A measles epidemic has been raging since the beginning of the year (2015) in the former province of Katanga in the southeast of Democratic Republic of Congo (DRC). According to the Ministry of Public Health, as of 20 November 2015 a total of 39,619 cases including 474 deaths have been officially reported in Katanga since early 2015. More than 77 percent of children affected were aged one to five years, and 88 percent of the children who died were from this age-group.
Katanga is almost the size of Spain and has more than ten million inhabitants. Twenty-four of its 68 health zones have been affected by the epidemic, according to the Katanga Provincial Health Inspection, based in the provincial capital Lubumbashi.
In the most remote and economically depressed parts of this mineral-rich province, healthcare is out of reach for many. Most people have lost confidence in the health system, which suffers from a chronic shortage of medicines and a lack of trained medical staff. Treatment costs are so high as to prevent the mostly poor population from seeking care.
Katanga was the scene of a large measles epidemic in 2011, after which MSF vaccinated 2.1 million children. Measles vaccinations are theoretically part of the Expanded Programme on Immunisation (EPI) and should be available in all Congolese health centres. In addition, catch-up vaccination campaigns are held each year. The current measles epidemic raises questions on the effectiveness of previous vaccinations campaigns.
Measles has become endemic in DRC, with recurrent and cyclical epidemics. The disease is particularly dangerous for children under the age of five, especially those with acute malnutrition. Children who contract measles become even more vulnerable to other diseases such as malaria.
In recent years, international donors have provided funds to improve overall immunisation coverage. Since September 2015, donors have allocated more than US$5 million to support the Ministry of Health and its partners in the response to this emergency.
The latest epidemic appears to be on the decline, but the risk of it spreading to other regions remains a concern.
Main challenges in the response to the epidemic:
- It took time for the authorities to officially declare the epidemic, which led to a significant delay in the response.
- The number of cases and deaths is widely underestimated due to a lack of reliable data from health centres, particularly in the remoter areas of Katanga province.
- The national response plan focuses solely on vaccination, and does not include curative care for children with measles.
- Decisions about which areas and age groups of children to vaccinate do not take into account epidemiological data or the way the epidemic is evolving.
- The response to the epidemic is hindered by logistical constraints - difficulties of access -which dramatically increase the costs. Maintaining the cold chain in such conditions is one of the biggest challenge.
- There is a significant lack of equipment and qualified health staff to respond to this epidemic.
MSF response to the epidemic MSF started its response in April in Malemba Nkulu health zone. As the epidemic gained ground, MSF teams quickly expanded into other areas.
MSF's response is based on supporting local health centres with the following:
- Managing simple cases on an outpatient basis by providing health centres with supervision, donations of medicines, and training and bonuses for staff.
- Referring serious cases to hospital for inpatient care.
- Managing complicated cases that require inpatient care.
- Vaccinating children aged six months to 15 years.
- Caring for children with severe acute malnutrition (in some areas, more than 10% of children screened) and malaria ( in certain hospitals, 90% of children are tested positive).
- Actively detecting cases of measles in communities.
As of early December 2015, MSF teams had vaccinated more than 962,900 children aged six months to 15 years, and provided support to nearly 30,000 children with simple or complicated cases of measles.
In December, more than 500 international and national staff were deployed to respond to this epidemic.