ISLAMABAD, 2 August 2007 (IRIN) - Extra precautions are being taken to mitigate the risk of a possible measles outbreak in flood-affected southern Pakistan.

"There are three things that are going to kill children after an emergency and one of them is measles," Bill Fellows, senior water, sanitation and hygiene adviser for the UN Children's Fund (UNICEF) in South Asia, told IRIN in the Pakistani capital, Islamabad, citing diarrhoea and acute respiratory infections as the other two.

Although no outbreak of the disease has been reported so far, the additional measures are viewed as prudent in light of conditions on the ground.

An estimated 2.5 million people were affected by heavy flooding after four days of torrential rain in Balochistan and Sindh provinces, leaving over 300 dead and hundreds of thousands homeless, with over 35,000 currently living in camps.

"Even where you have a relatively good immunisation programme in place before the emergency, it's always advisable to do a campaign after an emergency, thereby taking measles out of the equation because it's 100 percent preventable," Fellows said.

But ongoing vaccination coverage in Pakistan's largest, but least populated province, with just 8 million inhabitants, has never been particularly high.

Balochistan is "a very large province with a very scattered population", said Dr Rehan Hafiz, national programme manager for the expanded World Health Organization (WHO) immunisation programme in Pakistan. "Outreach activities are obviously more complicated than in other areas of the country where you have more access to more children in a smaller area."

Compounding the challenge further are long-standing suspicions over the safety of such vaccines amongst local communities, aid workers on the ground say.

Officials emphasise the need to enhance current prevention measures. "We need to encourage people to come out and be vaccinated," Hafiz said.

The threat

Cas Taylor, WHO's disease early warning system coordinator for Pakistan, described measles as one of the first risk diseases, given the speed with which it can spread, especially in situations where displaced persons are living in close proximity to each other. She said this had prompted the establishment of an early warning system in some areas of the flood-affected region.

"Access to children, as well as women in the area can be difficult," Taylor said. "It's been a challenge all the way along. Now that there is an emergency and people are squashed together in a way they would not normally be, it's very much more of a risk. This is why it [measles] has always been a concern. It kills - and kills children particularly," she said.

According to UNICEF, upwards of 21,000 children die each year from measles in Pakistan, while many more are affected by its complications, including blindness.

"Given that routine immunisation coverage against measles across the country remains low, the government of Pakistan earlier this year launched a measles campaign targeting 63 million children in phases to protect those between the ages of nine months and under 13 years of age," Melissa Corkum, a UNICEF spokeswoman said, noting that six districts of Balochistan had just completed their measles campaign.

To compliment those efforts in the flood-affected areas further, UNICEF, together with the government and its partners, was working to ensure those children receive a supplemental dose of measles vaccine, together with other antigens, including vitamin A.

"We have an ongoing measles campaign, but this is an opportunity, given that there is a possibility of an outbreak, to do more as people will be in one area at one time," Corkum said.

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