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DRC: Innovative Vaccination Strategies to Respond to the Measles Epidemic
September 23, 2013
Doctors Without Borders/Médecins Sans Frontières (MSF) nurse Tessy Fautsch recently went to Wamba, in the north of the Democratic Republic of the Congo (DRC), to participate in a measles vaccination campaign that is part of a new project aiming to respond to the epidemic that has been devastating the country since 2010. This new project aims to treat confirmed cases in order to reduce mortality and develop new vaccination approaches that can be imitated by the Ministry of Health in order to contain the disease.
Reaching Remote Populations
The vaccination project Fautsch was involved with was set up in Orientale province, one of the regions most affected by the epidemic.
“When the measles epidemic is seen to be spreading in an area, as many children as possible need to be vaccinated, even if it is difficult to reach [that] area,” says Fautsch. “Going to treat populations where they live is key to a successful vaccination campaign and is sometimes a real challenge.
"For example, the Orientale province in the north of the DRC is very difficult to get to. In this region there are few roads because the equatorial forest is very dense. These roads are not maintained and are in a very poor condition. Before the rainy season, it took us two days to travel 450 kilometers [about 280 miles] between Kisangani, the capital of Orientale province, and Wamba. On the way back it was even more difficult as the cars and trucks got stuck in the mud.”
It can sometimes take a week to reach certain vaccination sites. “In isolated regions, vaccination coverage is poor and measles causes many deaths in children under the age of five,” Fautsch continues. “However, we also see many cases in adolescents and adults. In Wamba, we therefore decided to vaccinate populations between the ages of six months and 15 years, as well as some adults to limit transmission. Vaccinating at least 95 percent of the target population reduces the circulation of the virus and as a result reduces the risk for unprotected populations.
"In the Wamba health zone, MSF vaccinated over 50,000 children—97 percent of the target population—preventing the epidemic from spreading. Now the project is moving to the south, to the West Kasai province, to respond to a new wave of the epidemic.”
New Vaccination Approaches
MSF is developing an innovative new two-stage strategy to reduce measles-related mortality in Orientale and other areas most affected by the epidemic.
“First, we concentrate our effort in the areas most affected in order to respond to the emergency,” explains Fautsch. “We treat reported cases by aiding general referral hospitals and health centers in the area. For example, in Wamba we treated over 860 patients infected with measles. At the same time, we vaccinated the population in these outbreak areas in order to contain transmission. This lasted for three or four days and 400 to 500 children could be vaccinated in 24 hours in rural areas.
"Next, we covered the entire region. The aim was to save resources and make it our priority to travel to the locations where there were cases in order to control the epidemic as soon as possible in a targeted fashion. We adapt according to the information available and change the vaccination order that had originally been planned in order to be able to respond more quickly to the spread of the epidemic.”
From a technical point of view, one of the issues with a vaccination campaign like this is the cold chain, the logistical network that allows the vaccines to be properly preserved.
“We have a centralized cold chain so that we can store the vaccines at between 2 and 8°C,” says Fautsch. “During vaccination campaigns in isolated areas, we do not need electricity on-site as our insulated boxes are good for up to five days. As such, we have tried to do without refrigerators as far as possible to show that you can carry out vaccination campaigns with limited resources in isolated areas. By using insulated boxes to transport vaccines from the storage site to the vaccination sites, we are able to travel to the most isolated areas.”
This strategy allows mortality to be reduced with minimal costs. “It is a strategy that we have implemented in order to demonstrate to the Ministry of Health how effective it is,” says Fautsch. “Ultimately, we hope to see it being adopted by the government and its partners.”
Since 2010, over 200,000 people have been infected with measles in the DRC, and over 4,500 children have died from the disease. In two years, four million people have been vaccinated thanks to the work of MSF and good collaboration with the local health authorities.