NPR
Measles kills more than 500 children in Bangladesh
While outbreaks of Hantavirus and Ebola capture global headlines, a serious measles outbreak in Bangladesh continues to unfold with little international attention.
"We've been crying out loud about this from the beginning, but it has been a silent situation," expresses Hasina Rahman. She is referring to the alarming measles outbreak that has struck Bangladesh.
Since mid-March, the nation has reported over 60,000 suspected cases and 528 fatalities believed to be related to measles. The majority of the cases and the resultant deaths involve children under five years of age.
"This is a significant crisis that places immense strain on the healthcare systems," states Rahman, who serves as the International Rescue Committee's deputy regional director for Asia.
The family of Miftahul Zannat has encountered the limitations of the healthcare system personally. The 2-year-old exhibited traditional symptoms of measles—fever, rash, along with vomiting and diarrhea.
After two hospital visits close to their home in Bhairab yielded no improvement, Zannat's condition deteriorated; she became lethargic and lost her appetite. "Once she fell ill, she became completely bedridden. She couldn't even open her eyes," recalls her father, Mohammad Kamal.
Concerned for their daughter, Zannat's parents, similar to numerous families in distress, decided to seek care in the capital city of Dhaka, where hospitals are better equipped to handle severe cases. However, upon arrival, they were turned away from two facilities that were already overwhelmed with measles patients.
Although most individuals recover from measles within weeks, the infection can pose serious risks, leading to complications such as pneumonia, encephalitis, and blindness. In 2024 alone, nearly 100,000 deaths globally were attributed to the disease.
Children suffering from malnutrition are particularly susceptible to the effects of measles. In Bangladesh, one in four children under the age of five is stunted due to undernutrition, while one in ten faces acute malnutrition. Furthermore, if malnourished children receive the measles vaccine, its efficacy may be compromised. This undernutrition significantly contributes to the severity of the outbreak in Bangladesh, resulting in higher rates of severe cases and fatalities compared to high-income countries. The fatality rate in Bangladesh approximates 1%, in contrast to the 0.1% to 0.3% observed in the United States.
Kamal, who works as a cook in his village, acknowledges previous struggles to provide sufficient food for his family. He feels relieved to have finally found care for Zannat at the third hospital in Dhaka but remains worried about her health. "My child was cheerful, loved to play, run, and smile. After getting infected with measles, she became silent, not eating food, and had no smile on her face," he reflects.
From vaccine success story to massive measles outbreak
Prior to this crisis, Bangladesh was recognized for its successful efforts to eradicate measles through a strong, community-driven vaccination program, serving as a model for low-resource nations.
In 2019, the then-Prime Minister Sheikh Hasina Wazed received The Vaccine Hero Award from Gavi, the Vaccine Alliance, in recognition of the remarkable progress made in the country.
However, the situation changed drastically in 2024.
With the overthrow of the long-standing regime, a temporary government assumed power. Over its 18-month tenure, the interim leaders attempted to overhaul the vaccination system, but the transition was fraught with difficulties.
Bureaucratic obstacles disrupted the country's vaccine supply. Immunization campaigns were postponed, leading to widespread availability issues.
These disruptions caught the attention of stakeholders. Rana Flowers, the UNICEF representative to Bangladesh, noted during a press conference on May 20 that she had warned the government for two years about the potential for a crisis. "I sat with the interim adviser and staff on at least 10 occasions saying, 'We are worried. Look at my face. I am worried. You're going to face a mountain,'" she recounted.
Various organizations, including the World Health Organization and Gavi, publicly urged the government last year to take decisive action.
Yet, the response was insufficient, according to Dr. Reaz Mobarok, a senior professor and head of the High Dependency and Isolation Unit at Bangladesh Shishu Hospital and Institute, the largest children's hospital in the nation. He stated, "The interim government did not prioritize vaccination, resulting in numerous children remaining unvaccinated for measles."
The initial warnings proved to be accurate.
Daily death counts
In early April, Bangladesh notified the WHO of a notable increase in measles cases. By that time, there were nearly 20,000 suspected cases across 58 of 64 districts, with over 150 fatalities.
Since then, the outbreak has escalated significantly.
Local media now report a daily tally of deaths, which can range from single digits to much higher numbers. On one occasion, May 4, 17 children lost their lives. The number of new suspected cases exceeds 1,000 daily and has sometimes surpassed 1,500. As of May 24, the death toll stood at 528.
This outbreak marks the most significant measles crisis Bangladesh has faced in decades.
"This is a major outbreak with a considerable mortality rate," asserts Dr. William Moss, a measles expert at the Johns Hopkins Bloomberg School of Public Health, who is closely monitoring the developing situation. He elaborates that the measles virus diminishes the immune system, making patients susceptible to secondary infections that require medical intervention.
