Addressing Childhood Communicable Disease

Intra-Health International
One of the tope 10 global health issues identified by Intra-Health International in 2013 is: Helping even more children to live longer. According to the 2012 UNICEF report,
Committing to Child Survival: A Promise Renewed, the number of child deaths has decreased in many countries across the globe (“Intra-Health,” 2013). Indeed, child mortality rates have decreased nearly 50% from a 1990 figure of 12 million under-five deaths to a 2011 figure of 6.9 million. In absolute terms, if the child mortality rate could be reduced to just 20 child deaths per 1,000 live births in every country by 2035, a minimum of 45 million children saved (“Intra-Health,” 2013). Recommendations from the Child Survival Call to Action hosted by USAID point to the need for better and more systematic collection of health sector data, as well as better implementation of high-impact interventions to tackle the major causes of newborn and child mortality (“Intra-Health,” 2013).
The recent outbreaks of measles in the continental United States is indicative of an increasing complacency in developed countries about the communicable diseases of childhood and an increasingly influential corpus of misinformed people who mistrust the safety of vaccinations. The exigencies associated with these two conflating influences pose decision-making dilemmas to parents, educators, and healthcare workers. The situation also requires conversations about values clarification, particularly with regard to religion-based exemptions for requiring children to receive immunizations before they can attend public school. Issues related to the suppression, eradication, and management of childhood infectious disease must be clearly identified and appropriate resolutions generated and implemented. Rubella is a particularly insidious disease since it is so easily spread, appears to be a mild disease, but is associated with serious birth defects. Indeed, a cluster of birth defects known as congenital rubella syndrome (CRS) occurs in children born to mothers who were infected with rubella, particularly during the first trimester of pregnancy.
Mitiku, et al. (2011) analyzed rubella cases that had been reported to the measles case-based surveillance system during the period between 2004 through 2009. A sample of 8212 was tested for the rubella immunoglobulin (Ig) M. Of these members of the sample, 992 or 12.1% included specimens that were shown to test positive for rubella IgM. The age distribution of the patients identified as rubella-positive cases spanned ages of 3 months to 44 years. It is important to note for the purposes of this analysis that a majority of the rubella-positive cases — 94.7% — were children younger than 15 years of age. As one might expect, given the infectious nature of rubella, the rate of incidence of rubella-positive cases was higher in urban areas at 19.4% than the incidence rate of rubella-positive cases in rural areas at 11.6%.
The researchers argued that Ethiopia does not include rubella vaccine in its infant vaccination schedule, nor does Ethiopia operate a surveillance program to monitor rubella or congenital rubella syndrome. However, Ethiopia has established a measles case-based surveillance system that includes laboratory testing for measles-specific and rubella-specific antibodies. One important variable that may result in under identification of rubella is that the disease may present without a rash or a fever in an estimated 50% of the patients, thereby often occurring on a subclinical basis. Mitiku, et al. (2011) asserted that a comprehensive surveillance system needs to be adopted in Ethiopia, which would include the establishment of a sentinel surveillance for congenital rubella syndrome. Importantly, Mitiku, et al. (2011) call for a research to define the susceptibility profile in women and school-aged children who are of childbearing age.
Although the article reviewed herein describes a review conducted in Ethiopia, the continual movement of people between countries and the existence of heavily trafficked ports in coastal states establish what happens in Ethiopia to be a concern for people across the globe — this is true for any nation struggling to control infectious childhood disease. The recommendations that resulted from the Mitiku, et al. (2011) research would be combined with appropriately robust strategies to control rubella in Ethiopia. Adopting these measures would strengthen the nation’s ability to reduce the prevalence of preventable birth defects found in the congenital rubella syndrome. That is to say that fewer children will be borne with birth defects such as developmental delay, autism, sensorineural deafness, heart defects, craniofacial abnormalities, and any of several ophthalmic defects, including cataracts, glaucoma, microphtalmia, and chorioretinitis.
References
Mitku, K., Bedada, T., Masresha, B., Wenemagegn, K., Nafo-Traore, F., Tesfaye, N., and Beyene, B. (2011). The epidemiology of rubella disease in Ethiopia: Data from the measles case-based surveillance system. Journal of Infectious Diseases, 204(1), S239-S242. DOI: 10.1093/infdis/jir120. Retreived from http://jid.oxfordjournals.org/content/204/suppl_1/S239.full.pdf html
____. (2013, January 15). The top 10 global health issues to watch in 2013. Intra-Health International. Retrieved from http://www.intrahealth.org/page/the-top-10-global-health-issues-to-watch-in-2013