Guinea dropped from 93,685 between 1994 and 2003 to just 6,937 cases between 2004-2013.

But Ebola's impact has interrupted the progress made and could leave an entire generation of children vulnerable to a new wave of illness just as the country's begin to bounce back from Ebola, the researchers wrote.

It's not too late to fix the problem, though. The researchers recommended heeding the warning and introducing a targeted vaccination campaign to close the gap before a deadly outbreak of measles or another vaccine-preventable disease begins to sweep through the Ebola-affected countries.

"Planning for such a vaccine campaign should begin now so that we can respond quickly when the situation stabilizes and minimize the time at risk for disease outbreaks," the study reads. "The growing pool of susceptible individuals in Guinea, Liberia, and Sierra Leone may place bordering countries at increased risk for a measles outbreak; they too may have suffered disruptions to their health care systems due to a focus on the threat from Ebola."