Measles in Roraima: It is crucial to vaccinate, alerts Dr. Tânia Chaves

Travelers are a sentinel population for public health diseases in a particular region, country or even continent

One of the factors linked to the current measles situation in Roraima owes to the migratory movement from Venezuelans crossing the border seeking better living conditions and new work opportunities, while escaping from Venezuelas social and economic collapse. According to infectious diseases physician, Professor at the Pará Federal University and researcher at the Evandro Chagas Institute, Dr. Tânia Chaves, these people can be considered refugees and represent part of the travelers population that forcedly leave their countries, for several reasons. When arriving in Brazil, many of them form settlements in precarious basic sanitation conditions, situations that favor the introduction and transmission of agents such as the measles virus and other airborne infections, like diphtheria and others, including vector-borne diseases as malaria, she says.

To Dr. Tânia Chaves, who is also vice-president at the Sociedade Latinoamericana de Medicina del Viajero – SLAMVI [Latin-American Society of Travel Medicine], member of the Travel Medicine Committee and coordinator of the Tropical Medicine Committee at the Brazilian Society of Infectology, governments have failed controlling infectious diseases and there is no doubt of this failure by the Venezuelan health system. To her, the dramatic social, political and economic situation in the Country, without a doubt, reflects in the health system. It lacks official data about public health diseases; it lacks medications, materials and infrastructure to assist the population. The Venezuelan health prevention program also suffers with low vaccine coverage rates, which is verified by the increase in the number of diseases such as measles. Speaking of Brazil, another aspect to be considered that brings concern, specifically about measles, are the variations in vaccination coverage the Country has reported in the past years. This fact can contribute to the concentration of susceptible individuals and, therefore, result in an increase in the number of measles cases to epidemic. Brazil is on alert; the Ministry of Health has sent 377,930 vaccine doses of the triple viral vaccine to Roraima and Amazonas to suppress the demand for routine services and detect the disease. I believe implementing public policies to handle and confront refugee health in Brazil is urgent, while vaccination is one of the crucial points (but not the only one) to admit these individuals, she says.

Despite the gaps in Brazilian health system, the refugee scenario tents do worsen the situation

The specialist forwards that the situation could worsen if no confrontation measures to the refugee populations coming from Venezuela are taken in a practical, urgent and effective way. Along with the worsening of the Venezuelan situation, we expect an increasing number of families in Brazil. The Brazilian government has reported that the number of Venezuelans who requested refuge jumped from 54 to 2,595 in the 2016 first eleven months. Numbers from official institutions report that 54,764 Venezuelans live in Roraima. These numbers affect the states health system and severely contributes to the expansion of attendances and hospitalizations.

Regarding the concern of imported cases evolving to an outbreak, yes, it is true, but it does not mean we will wait for it to happen. For this reason, surveillance and control actions, including vaccination campaigns have been intensified in Roraima, aiming the target population. To the expert, it is urgent to discuss the construction of public policies targeting refugees, with the participation of different sectors, including health. The researcher defends the Brazilian health system in the Brazil-Venezuela border, where migratory flow is intense, should reinforce its actions against infectious diseases, i.e., for measles, that has a high transmission rate.

Brazilian health system should reinforce its actions to control infectious diseases

Brazil already ranks second in the list of American countries with most numbers of the disease this year; Venezuela is the first. These numbers were reported by the Pan-American Health Organization (PAHO), body of the World Health Organization (WHO). The expert states that since the year 2000, all measles cases diagnosed in Brazil were imported. Until april 11, 59 cases were reported and laboratory analysis by Fiocruz identified the G8 genotype in all cases, the same genotype that circulated in 2017 in Venezuela.

The Country has presented downtrend oscillations in vaccination coverage, especially when it comes to measles. In 1997, the measles virus caused a subcontinental-proportion outbreak, striking 53,664 people in Brazil triggered by a case imported from Japan. During this period, the measles vaccination coverage was only 76.91% in the Brazilian Southeast, she reminds.

Recently the Ministry of Health invited technicians from the Ceará Secretary of Health to support and contribute with Roraima by sharing experiences from the 2013 and 2015 outbreaks. Amazonas, in attempt to ensure greater vaccine efficiency, avoiding the vaccination primary bubble has recommended the reinforcement of the dose in all vaccinated adults. Dr. Tânia Chaves explains the actions should be held according to the local reality of each state and evaluated by their technicians. It is worth stressing that vaccination in Roraima must also be available for Venezuelans, who do not always have permanent residence and thus, such actions must be carried in a way to reach this group, she says.

Finally, the specialist remembers other strategies used to control measles outbreaks, including actions held in Ceará: preserving routine vaccination, door-to-door vaccination, vaccination reinforcement and fast vaccination coverage monitoring. Epidemio. Serv. Saúde, Brasília, 27(1) e 201634310, 2018.…