Rahman of the International Rescue Committee notes that the crisis in Bangladesh has been exacerbated by reductions in foreign aid directed towards global health in the past year. Many community health programs were cut, leading to staffing shortages and further strain on the healthcare system. Parents are now often left helpless outside children's hospital wards, overwhelmed and uncertain about the next steps, which Rahman describes as "heartbreaking."
A 9-month-old's prognosis
When Mim Akhter suspected that her 9-month-old son, Rizvi Ahmed Raihan, might have contracted measles, she was filled with dread. The alarming reports of the rising death toll lingered in her thoughts. As the infant struggled to breathe and became dehydrated, she undertook a three-hour journey by car from their home in Manikganj district to Dhaka in search of medical assistance.
However, the conditions at the hospital where they arrived were grim. Due to the surge of measles patients, Akhter and her child were accommodated on a floor mat directly in front of an elevator.
"To get the treatment, we have to lie down here on the floor," she explains in Bengali. While on the floor, the infant received essential supplemental oxygen, fluids, and rehydration, as no specific treatment exists for measles. Fortunately, after five days, his condition improved, allowing for his release.
Patients have described not only overcrowding but also insufficient medical care.
Challenges include understaffing and shortages of crucial medical supplies. In some cases, two measles patients share a single Intensive Care Unit bed, with both patients requiring respiratory assistance.
Furthermore, certain hospitals lack the capability to fully isolate measles patients from other individuals receiving care. For instance, at the Infectious Diseases Hospital in Dhaka, patients with HIV/AIDS, who have weakened immune systems, are placed in the same compound as measles patients — albeit on a different floor.
"My hospital has only 100 beds, and almost every day we are receiving more than 100 patients," states Dr. F. A. Asma Khan, Superintendent of the Infectious Diseases Hospital. She clarifies that while not all patients are diagnosed with measles, many can have measles or related complications.
Nearby, Dr. Reaz Mobarok mentions that his hospital is transforming administrative areas into patient-care facilities. "We told the doctors: 'You will work in other locations if discussion is necessary,'" states Mobarok.
Desperate parents
As parents navigate the emotional strain of having an ailing child, they are also contending with financial burdens. Although healthcare is free in many Bangladeshi hospitals, ancillary costs can quickly escalate.
Mohammad Kamal Hossain, a rickshaw driver in Bhola, illustrates this struggle. Earning approximately $4 a day, he has been unable to work during the past 20 days while caring for his 9-month-old daughter, Saifa. After she developed pneumonia, a frequent complication linked to measles, he was advised to secure specialized care in Dhaka. Hossain has already incurred $160 in transportation costs and must cover daily expenses associated with living in the hospital, including food.
"My elder child is in ninth grade, and I am uncertain how I will afford her tuition fees this month, as I am already in debt due to transport costs and hospital living expenses," Hossain laments.
How the government is responding
The newly elected government of Bangladesh, which came to power in February, initiated a significant measles vaccination campaign on April 5.
Officials report that they have already met their goal of vaccinating approximately 18 million children. Their next objective is to identify any children missed during the mass campaign, ensuring "no child is left behind," says Dr. Halimur Rashid, the director of disease control in the Directorate General of Health Services (DGHS) of Bangladesh.
This initiative has received extensive commendation, including from UNICEF's Flowers. "The response was immediate and decisive from the Ministry [of Health]. For that, I am very grateful," she remarks.
Rashid also indicated that efforts are underway to ensure hospitals are effectively addressing the crisis. "All hospitals have been instructed to open isolation units for patients with measles, and Vitamin A capsules are being administered to affected children," he affirms.
Moss from Johns Hopkins views this approach as appropriate. "Vitamin A therapy can significantly reduce the risk of mortality associated with measles," he observes, noting that while vitamin A deficiency is uncommon in the U.S., it can be prevalent in countries like Bangladesh.
Despite the government's response, some parents and health professionals express frustration. There are ongoing calls to close schools until the outbreak is contained and for a national healthcare emergency to be declared.
Moss anticipates an eventual improvement. "It may take a month or longer before we start to observe a significant impact from the vaccination campaign,” he notes. “But I remain hopeful that we will soon see a decrease in the number of cases due to this extensive measles mass vaccination initiative."
For many in Bangladesh, this measles outbreak evokes memories of the country's struggle during the peak of the COVID-19 pandemic, which claimed nearly 30,000 lives. However, there is a crucial distinction between these two crises; during the COVID outbreak, Bangladeshis felt they were part of a collective global effort. In this instance, Dr. Mobarok of the Bangladesh Shishu Hospital and Institute asserts, "We are not receiving substantial support."
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