Measles is one of the main causes of child death in Africa. The World Health Organisation supports routine vaccination programmes but still does not recommend massive vaccinations once an epidemic has broken out. MSF experience, and several scientific studies, indicate that measle epidemics remain frequent, and that a vaccination campaign in the epidemic period limits both the number of cases and deaths. More than 300,000 people were also vaccinated in Niger in March and April, and double that figure will be vaccinated from the start of July, in Katanga province (Democratic Republic of Congo). With the measles epidemic in decline, the meningitis epidemic over, and nutritional screening failing to highlight alarming rates, the emergency mission will soon be terminating for MSF's team there. Still, bags are not yet packed and treatment of measles patients and undernourished children continues. Two months after the mission was launched, Marcella Allheimen, Emergency Co-ordinator, sees some positive signs: "We are seeing a reduction in the number of case of measles precisely where we vaccinated at the beginning of the campaign. We started with the worst hit places and it's there that we are today observing the largest decreases."
Over a thousand new patients per week during the peak
The toll from the measles epidemic in the state of Yobe stands at 7,500 sick and 167 fatalities since the start of the year. The peak occurred at the beginning of June, with more than 2,300 new patients over a two week period. In two months, the MSF team treated complicated measles cases, over 4,000 patients, and supplied health outlets with around 3,500 kits containing the necessary medical equipment for treating simple cases. To limit the epidemic, a vaccination campaign was launched. In collaboration with the Ministry of Health, vaccination teams travelled to over 300 sites, and more than 237,000 people were vaccinated from June 4 to 29.
Vaccination campaign for under-15s
"The indicators are so good that we can't believe it", said Marcella Allheimen. "According to official population figures, we have vaccinated not quite 130 percent of children under five in the area! Which signifies that these figures are certainly underestimated; they don't represent a reliable basis. "However, what we do know is that the population participated very actively; a lot of people came in." At Yobé, the vaccination age group was extended to include under-15s. Cases of measles in children under age five are rarer, but the advantage in vaccinating all children under 15 is that is cuts transmission of the illness", explained Marcella Allheimen.
Nutrition included in measles treatment
Malnutrition is a frequent complicating factor in measles. The child loses weight during the illness and cannot put it back on. MSF's measles treatment strategy includes rations of food complement, taken for one month after recovery, to help the child gain strength. Additionally, the vaccination teams took the opportunity of checking the nutritional condition of the under-five's. Out of a total of 119,000 screened, almost 900 children required medical and nutritional care. "These figures do not indicate an alarming situation," Allheimen observed. "We concentrated initially on several hospitals in the area. One team decided to distribute nutritional products at several sites to children who were not, or had never been, hospitalised; either convalescing after measles; or under-nourished but without medical complications. In all we monitored over 1,600 children in this way. "We progressively set up MSF structures. We now have several nutritional centres, including one with hospitalisation capability. Currently, 430 children are being treated in these centres."
End of the meningitis epidemic
A meningitis epidemic spreading through the same area since the start of the year, faded out without a single vaccination being necessary. In all, 1285 cases were declared, with MSF treating 355 complicated cases and distributing almost 500 treatment packages to hospitals and health-ministry health centres.