Ongoing threat of a large-scale measles outbreak in Yemen
Authors: Naseeb Qirbi, Sharif A Ismail
Journal: The Lancet Global Health (2016)

A year into the protracted and increasingly bloody conflict in Yemen, a sharp decline in coverage of measles and rubella vaccination poses a substantial threat to population health. Falls to around 54% coverage nationally by late 2015 have been noted elsewhere,1Burki T Yemen health situation "moving from a crisis to a disaster".Lancet. 2015; 385: 1609Summary Full Text Full Text PDF PubMed Scopus (12) Google Scholar but data available to us from sources in Yemen indicate that coverage might in fact have fallen to as little as 41%. This represents a sharp fall in a very short time period, to a level well below the herd immunity threshold, and in marked contrast to national rates that had hovered fairly consistently between 70% and 80% for the preceding decade or more despite periodic instability in Yemen (especially in the far north) and long-standing access difficulties, especially for rural communities.2WHO, Yemen Ministry of Public Health and Population. Measles/rubella surveillance bulletin number 52, 28 December. 2015.Google Scholar, 3Al-Taiar A Clark A Longenecker JC Whitty CJ Physical accessibility and utilization of health services in Yemen.Int J Health Geogr. 2010; 9: 38Crossref PubMed Scopus (64) Google Scholar Vaccination shortfalls have yet to translate into spikes in case reports, but we believe the risk of a large-scale outbreak is greater than at any time in recent years for two reasons. First, indiscriminate attacks on civilian areas, health facilities, and health workers, combined with movement restrictions imposed by all sides, make comprehensive vaccination delivery and appropriate case management extremely difficult. In December, 2014, 32% of the Yemeni population were without access to basic health care; that figure is now 54%.4UNOCHAMiddle East and North Africa: crises in focus—an overview of humanitarian needs in the region.http://reliefweb.int/sites/reliefweb.int/files/resources/MENA_HNO_Overview_ENGLISH_01.pdfDate: 2016Google Scholar Efforts to improve coverage through outreach work continue, but WHO estimates that 230 000 children younger than 12 months missed out on routine vaccinations last year.5WHO-EMROYemen conflict: situation report number 25, 16–29 February 2016.http://www.emro.who.int/images/stories/yemen/WHO_Yemen_situation_report_Issue_25_16_-_29_February_2016.pdf?ua=1Date: 2016Google Scholar Second, rates of malnutrition—high pre-conflict, and a well-recognised marker for poor outcomes from infection—are worsening. The UN Office for the Coordination of Humanitarian Affairs estimates that 14·4 million people are food insecure (58% of the population); 60% of households are using coping strategies, including meal size reduction to manage shortages.6UNOCHAFacts and figures on the humanitarian situation in Yemen.https://www.sheltercluster.org/sites/default/files/docs/yemen_crisis_fact_sheet_20160218.pdfDate: 2016Google Scholar The effect has been particularly pronounced for children younger than 5 years. The number of children with severe acute malnutrition now stands at 320 000 compared with an immediate pre-conflict figure of 160 000.7UNICEFYemen humanitarian situation report, 21 November–3 December.http://reliefweb.int/sites/reliefweb.int/files/resources/UNICEF%20Yemen%20Humanitarian%20SitRep%2C%2018%20Nov%20-%2001%20Dec%202015.pdfDate: 2015Google Scholar The conflict has undone important progress made in reducing the number of children with severe acute malnutrition in Yemen, which had stood at 280 000 in early 2014. The imperative for all parties to the conflict to enable humanitarian access to populations in need, and to safeguard health facilities and health workers is increasingly urgent. SAI is co-holder of a small grant from Saferworld, a third sector organisation specialising in conflict resolution, to support a diaspora engagement project working with Yemenis in the UK and elsewhere to support health system reconstruction in Yemen once the conflict there comes to an end. NQ declares no competing interests.