Urgent health update: rising measles cases in Kazakhstan

Kazakhstan is currently grappling with a significant health crisis, as measles cases have increased fivefold since the summer. According to the CDC, the country ranks third in the world in measles cases, trailing only Yemen and India. This fact is particularly striking given Kazakhstan's relatively low population of 20 million, in sharp contrast to India's 1.4 billion (Table 1).¹

Table 1.

Top 10 countries with measles outbreaks by December 10, 2023.

Rank	Country	Number of cases	Population size for 2023a	Cases per 1 million population
1	Yemen	25,216	34,790,896	724.79
2	India	14,927	1,434,447,629	10.41
3	Kazakhstan	12,985	19,705,053	658.97
4	Ethiopia	11,227	127,940,094	87.75
5	Pakistan	8316	242,579,707	34.28
6	Democratic Republic of the Congo (DRC)	5989	103,747,850	57.73
7	Russian Federation	4305	144,226,990	29.85
8	Iraq	4164	45,955,954	90.61
9	Indonesia	3827	278,540,815	13.74
10	Nigeria	3683	226,172,311	16.28

Note: Data were taken from CDC report¹ and modified including population statistics.

^ahttps://www.worldometers.info/world-population/kazakhstan-population/.

The situation may be more severe than reported, as there are indications that the true extent of the outbreak is being underreported. Alarmingly, 96% of these measles cases are among the unvaccinated, including 84% of unvaccinated children. The decline in vaccination rates is particularly alarming driven in part by the suspension of vaccination during the COVID-19 pandemic and exacerbated by the strong and growing anti-vaccination movement in Kazakhstan. In Astana alone, 40% of children in some kindergartens are unvaccinated.

The consequences of this declining vaccination trend are both immediate and tragic, as the recent death of a six-month-old child in East Kazakhstan due to measles complications. This tragedy is far from an isolated incident. In 2019, Kazakhstan experienced a significant outbreak resulting in 19 fatalities, some of whom were children engaged in a battle against cancer. This incident is part of a broader, alarming pattern observed over the past decade. According to Yerdessov et al., there has been a steady increase in measles cases in Kazakhstan, escalating from just 4 cases in 2010 to a staggering 13,326 in 2019.² This marks the third major measles outbreak in the country in the last 15 years, highlighting a persistent public health challenge.

Contributing to this public health crisis is the rising tide of anti-vaccination sentiment, fueled by misinformation spread through social media, celebrities, and even some healthcare professionals. A study by Akhmetzhanova et al. found that 35% of Kazakhstani respondents exhibited vaccine hesitancy, with nearly 22% linking vaccines to autism. Such resistance poses a significant threat to public health efforts and places the most vulnerable at risk.³

The study by Yerdessov et al., 2023 highlights a cyclical pattern in measles outbreaks in Kazakhstan, often correlating with a drop in vaccination rates and exacerbated by seasonal factors. This finding underscores the potential for more severe outbreaks in the future, particularly during the colder months.²

The role of healthcare providers in this scenario cannot be overstated. Individuals who trust and rely on their healthcare providers for information are less likely to exhibit vaccine hesitancy compared to those who seek information from the Internet.³ This trust underscores the critical responsibility of healthcare professionals to provide accurate and reliable vaccine information, thereby fostering trust among the populace.

To curb the ongoing spread of measles in Kazakhstan and achieve epidemiological stability, an additional mass immunization effort focusing on measles, rubella, and mumps (MRM) was launched on November 6 this year.^4,5 Starting in December, the initiative extended to include children aged 2–4, regardless of their measles vaccination history. It's important to recognize that the impact will not be immediate until a full immune layer is established in the population. Given the current situation, there is a potential scenario where the number of cases might rise, potentially setting a historical precedent for the nation.

This underscores the urgency of recognizing that the current measles outbreak is a symptom of broader public health challenges. Without immediate and decisive action, the country faces the risk of not only more severe measles outbreaks but also a resurgence of other vaccine-preventable diseases like polio and Hib. To address this crisis effectively, it's vital to continuously monitor and implement proactive vaccination strategies. Equally important is the dissemination of reliable information, particularly by healthcare providers, to combat misinformation and educate the public effectively.

Contributors

Conceptualization and data curation were done by AG and DA, formal analysis was handled by AG, and visualization was carried out by SY. The original draft was written by DA, and the writing – review & editing tasks were undertaken collaboratively by DA, SY, and AG. All authors participated and contributed to the revision of the text several times and agreed to the proposed recommendations.

Declaration of interests

There are no competing interests.