Although most countries in the world offer two doses of measles vírus (MEV) vaccine as a routine part of immunization services, MeV has reemerged on several continents. Low vaccination coverage contributes to this phenomenon, and was the main reason why Brazil, since 2018, has faced its largest measles outbreak in recent decades, with more than 10,351 cases confirmed (until March 2019) and sustained transmission by more than twelve consecutive months, resulting in the loss of measles-free country certification. This outbreak began after intense immigration from Venezuelan refugees, including people infected by MeV, finding a susceptible population in Brazil due to the low rate of immunization. Since then, the Brazilian health services have been working to eliminate the circulation of MeV in the territory. The purpose of this work is to discuss, from the perspective of a regional epidemiological surveillance service, the main challenges to achieve this goal. 1) The occurrence of mass events, planned or spontaneous, such as Carnival, America Soccer Cup, Pro- and anti-government street demonstrations, among others, often gather thousands of people and this agglomeration favors the spread of the virus. 2) Co-circulation of other fever and rash viruses, such as zika, chikungunya, dengue, parvovirus and coxsakie, may confound clinical reasoning in the approach of patients with such symptoms, increasing the need for the propedeutic skills of health professionals. 3) The etiological determination of exanthematic diseases depends, above all, on laboratory tests with good specificity; however, cross-reactions between measles and other viruses have been verified in serological tests used by public health laboratories, and this can impair the speed of transmission control procedures, regardless of the disease. 4) The reporting of suspected measles cases depends on a good integration between epidemiological surveillance and primary care services, but in some territories, this integration is incipient, favoring underreporting. 5) Given the high transmissibility of measles, the achievement of 95% vaccination coverage is, undoubtedly, the most essential action for effective elimination of MeV circulation. In Brazil, the success of the immunization program in the 1980s and 1990s meant that the current generation of parents did not live with measles, which contributed to a low perception of risk and little interest in the vaccine. In addition, the new dynamics of families, in which men and women work outside the home, makes it difficult to search for health services that work during office hours. Meanwhile, anti-vaccine movements and false news spread easily through social networks. The return of measles tested the responsiveness of Brazil’s health system, which is a country with a large territorial extension and numerous regional differences. Investments in health communication, combating fake-news, integration of surveillance services with health care, strengthening the community’s link with primary health care teams, offering permanent education for health professionals, greater flexibility in working hours functioning of the health units, extra-wall immunization actions are the means by which it is believed to make it possible to control the MeV and recover the measles-free country certification as soon as possible.
Epidemiological surveillance technician of East Regional Health Service, State Department of Health, Bahia, Brazil.
Master in Community Health, with emphasis in epidemiology, by the Institute of Collective Health of the Federal University of Bahia, Brazil.
Specialist in Public Health, Monitoring and Evaluation, by the Institute of Collective Health of the Federal University of Bahia, Brazil.
Specialist in Management of the National Policy of Food and Nutrition, by the National School of Public Health Sérgio Arouca, Oswaldo Cruz Foundation (FioCRUZ), Rio de Janeiro, Brazil.
Professor of Epidemiology and Surveillance in Health, at the School of Public Health Professor Jorge Novis, Bahia, Brazil.
Recent publication: Carvalho-Sauer, Rita et al. Congenital Zika Syndrome: Prevalence of low birth weight and associated factors. Bahia, 2015-2017. International Journal of Infectious Diseases, Volume 82, 44-50, 2019.