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MSF Responds to Meningitis Epidemic in the West Nile region of Northern Uganda
February 14, 2007
"If treatment is not available and vaccination campaigns are not launched, bacterial meningitis epidemics can spread fast and cause hundreds of deaths," said Renaud Leray, head of mission for MSF in Uganda.
Reducing mortality through quality case management
As of February 11, health authorities recorded 1,474 cases and 44 deaths in Koboko and Arua districts. MSF is supporting case management in 25 health structures in Arua and Koboko districts. "The case fatality rate is currently relatively low, between 2.4 percent and 5.6 percent, depending on the areas," said Dr. Chantal Umutoni, medical coordinator for MSF in Uganda. "But we need to continue monitoring the situation closely." MSF has already supplied more than 1,600 doses of oily chloramphenicol, the most effective antibiotic treatment, to the health structures where the organization is monitoring cases. A single injection is sufficient in most cases and effective within 24 hours. As a second-line treatment and for pregnant women and children aged between two months and one year, MSF uses ceftriaxone.
Targeting the most affected areas to contain the epidemic
Starting on February 2, MSF, MoH, and the WHO worked together to conduct a series of vaccination campaigns targeting a total of 450,000 people. MSF teams contributed to the provision of vaccines, medical supplies, and logistical and financial support. Since the vaccination campaign was launched, more than 191,000 people were vaccinated under MSF supervision in 70 different sites in Arua and Koboko districts. The MoH has also vaccinated an additional 260,000 people in Arua and Koboko districts.
"Containing a meningitis epidemic requires not only vaccines and syringes. You need to have a reliable epidemiological-surveillance system, quality case management, and a strong strategy for the vaccination campaign," said Leray. "You need to start vaccinating where the attack rate is highest and simultaneously treat all the severe cases. Then you can extend the vaccination to all locations where the alert threshold has been reached."
An additional order of vaccines is being placed with the International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control to complete the vaccination campaign.
Maintaining the "cold chain"
Mass vaccinations campaigns require sizeable logistical means. In order to preserve the efficacy of the meningitis vaccine, doses must be kept between 2 and 8 degrees Celsius from reception until delivery at the vaccination site.
Efficient supply management is also essential given that the target population changes with the spreading of the epidemic. As in other emergencies, MSF relies on prepackaged kits to respond quickly to epidemics or other emergencies. Each meningitis kit contains all of the medical supplies required to vaccinate 10,000 persons. The logistical team is also in charge of setting up crowd control and waste management systems at each site.