Measles outbreaks continue to spread rapidly around the world, according to the latest preliminary reports provided to the World Health Organization (WHO), with millions of people globally at risk of the disease.

In the first six months of 2019, reported measles cases are the highest they have been in any year since 2006, with outbreaks straining health care systems, and leading to serious illness, disability, and deaths in many parts of the world. There have been almost three times as many cases reported to date in 2019 as there were at this same time last year.

This follows successive yearly increases since 2016, indicating a concerning and continuing upsurge in the overall measles burden worldwide.

The Democratic Republic of the Congo, Madagascar and Ukraine have reported the highest numbers of cases this year. However, cases have dramatically decreased in Madagascar in the past several months as a result of nationwide emergency measles vaccine campaigns, highlighting how effective vaccination is in ending outbreaks and protecting health.

Major outbreaks are ongoing in Angola, Cameroon, Chad, Kazakhstan, Nigeria, Philippines, South Sudan, Sudan and Thailand.

The largest outbreaks are in countries with low measles vaccination coverage, currently or in the past, which has left large numbers of people vulnerable to the disease. At the same time, protracted outbreaks are occurring even in countries with high national vaccination rates. This results from inequities in vaccine coverage, and gaps and disparities between communities, geographic areas, and among age-groups. When enough people who are not immune are exposed to measles, it can very quickly spread.

The United States has reported its highest measles case count in 25 years. In the WHO European region, there have been close to 90,000 cases reported for the first six months of this year: this exceeds those recorded for the whole of 2018 (84 462) already the highest in this current decade.

The reasons for people not being vaccinated vary significantly between communities and countries including lack of access to quality healthcare or vaccination services, conflict and displacement, misinformation about vaccines, or low awareness about the need to vaccinate. In a number of countries, measles is spreading among older children, youth and adults who have missed out on vaccination in the past.

With governments and partners such as the Measles & Rubella Initiative, Gavi, the Vaccine Alliance and others, WHO is helping countries stop outbreaks, strengthen health services, and increase essential vaccination coverage.

Measles is almost entirely preventable with two doses of measles vaccine, a safe and highly effective vaccine. High rates of vaccination coverage 95 per cent nationally and within communities – are needed to ensure that measles is unable to spread.

According to WHO and UNICEF coverage data released in July 2019, 86 per cent children have received the first dose of measles vaccine and 69 per cent the second. This means that around 20 million children in 2018 received no measles vaccine through their routine vaccination programmes. Furthermore, 23 countries have yet to introduce the second measles vaccine dose into their national schedule.

WHO is urging everyone to ensure their measles vaccinations are up to date, with two doses needed to protect against the disease, and to check their vaccination status prior to travel.

According to its latest travel recommendations, everyone 6 months and older should be protected against measles prior to travel to an area where measles is circulating. Anyone unsure of their vaccination status should consult with their healthcare provider. WHO recommends that travelers get vaccinated against measles at least 15 days prior to travel.

Despite recent efforts-including distribution of mosquito nets, the Ministry of Health says there has been a 40 per cent increase in the Malaria, from 1 million cases in June 2018 to 1.4 million cases in June 2019.

“While this is lower than the number of cases registered between 2016-2017, it is important to note that this is the peak Malaria season where an increase in the Malaria cases are registered,” the ministry says in latest press release.

The increase in Malaria cases is attributed to prolonged intermittent rains in various parts of the country that have lasted right from June till to August 2019, reduced net ownership and use due to the aging of nets distributed in 2017 mass campaign, low malaria prevalence in areas such as Kampala, and as such people have become lax in prevention practices such as net use, closing doors windows early, early seeking of care and treatment.

The increase in the disease has also been attributed to population growth and refugee immigration in specific regions, Movement of populations from high burden areas (Busoga, West Nile, Northern Uganda, Karamoja) to low burden areas (Kampala, South Western Uganda) and vice versa for festive season, employment like farming.

“This was supported by evidence we got from Naguru hospital in July 2019 where 85 per cent of the malaria patients had travel history outside Kampala,” the ministry says.

People in areas with very little malaria such as Kampala (parasite prevalence less than 1 per cent) are prone to severe malaria due to reducing/low immunity. It is therefore important that everyone protects themselves whenever they travel upcountry in areas with high malaria burden/transmission In order to mitigate this situation.

The Ministry says it has put in place a number of interventions that will lead to a decrease in the overall number of Malaria cases. They include; supporting districts with increased cases to order and receive emergency supplies (Artemisinin-based Combination Therapy (ACTs) and Rapid Diagnostic Tests (RDTs) to ensure facilities are well stocked but also revised the quantification of ACTs for this financial year, 2019/20 to take into account this increase in cases.

Also, the ministry says, there has been redistribution of Malaria Commodities from facilities and districts with overstocks to those that are facing a stock out of malaria commodities, monitoring of malaria cases, admissions and deaths and using data to guide decisions at all levels that has helped identify and contain many outbreaks, strengthening the capacity of Village Health Teams (VHTs) at community level through training and providing adequate stock of antimalarials.

