MSF measles programs

Malawi 2010: emergency immunizations underway for around three million children and adolescents

Since the beginning of 2010 until May 23, there have been over 9,200 cases and 44 deaths recorded, primarily in the southern region. MSF is supporting the Ministry of Health in eight districts (Lillongwe, Blantyre, Mzimba, Chiradzulu, Thyolo, Mangochi, Michinga et Balaka) in three areas: surveillance, patient care, and immunizations for a target population from six months to 15 years of age.

The most affected city was Blantyre, with over 6,800 cases and 23 deaths (population: one million inhabitants). From May 3 to May 18, 1.1 million children aged six months to 15 years of age were immunized in the districts of Blantyre, Chiradzulu and Mzimba.

In these three districts, MSF has distributed treatment kits for over 8,000 patients to district health centers. In the district of Thyolo, there are constantly over 50 measles patients in an isolation unit set up in the hospital. 25% of the people contaminated with this disease are over 14 years old. A measles vaccination campaign ended June 9,328,000 children have been vaccinated. Mid-June, a total of 1,300,000 children from six months to 15 years of age has been vaccinated and the emergency intervention is going on. Ministry of Health and MSF vaccination teams are beginning new campaigns, in Mangochi district, for a target population of 380,000 and in southwestern districts, Michinga and Balaka, for a target population of 400,000 children.

In the Malawian capital of Lilongwe (population: two million), 900,000 individuals will be immunized in June. This last operation will mobilize 90 vaccination teams for two weeks. The Malawi Ministry of Health has announced a national measles vaccination campaign, for children from 6 months to 15 years, starting July. The districts where children have already been vaccinated won’t be included.

Yemen 2010: mass immunization campaign in the governorate of Sa’adah Between the end of February and mid-April 2010, about 700 cases of measles were treated in the Al Talh hospital in the country’s northern region. More than one million cases have been recorded throughout the Sa’adah governorate, mostly in the Sahar district.

MSF is supporting the Ministry of Health in nine districts (Majr, Sahar, Qataber, Haydan, Baqim, Razeh, Alasfra and the city of Saada), or about two-third of the governorate, in three areas: surveillance, treatment of patients, and immunizations for a target population from 6 months to 15 years of age. A dedicated 35 to 40-bed treatment unit was been set up in the Al Talh hospital. In parallel, a mass immunization campaign was initiated on April 26.

As many as 82 teams, composed of about 200 persons and with an average of 35 vehicles, were mobilized for this immunization campaign, which reached other districts as well. At the present time, 125,000 children aged 6 months to 15 years have been immunized. The total target population is over 200,000 persons.

Zimbabwe 2010: supporting the Ministry of Health in two areas affected by the national outbreak

In Zimbabwe, the present outbreak that began in September 2009 has affected 55 of the country’s 62 districts; 384 children have succumbed to the disease. In the Buhera district, in the Manicaland province, the outbreak declared toward the end of 2009 is still underway. Over 1,800 cases have been recorded over about seven months, primarily within a community that is refusing immunization.

As of February 2010, one portion of the at-risk population has been immunized in the most affected areas and the Ministry of Health carried out non selective activities at the end of May, for the six months to 14 year-old age group.

MSF supported these activities and the team is still vaccinating ad hoc non vaccinated children and searching actively measles affected people to treat them.

In Epworth, a neighborhood in the southeast of the capital Harare, the epidemic started at the beginning of 2010. Until June 6th, 1,946 suspected cases and 12 deaths had been recorded. MSF teams are participating in the treatment of patients and complicated cases are referred to a hospital of the Ministry of Health in Harare. An immunization campaign has just been completed in Epworth with 46,881 children vaccinated.

South Africa 2010: measles epidemics in nine provinces

© Francesca Zuccaro/MSF

The South African government has recorded over 14,000 patients (between the beginning of 2009 and May 2010) in its nine provinces. An increase in the number of new cases has been observed each week in some of these areas, notably in KwaZulu-Natal and Mpumalanga. MSF is also participating in an immunization campaign in Khayelithsa township for over 100,000 children 6 months to 15 years of age.

Swaziland: ongoing epidemic, intervention in Shishelweni Swaziland is in the midst of an ongoing measles epidemic. The most affected region is Shishelweni, where MSF is already largely involved via its HIV/TB project. A vaccination campaign has been planned by the MoH from 5 to 15 years. In order to deal with suspect and confirmed measles cases, treatments kits will be distributed in all the Shishelweni health structures.

