key: cord-0938292-rbeqas1l authors: Tanveer, Maria; Ahmed, Ali; Siddiqui, Adeel; Gudi, Sai Krishna title: The mystery of plummeting cases of measles during COVID‐19 pandemic in Pakistan: Hidden impact of collateral damage date: 2021-05-03 journal: J Med Virol DOI: 10.1002/jmv.27045 sha: c680eb021ad763b38a688c36eb0717f20110ff8e doc_id: 938292 cord_uid: rbeqas1l nan The mystery of plummeting cases of measles during COVID-19 pandemic in Pakistan: Hidden impact of collateral damage Dear Editor, The war against the Coronavirus disease-2019 (COVID-19) is merely a year and a half old; however, it has jostled healthcare systems and disrupted practices that health authorities have been trying to build for decades. Routine immunization against communicable diseases is one such practice that has been affected to the core by the surging pandemic. Accordingly, around 117 million children from 37 countries are at risk of not receiving measles vaccines alone, 1 as collateral damage due to the shift of national priority towards handling the current pandemic. Besides, measles immunization campaigns have either been disrupted or delayed in over 24 countries 1 Similarly, from January to April 2021, there is a markable decrease in measles cases compared to the same time period in 2020. However, a whopping increase of 151 cases was reported from March 21-27, 2021 alone. A point to ascertain is that vaccination to achieve herd immunity may not be responsible for this downfall of Pakistan's measles cases because for that measles vaccination coverage has to reach 95%. 3 The WHO states that to prevent an outbreak, immunization rates must reach a coverage of 95%, 3 which in Pakistan has fallen short to approximately 66% by 2018 8 and was declined further in 2020 9 as well as 2021. 9 This decrease might be due to the surge in COVID-19 cases which has shifted the attention of health authorities leading to lack of its immunization strategy to avoid this collateral damage. Another possible consideration for such a decrease in measles cases might be the social distancing, personal hygiene, and lockdown measures being implemented during the pandemic. Since measles is also a respiratory disease and the similar preventive measures apply to COVID-19 may partially responsible for such decline in measles cases. However, Pakistan is a limitedresourced country, and the sweeping pandemic has burdened the country's already over-stretched healthcare infrastructure, which has led the authorities to divert all its scarce resources in controlling and preventing COVID-19. This attention shift has been responsible for shunting disease surveillance programs that may consequently be responsible for a decline in the number of measles cases that may or may not represent the actual situation. Another plausible explanation would be that more people switched to home remedies to combat diseases due to the panic caused by COVID-19, where people might avoid reaching out to hospitals and healthcare facilities altogether. Consequently, this may partially be responsible for the under-reporting of measles cases, translating to a decline in the country's cases (Figure 1 ). The decline in transmission of airborne diseases has been reported due to the precautionary measures from COVID-19. 10 In Taiwan, the decline in lung infections was up to 50%, 10 while in a study conducted COVID-19's Impact on Measles Vaccination Coverage Global Measles Outbreaks Worldwide measles deaths climb 50% from 2016 to 2019 claiming over 207 500 lives in 2019 Why have immunization efforts in Pakistan failed to achieve global standards of vaccination uptake and infectious disease control? Risk Manag Healthc Policy Ministry of National Health Services, Regulations & Coordination Government of Pakistan, National Institute of Health Impact of COVID-19 pandemic on Measles surveillance in Pakistan The New Humanitarian | In Pakistan, missed immunisations drive new disease fears as coronavirus swells Vaccination and Immunization Statistics -UNICEF DATA. https:// data.unicef.org/topic/child-health/immunization The outcome and implications of public precautionary measures in Taiwan-Declining respiratory disease cases in the COVID-19 pandemic The impact of COVID-19 control measures on the morbidity of varicella, herpes zoster, rubella and measles in Guangzhou What is the impact of lockdowns on dengue?