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MSF launches a massive measles vaccination campaign for 550,000 children Kinshasa/Brussels, 13 March 2006 - In January, a measles outbreak was identified in Mbuji Mayi, where an estimated 2,5 million people live. Since the beginning of the year, more than 1,000 new cases have been reported. After receiving information from the first exploratory missions as well as authorisation from the Congolese authorities, MSF started composing a team of 10 international workers and 500 Congolese staff to set up and run the vaccination campaign. The town is divided in 10 health zones, in which 102 sites for vaccination have been identified. MSF is working in close cooperation with Congolese Ministry of Health. In addition to vaccinations, free treatments will be provided to those children already affected by the disease.
The aim is to get at least 85% of the children in affected areas vaccinated. In a precarious context like DRC and in places where measles outbreaks are endemic, it is essential to increase vaccination coverage. “In a country devastated by a chronic humanitarian catastrophe it is very hard to launch a massive vaccination campaign for 550,000 children between 6 months and 5 years of age. We’re talking about vaccinating a target population bigger than the total under-five population in countries like Sweden (415,000) or Switzerland (365,000) but with an extremely poor infrastructure. In Mbuji Mayi, transport by car is very difficult and most of the vaccination sites will have to be reached on motorbikes”, says David Goetghebuer MSF’s Head of Mission in DRC. “Our strategy is to move simultaneously towards two objectives: to launch the vaccination campaign and to guarantee a free and complete treatment for all the children already infected. These two steps are essentials to control the mortality rate and to reduce the spread out of the outbreak”, continues Goetghebuer. Worldwide, measles kill an estimated 450,000 people per year (an average of 1,200 per day) and the majority of them are children. Measles is one of the most contagious diseases known and almost all non-immune children contract the infection if exposed to the virus. In the beginning of 2006, MSF already vaccinated 120,000 children against measles in the DRC’s Bas-Congo province. In late 2004 in Equateur province, MSF concluded a campaign for more than 600,000 children under 15 years of age. The campaign took more than a year to complete because many villages could be reached only by dug-out canoe.
Free treatment of measles cases In conjunction with a massive measles vaccination campaign in the city of Mbuji Mayi, MSF also provides medical and logistical support to 4 health centres for the management of measles cases. In Muya and Dipumba hospitals, as well as in the Christ Roi and Bakwatshiimuna health centres, all measles cases are treated at no cost. ‘The MSF Congo Emergency Unit has a well developed contacts network across the Congo’ explains Fabien Kabumgo – “Dr. Fabien” as he is know here – a doctor from the unit. ‘This is how the unit came to know about the epidemic in Mbuji Mayi. On 9th February, we arrived here for a first assessment. On the 15th, it was decided to intervene. MSF provides medicines against measles and support health staff in administering them’. After one month, about 700 measles cases had been treated in the four
supported health centres. ‘And the number of sick people seeking
treatment is on the increase’ adds Dr Fabien. ‘This happens
because the epidemic is still raging in and around the city, but also
because a sensitisation effort is taking place among the population’.
Behind Muya hospital - the only state hospital in town -, two MSF tents have been erected. On average, 25 new consultations for measles take place every day. ‘We have chosen this hospital because there are many measles cases in the area and the zone is quite easily accessible’. ‘The first tents is used both for consultations and hospitalisations’ adds Fabien. ‘Four nurses have been seconded to the hospital to deal with measles cases. With Grace Nsambu, a nurse from MSF emergency unit, I manage their activities’. The vast majority of patients are very young children. Under-five children are indeed the most affected by the epidemic. Here, as in other centres, straightforward measles cases are treated. The doctors describes the main signs of the disease: ‘measles causes strong fevers, red sports around the mouth, runny nose, irritated eyes, rashes starting from the face and spreading to the neck, torso and the legs. There is a strict medication protocol for these children. The patient then gets antibiotics for fives days, a cream against conjunctivitis, vitamin A and, in case of dehydration, re-hydration salts. To prevent stomatitis (mouth infection), gentian violet is used’. Opposite the consultation area, mothers are seated on beds holding their child in their arms. ‘We hospitalise children with complications and therefore need to be monitored. This decision is not easy to deal with for mothers who often have more children waiting at home. When there is absolutely no way for them to stay at the hospital, we insist that they come back everyday with their child for consultation’. Most complication are respiratory ones. They can lead to pneumonia or bronchopneumonia. Scars inside the mouth can also get worse and led to malnutrition. ‘This is one of the greatest complication of the disease’, highlights the MSF doctor. ‘It is crucial for the children to keep eating, even small quantities. On the other hand, children suffering with malnutrition are weaker to face the disease and therefore more at risk of complication’. In the second MSF tent, some mothers have come back for the second, or even third time with their sick children. Antibiotics have not reduced the fever, scars in their mouths are getting worse… So mothers come for another consultation. Elsewhere in the city, in the zone of Bipemba, MSF supports a health centre managed by the sisters congregation of “Christ Roi”. Here too, in collaboration with the centre’s staff, free consultations are provided for measles cases. Cases with complications are referred to Dipumba hospital where two interns provide consultations. A dozen children are currently hospitalised. Since treatment was first provided, 8 deaths have occurred in supported health centres. On the outskirts of the city, in the health centre of Bakwatshiimuna, MSF hired a nurse manages measles cases, which is widespread in that zone. The motorbike trip – almost the only way to move around in Mbuji Mayi – is quite tricky. ‘I can only go to that health centre twice a week’, says Dr. Fabien. ‘this is why we hired a nurse’. In less than a week, he has already treated 35 people.