Chad 2010: large outbreak in the capital of N’Djamena

© Mudasiru Ayoola/MSF

In N’Djamena, more than 8500 cases and 30 deaths were reported between the start of the year and the end of April. On March 26, an emergency immunization campaign was initiated in four districts of the capital. More than sixty fixed and mobile teams activated in N’Djamena to provide immunization for all children aged 6 months to 15 years (around 580,000 children). One treatment unit for complicated cases enabled the care of 503 children in the first five weeks of the intervention. The organization likewise provides medications and supervises the care provided in the health centers. Finally, MSF has established Therapeutic Feeding Centers to accept children suffering from severe malnutrition detected during the consultations and immunizations.

Nigeria 2010: Over 11,000 cases of measles at the start of 2010 A measles outbreak was identified in the state of Kebbi in mid-December 2009. In spite of a responsive immunization campaign conducted by the Ministry of Health, the epidemic has continued. There has been almost 12,000 cases of measles in this state between January and April 2010. MSF teams participated in a targeted immunization campaign in Argunfu on April 12–18. Twenty immunization teams were mobilized, each one composed of 8 individuals. In total, 47,596 were immunized.

DRC North Kivu 2009: prevention hindered by lack of security

© Frederic Bonnot/MSF

In certain areas of the Masisi health zone, in the east of the Democratic Republic of Congo (DRC), the health departments are no longer able to provide systematic immunizations due to a lack of security, and the high concentration of families who have fled to camps is significantly increasing the risk of infection with the disease. In total, 1036 children with measles were counted in the Masisi territory between January and November 2009, 85 of whom lost their life. MSF has supported the health system in the health zones of Miandgja, Ngomashi, and Lwibo, and is ensuring that patients with measles can be isolated and receive the needed drugs in time. A large-scale immunization campaign was organized: more than 175,000 children and adolescents (6 months – 15 years) were immunized over the course of 11 days in October 2009. MSF teams also intervened around Kisangani, in the oriental province, and in Lubutu, in the Maniéma province, in 2009. In total, over 600,000 children have been immunized by MSF in DRC in 2009.

Mali 2009: mobile teams provide care for patients

© Jean-Michel Van Laere/MSF

A measles outbreak struck the north of Mali in 2009. More than 2500 individuals contracted measles in the regions of Tombouctou and Gao between January and June. Starting in mid-April, MSF began providing care for these patients and conducted a massive immunization campaign for more than 320,000 children aged six months to 15 years in the region of Tombouctou. Three measles treatment centers were established in Tombouctou and two more in Gao. In addition, four mobile teams were circulating the region to search for patients, provide outpatient care for them, or refer them to treatment centers if there are complications.

Somalia 2009: the most measles victims in five years Between April and June 2009, a measles outbreak ravaged the city of Guri El and its surroundings in the region of Galgaduud in the center and south of Somalia. Normally, the young children are the ones who are affected by the most severe cases of measles: however, 65% of the patients in this case were older than five years. Some of them were even adults. The children under five years of age were the beneficiaries of systematic immunization activities that MSF has conducted in the hospital over the past three years. The irregularity of the immunization campaigns conducted previously in the region could explain the high proportion of older children and adults affected. Two isolation tents were installed in the Galgaduud hospital to care for the most severe cases. In the last two weeks of April, the MSF teams immunized over 16,000 children between six months and 15 years of age in Belet Weyne, in the region of Hiraan, just south of Galgaduud. In Galcayo, in the region of Mudug, the teams cared for more than 230 patients between mid-April and mid-June.

Burkina Faso 2009: a very serious measles outbreak

In 2009, Burkina Faso was struck with the most serious measles outbreak that country has experienced in several decades. In the first six months of the year, there were more than 51,000 cumulative suspected measles cases, with 333 reported cases, for a case fatality rate of 0.65%. The outbreak actually started in February and the peak was reached at the beginning of May. Starting in March, MSF began to offer treatment kits and provide free care for persons with measles in five public health centers in the capital of Ouagadougou. Up to mid-June, MSF teams provided medical care to more than 3,000 measles patients in Ouagadougou. Starting in May, another intervention was conducted in the districts of Bogande, Pama, Manni and Diapaga, in the east of the country. More than 3600 treatment kits were distributed in the health centers of the Ministry of Health and almost 400 complicated cases were referred to MSF facilities. An emergency MSF team proposed a collaboration with the Ministry of Health of Burkina Faso at the start of March to perform an immunization campaign in the five districts of Ouagadougou. The Ministry of Health finally organized a measles immunization campaign on June 17–21 in 31 of the 63 districts of Burkina Faso, for a target age group of six months to 14 years of age.