Fieldset
Measles in Maiduguri: "It can spread like wildfire"

As malaria season starts to slow down in northeastern Nigeria, Swedish doctor Mårten and his team spot an increase in children arriving with measles. Could there be an outbreak of this life-threatening disease nearby?

The rain stopped almost two months back, and now a dry wind has started to blow from the north – the infamous Harmattan that blows from the Sahara Desert. It dries out the skin and makes the nights cooler.

In the morning, most people who can here dress in a jacket or hooded sweater, or wrap up in shawls.

However, as a Swede, the opportunity to carry out morning gymnastics in 18 degrees Celsius instead of 28 is appreciated. In the afternoon it will still be 35 degrees. Winter is coming, they say…

The grip of malaria

With the change of weather, we have also seen an expected and long-awaited shift in the disease landscape.

I first came here just over two months ago. Back then our hospital was filled beyond capacity with malaria patients, but as the mosquitoes become fewer, the disease has now slowly started to release its grip.

Measles is a highly contagious disease. In an unvaccinated community, it can spread like wildfire, mainly affecting small children who have not had it before.

However, given how many pools, puddles and tanks of water are found in the city, we haven’t got rid of mosquitoes or malaria completely.

The number of patients in the hospital are now only one third of the number we had when the malaria ravaging this community was at its worst. All patients now get their own bed (rather than having to share) and our nursing team is less stretched.

It's a nice feeling and provides much-needed respite for the worn-out staff.

The measles tent

One morning, I am called to our isolation tent to assess a patient alongside one of our doctors. This tent is where we treat children with measles – a disease we started to see more of in late November.

In one of the beds lies a little boy who gasps in his mother's lap. He came here a few days ago. He has had a fever for a few days and a rash on his face. Now, he has suddenly deteriorated during the night and stopped eating.

He is awake, but drowsy, with no clear eye contact.

We have had a few cases of measles throughout my time here, but now we have seen a clear increase. It is common in this period when the Harmattan sweeps in and it gets colder, the local staff tells me.

Measles is a highly contagious disease. In an unvaccinated community, it can spread like wildfire, mainly affecting small children who have not had it before.

Vulnerable communities

You may think that a little fever, a cough, a runny nose, red eyes and some spots cannot be so dangerous. However, the danger of measles is that it affects the immune system and can lead to serious secondary infections such as pneumonia, brain inflammation and diarrhoea with dehydration.

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New arrivals at a camp for internally displaced people in Maiduguri State
New arrivals at a camp for internally displaced people in Maiduguri State

In a community like Maiduguri, where many people already have an impaired immune system due to malnutrition and vitamin deficiencies, a measles outbreak can have very serious consequences.

As a result, a mass measles vaccination is always a central part of preventative measures during a humanitarian disaster response. It has been implemented in Maiduguri on several occasions before.

However, it is a challenge to vaccinate everyone in a community that is constantly growing and moving, as well as where many internally displaced people live either with relatives, friends or in disorganised temporary camps.

So far, of our more than 50 measles patients, two have died in the last month due to pneumonia. There is, unfortunately, a risk that there will be more.

We soon notice that many of the measles patients who have been arriving come from the same area and that most were unvaccinated.

We always report measles cases to the Nigerian Public Health Authority, which is supported by the World Health Organisation.

A team from the Public Health Authority come to visit and to get samples from our patients. Their next step is to actively search for measles cases in the areas that the patients come from, to assess whether an outbreak is going on, and, if so, quickly initiate a vaccination campaign.

Recovery and risk

We confirm that the little boy has severe pneumonia as a result of his measles, even though he was on antibiotics.

We now give him an intravenous treatment and more oxygen. We ideally want to move him to our intensive care unit, which unfortunately is not possible since he would infect all the other patients there. So, we must do as best we can in the measles tent.

The next morning, his breathing has calmed down somewhat, and he’s interested in breastfeeding again. Hopefully, he'll be fine.

So far, of our more than 50 measles patients, two have died in the last month due to pneumonia.

There is, unfortunately, a risk that there will be more.