Measles vaccination : end of first round, start of the second one After 4 days of vaccination, the first phase of this massive
campaign comes to an end. During the first phase of vaccination, some teams moved after 2 days. This strategy called “advanced” will also take place in the second phase: two days of vaccination on the agreed sites and then, for some teams, two days in the zones were the number of vaccinated children drops. After two and a half days of vaccination, the number of vaccinated children has already reached 83,000. The 100,000 mark will certainly be reached by the end of the first phase. In terms of percentage, after three days of intensive vaccination, 73% of the target population had been covered in the Mpokolo zone, 69% in the Bipemba and 102% in Nzaba. ‘This excessive number is explained by the fact that children from a neighbouring health zone, Bonzola, have been vaccinated” says Ann Decoster, the campaign coordinator. “We have to wait for results after we have covered the 10 health zones. At the moment, I hope that we will have reached 30-35% of our target population by the end of the first phase”. Elsewhere, the preparation for the next phases is ongoing : today, the
Kansele zone was visited one last time before the beginning of the vaccination
by two MSF expatriates. On each vaccination site, they met with the leader
of the vaccination team, handed the plastic tape that will be used to
mark the vaccination area, the waiting queues, the place where the vaccines
and the icepacks will be stored. Measuring boards to determine the children’s
age if it is unknown have also been located at every vaccination site.
Measles vaccination campaign ends. Treatment for the disease continues to be provided for free to infected people. In total, it is estimated that 97,6% of the target population in Mbuji Mayi, in the Kasai Oriental Province (DRC) has been vaccinated against measles. During 12 consecutive days, more than 500 people have worked together to complete the vaccination campaign. The MSF team consisted of 10 expatriates and a few logisticians from MSF’s emergency pool in DRC. They all collaborated with local health structures’ staff. The target population was all children aged between 6 months and 5 years in Mbuji Mayi, a city that has an estimated population of 2.5 million people. In the beginning, 550,000 doses of the vaccine had been sent. Anne Decoster, coordinator of the mission, explains that “we always stock much more doses for that kind of campaign. Populations in Africa are not easy to estimate. In some cases, when we need to vaccinate children between 6 and 59 months, we calculate our target group by estimating that it represents 17, 18 and sometimes 15% of the global population. In this case, we have used the figures provided by the local representation of the EPI (Extended Programme of Immunisation), which estimates that in Mbuji Mayi, 16% of the population is aged between 6 months and 5 years. The city’s censuses thus indicate that there are 368,282 children. After the planned 12 days of vaccination; we had vaccinated 359,318 children. This means we have reached more than 97% of the target population. Those results are based on the number of doses actually administered to children. In order to evaluate with more precision the success of the campaign, a survey among the population is currently being undertaken. In each of the 10 health zones of the Kasai Oriental’s capital, 4 days of vaccination were organised. More than a hundred vaccination sites were installed on which one or two teams vaccinated thousands of children. The campaign was divided into three phases: the first one targeted the zones of Nazba, Bipemba and Mopkolo, the second focused on Diulu, Muya and Kansele, and the last one covered Bonzola, Lukelenge, Lubilanji and Dibindi. Behind those names are hundreds of thousands of people who have walked through the successive steps of the vaccination line: first the person who hands the vaccination cards, then the two who prepare the vaccine, the vaccinator and finally the person who fills in the tally sheets to keep track of the number of vaccinated children. There were also agents recruited to keep the order in case of high flux of people. Teams also worked across the zones to sensitise people through megaphones repeating the same message about a free vaccination campaign against a deadly disease. The logistical set up for this campaign required a lot of work, especially in terms of equipment and vaccines transport to the different sites, often only accessible by motorcycle. About 60 of them and 10 more vehicles were used during the campaign. “Now that the campaign is over we need to take inventory of the remaining stock” says Ann Decoster. “The remaining vaccine doses initially given by the Kinshasa EPI will now be left with the Mbuji Mayi EPI. Also, free treatment of measles cases continues to be provided in 4 health centres and hospitals. This will probably end at the end of April”. A doctor and a nurse from the MSF’s emergency pool in DRC will remain for that purpose. Expatriates are starting to head back home. Two logisticians have left Mbuji Mayi already, and a part of the team will follow them. Some will stay to follow up the treatment effort and others to be involved in the epidemiological survey which should, in a few weeks time, provide an analysis of the outbreak and the impact of the vaccination campaign.
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