Venezuelan crisis causing resurgence in deadly vaccine-preventable diseases - measles, diphtheria

A report published today by The University Medical Center Groningen (UMCG), authored by an international network of scientists will highlight explosive new insights into a growing epidemic of measles and diphtheria in Venezuela as political unrest in the country reaches crisis point.

The report, entitled Resurgence of Vaccine-Preventable Diseases in Venezuela as a Regional Public Health Threat in the Americas provides evidence to suggest there exists a growing health crisis in Venezuela which is now spreading to neighbouring countries including Colombia and Brazil.

Sixty-six percent of the Venezuelan population currently live in extreme poverty, amid escalating violence and crumbling healthcare infrastructure more typical of conflict zones or war-torn nations. More than 280,000 children are now perceived to be at risk of death from severe malnutrition.

Measles

The report provides data taken over a 16 month period (June 2017-October 2018) during which time a total of 7,524 suspected measles cases have been reported in Venezuela. Of these, 6,252 have been laboratory confirmed and 75 have resulted in death. Outbreaks of measles disproportionality affect the indigenous populations in the Amazon and Orinoco River Delta regions of the country.

Venezuelan national coverage rates for the 2nd dose of the measles vaccine were estimated at 52% as per the last reports from the Venezuelan Ministry of Health, released in 2017. In the space of less than 8 years, Venezuela has moved to the bottom of vaccine coverage in the South American region. Numerous measles cases have spilled over into Colombia, Brazil and Ecuador with around 2,800 cases in Brazil linked to the Venezuela outbreak.

Diphteria

The report goes on to consider diphtheria, which has reemerged since 2016, after 24 years without reporting of cases in the country. A total of 2,170 cases were reported from July 2016 to October 2018. As with measles - indigenous comminutes have been the worst affected. Of the 2,170 cases, 1,249 were laboratory confirmed with 287 reported deaths (17 in 2016, 103 in 2017 and 167 in 2018) producing a lethality rate of 22 %. Most cases, and deaths, are among infants and children.

Prior to 2016 - there were no confirmed cases of diphtheria in Venezuela. Unofficial data suggests that for 2018, the national diphtheria vaccine coverage may not even reach 50%. Venezuela ranked 4th in the world for diphtheria cases in 2017, behind countries who's populations number in the hundred of millions or billions (Nigeria, India, Indonesia).

Since the early 2000s Venezuela has faced a severe economic crisis caused by political instability and declining oil revenue. In particular, public health provision has suffered with an exodus of trained medical professionals and long-term shortages in medicines and medical supplies.

Recommendations

Lead authors Dr. Alberto Paniz-Mondolfi (IDB Biomedical Research Institute & the Venezuelan Science Incubator, Venezuela), Dr. Adriana Tami (Department of Medical Microbiology and Infection Prevention, UMCG), Prof. Maria E. Grillet (Universidad Central de Venezuela and Visiting Professor to the UMCG) and colleagues make a number of recommendations to mitigate the crisis. Among these they indicate that:

• Global and hemispheric health authorities should urge the Venezuelan government to allow establishing a humanitarian channel in order to provide immediate relief efforts addressing extreme food and medicine shortages.
• Emergency relief operations should be put into effect across borders along with the Colombian and Brazilian authorities in order to ameliorate the effects of massive migration by implementation of early nutritional and immunization interventions.