The world’s largest measles outbreak has killed more than 4,000 people in the Democratic Republic of the Congo this year, according to UNICEF.

The agency found that 203,179 measles cases have been reported throughout the country’s 26 provinces since January, according to UNICEF, including 4,096 deaths. Seventy-four percent of infections and nearly 90 percent of deaths have been children under the age of five.

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The number of measles cases in the central African nation more than tripled compared to all of 2018, according to the agency, and has surpassed the death toll of Ebola, which has killed 2,143 people in DLC,

“We’re fighting the measles epidemic on two fronts — preventing infections and preventing deaths,” said Edouard Beigbeder, the UNICEF representative in the DRC.

“Along with the government and key partners, UNICEF has been racing to vaccinate children against measles, and at the same time, supplying clinics with medicines that treat symptoms and improve the chance of survival for those already infected,” he added.

UNICEF has provided more than 8.6 million doses of the measles vaccine in the past year, leading outbreak responses in eight of the hardest-hit provinces, most recently in Kasai Central, where more than 21,000 children received it.

“We’re facing this alarming situation because millions of Congolese children miss out on routine immunization and lack access to health care when they fall sick,” said Beigbeder. “On top of that, a weak health system, insecurity, community mistrust of vaccines and vaccinators and logistical challenges all contribute to a huge number of unvaccinated children at risk of contracting the disease.”