Measles and malnutrition in Niger

Interview with Iza Ciglenecki, medical advisor.  

"The MSF emergency teams arrived in Niger about two and a half weeks ago, with the purpose of organizing a mass vaccination campaign in Magariya district - an area where MSF had already had a long-term nutrition program. Since the end of 2007, there has been an ongoing measles outbreak in Niger.

"More than 2,000 cases have been reported from the beginning of 2008 to mid-march of 2008. The ministry of health had organized a mass measles vaccination campaign in the middle of January, but this has not stopped the outbreak. The vaccination campaign had only targeted children between the ages of 9 and 59 months. The statistics found by MSF are much higher than the numbers reported through the national surveillance system.

"The number of cases we have found during this past week is almost ten times higher than the ones reported by the system. Similarly, for the deaths, while there were no deaths reported for this area through the national surveillance system, MSF found records of more than 20 deaths in the same area.

"Measles is a childhood disease that has, if not treated properly, quite a high mortality: between four and eight percent of children will die of measles if untreated. Measles is also a very infectious disease; the transmission is very fast. If all the children of Magariya are not vaccinated soon, all of them will be at an increased risk of contracting measles.

"Mortality in children affected by measles is highest among children who are also malnourished. Compounding the problem, malnutrition is often brought on by measles. The children who had only measles previously might become malnourished as well within several weeks.

"As the number of cases did not decrease following the vaccination campaign in January, MSF decided to re-vaccinate the area of Magariya, hoping to conduct a mass vaccination campaign of all children between six months and 15 years old. MSF started its vaccination campaign on March 27, and during the first week of vaccination in the Magariya [area] MSF vaccinated almost 50,000 children against measles.

"At the same time as the vaccination campaign, we conducted active case-finding in this same area. We were able to find more than one hundred children currently affected by measles. At the same time, in the community we were told of several deaths - several children that had died due to measles.

"MSF wishes to vaccinate all of the children of Magariya district; this is a target population of around 300,000 children. We hope to finish the vaccination within a one-month period of time."