The ministry says it will continue the routine distribution of Long Lasting Insecticide treated mosquito Nets (LLINs) to pregnant women attending Antenatal care and children in immunization clinics as well as fast tracking the implementation of the 2020 LLIN Mass Campaign and introduce new channels of LLIN distribution such as school distribution in selected districts plus community outreaches in high burden areas to conduct testing and treatment.

How Malaria is transmitted

Malaria is transmitted by female Anopheles mosquitoes which normally bite at night when a person is sleeping. An infected mosquito bites a human being and transmits the plasmodium into the blood of the person.

The signs and symptoms of Malaria in your body

The signs and symptoms of Malaria are; fever, headache, vomiting, Chills (shivering), sweating, Backaches, Body weakness, loss of appetite and diarrhea.

The Ministry urges the public to sleep under a mosquito net every night to avoid Malaria, always seek early treatment from the nearest Health Facility within 24 hours of onset of symptoms, take and complete dosage of Malaria medicine as advised by the health worker, clear all mosquito breeding sites (stagnant water, bushes and broken containers) around your homestead.” All pregnant women must attend all antenatal care visits 6. Avoid self-medication and sharing of medicine,” it says.

Ebola may soon be a “preventable and treatable” disease after a trial of two drugs showed significantly improved survival rates, scientists have said.

Four drugs were trialled on patients in the Democratic Republic of Congo, where there is a major outbreak of the virus.

Two of those were considerably more effective in treating the disease, the study found.

The drugs will now be used to treat all Ebola patients in DR Congo, according to health officials.

The US National Institute of Allergy and Infectious Diseases (NIAID), which co-sponsored the trial, said the results are “very good news” for the fight against Ebola.

The drugs, named REGN-EB3 and mAb114, work by attacking the Ebola virus with antibodies, neutralising its impact on human cells.

They are the “first drugs that, in a scientifically sound study, have clearly shown a significant diminution in mortality” for Ebola patients, said Dr Anthony Fauci, director of NIAID.

REGN-EB3 and mAb114 were developed using antibodies harvested from survivors of Ebola, which has killed more than 1,800 people in DR Congo in the past year.

Two other treatments, called ZMapp and Remdesivir, have been dropped from trials as they were found to be less effective.

What were the results of the trial?

The trial, conducted by an international research group co-ordinated by the World Health Organization (WHO), began in November last year.

Since then, four experimental drugs have been tested on around 700 patients, with the preliminary results from the first 499 now known.

Of the patients given the two more effective drugs, 29% on REGN-EB3 and 34 per cent on mAb114 died, NIAID said.

In contrast, 49 per cent on ZMapp and 53 per cent on Remdesivir died in the study, the agency said.

The survival rate among patients with low levels of the virus in their blood was as high as 94 per cent when they were given REGN-EB3, and 89 per cent when on mAb114, the agency said.

The findings mean health authorities can “stress to people that more than 90 per cent of people survive” if they are treated early, said Sabue Mulangu, an infectious-disease researcher who worked on the trial.

What impact could the drugs have?

Hailing the success of the study, Jeremy Farrar, director of the Wellcome Trust global health charity, said the treatments would “undoubtedly save lives”.

The findings, Mr Farrar said, indicate scientists are getting closer to turning Ebola into a “preventable and treatable” disease.

“We won’t ever get rid of Ebola but we should be able to stop these outbreaks from turning into major national and regional epidemics,” he added.

A sense that Ebola is incurable, paired with widespread mistrust of medical workers in the DR Congo, has hampered efforts to stop the spread of the disease.

It is hoped that the effectiveness of the drugs, made by US-based pharmaceutical firms, will make patients feel “more comfortable about seeking care early”, said Dr Fauci.

But the best way to end the outbreak, he added, is “with a good vaccine”. A vaccine is a type of medicine that improves immunity to a particular disease.

How serious is the DR Congo outbreak?

The current outbreak in eastern DR Congo began in August last year and is the biggest of the 10 to hit the country since 1976, when the virus was first discovered.

In July, the WHO declared the Ebola crisis in the country a “public health emergency of international concern”.

But it is dwarfed by the West African epidemic of 2014-16, which affected 28,616 people, mainly in Guinea, Liberia and Sierra Leone. About 11,310 people died in what was the largest outbreak of the virus ever recorded.

However, attempts to contain the latest outbreak are proving difficult. In particular, militia group violence and suspicion towards foreign medical assistance have hindered efforts.

Earlier this month, three Congolese doctors were arrested in DR Congo over the killing of a WHO medic.

About 200 health facilities have been attacked in the country this year, causing disruption to vaccinations and treatments. In one incident, family members assaulted health workers who were overseeing the burial of their relative.

A 2018 study published in the Lancet medical journal says “belief in misinformation was widespread” concerning the Ebola outbreak.

What is Ebola?

Ebola is a virus that initially causes sudden fever, intense weakness, muscle pain and a sore throat

It progresses to vomiting, diarrhoea and both internal and external bleeding

People are infected when they have direct contact through broken skin, or the mouth and nose, with the blood, vomit, faeces or bodily fluids of someone with Ebola

Patients tend to die from dehydration and multiple organ failure