The measles outbreak that started in Malangawa Municipality of Sarlahi district in January and reached Dhorpatan Municipality in Baglung district about 10 days ago, has now spread to the neighbouring Nisikhola and Badigad rural municipalities.

As many as 83 people, mostly children over 10 years of age from Dhorpatan, have been infected as of Thursday, and the number of patients seeking care is rising every day, officials said.

“Now the disease has spread to adjoining Nisikhola and Badigad rural municipalities,” said Dr Abhiyan Gautam, chief of the Immunisation Section at the Family Welfare Division under the Department of Health Services. “Over a dozen infected patients with high fever, and some who have already developed pneumonia [as a complication of measles], have been hospitalised.”

One child in serious condition has been referred to Gandaki Medical College, Pokhara, according to Gautam.

Health officials serving in Dhorpatan said that the disease has spread in wards 7, 8, and 9 of the municipality. “Eleven children with high fever and other complications have been admitted to Burtibang Hospital,” Bhumishwar Sharma, a public health officer serving at Dhorpatan Municipality, told the Post over the phone from Baglung. “Six others have been admitted to a local health post.”

Measles is a highly contagious disease transmitted through respiratory droplets from the nose and mouth of an infected person. It can be potentially deadly for unvaccinated people. The disease can be prevented with a two-dose vaccine, administered to babies at 9 months and 15 months. The government provides measles vaccines free of charge at health facilities across the country.

The outbreak in Nisikhola is the fourth in the past two months, meaning that spread of the virus has not yet been contained.

Even infants under nine months have been infected. Health officials say that most of those infected are over 10 years of age with immunisation status unknown.

Gaps in immunisation over the past decade could be responsible for the current spread, according to officials.

Meanwhile, the government began immunisation in Dhorpatan Municipality on Friday with a plan to vaccinate around 7,000 children aged 10 to 19.

“We will also vaccinate children in the neighbouring Nisikhola and Badigad rural municipalities and have started preparations accordingly,” said Gautam, the immunisation chief. “We have requested the Measles & Rubella Partnership for emergency vaccine supply.”

The Measles & Rubella Partnership is a global alliance of major international organisations working to eliminate measles and rubella.

Health authorities had requested vaccine doses from the agency following the outbreak in Sarlahi to cover all eligible children in Malangawa Municipality. But after the Ministry of Health could not provide enough doses, vaccination was carried out only in the affected wards of the municipality.

Child health experts question the government’s preparedness to contain the outbreak of vaccine-preventable diseases.

“Immunisation campaigns must be launched immediately after an outbreak,” said Dr Shyam Raj Upreti, former director general at the Department of Health Services. “If the government does not have sufficient vaccine doses in stock, this raises questions about its outbreak response readiness.”

Immunisation experts say multiple outbreaks in a short span of time indicate low immunisation coverage and wide vaccination gaps.

“This has also made our measles elimination goals challenging,” said Upreti, who is also an immunisation expert. “Recent outbreaks show vaccine coverage is not uniform, and there are pockets where coverage is too low. We must make additional efforts to reach unvaccinated populations. ”

Low vaccination coverage, a floating population, lack of public awareness of the importance of vaccines, and apathy among government agencies in plugging loopholes are among the reasons for the regular outbreaks of measles across the country, according to experts.

Nepal aimed to eliminate measles by 2026, as there had been no outbreak since June 2023. However, recent outbreaks in Baglung and Sarlahi have hindered the country’s progress towards meeting the goal.

The country earlier missed the 2023 and 2019 deadlines. Major measles outbreaks occurred in 2022 and 2023.

To declare measles eliminated, cases must be fewer than five per 1,000,000 people per year. The country must verify progress through foreign, independent verification. For independent verification, there should be no new outbreak for three consecutive years, officials say.

Doctors say people of all age groups are vulnerable to measles. Underage children, pregnant women, elderly people and those with weak immunity, such as HIV-infected people, are highly susceptible to the disease.

Early symptoms, which usually appear 10-12 days after infection, include high fever, runny nose, bloodshot eyes and white, tiny spots inside the mouth. Several days later, rashes develop on the face, upper neck and other parts of the body.

Some people may experience severe complications, such as pneumonia and encephalitis, and these diseases may also cause death.

Measles was endemic in Nepal, and an average of 90,000 cases were recorded every year from 1994 to 2004. Routine measles vaccination began in the country in 1979, starting with three districts. The campaign was made nationwide after 10 years.