DRC: Measles Epidemic in Decline, but Risk of Further Outbreaks Remains

A measles epidemic has been raging since the beginning of 2015 in the region of Katanga in southeast Democratic Republic of Congo (DRC). According to the Ministry of Public Health, as of November 20, 2015, a total of 39,619 cases—resulting in 474 deaths—had been officially reported in Katanga.

More than 77 percent of children affected were one to five years old, and 88 percent of the children who died were in this age group. However, it is thought that these figures are underreported. Here, Caroline Voûte, coordinator of the Doctors Without Borders/Médecins Sans Frontières (MSF) response to the epidemic, discusses the current situation.

"[Though] the epidemic of measles is now considered to be declining in Katanga, we remain very worried about the persistence of measles cases in most other provinces of DRC and, consequently, the risk of new outbreaks. DRC has experienced continuous epidemics since 2010. Enormous human and financial resources are repeatedly brought to bear to combat measles, a largely preventable disease, through vaccination.

This new health crisis again calls into question the effectiveness of previous vaccination campaigns. It is urgent to learn from this epidemic and take the necessary steps to improve routine immunization to prevent a new outbreak in the coming years. As a reminder, in 2011, Katanga had already faced one of the largest outbreaks of measles. MSF then vaccinated 2.1 million children.

Officially, at the end of November, more than 39,000 cases and nearly 500 deaths were reported in Katanga since the beginning of 2015, but these figures are largely underestimated, as retrospective mortality surveys in some areas have already shown. Indeed, in the most remote and economically depressed parts of this immense territory, the health landscape looks like a desert. Especially in rural areas, the health system has lost its legitimacy and credibility.

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Health centers are experiencing a chronic lack of medicines; trained medical personnel are scarce; and costs of care are exorbitant, discouraging the population, already very poor, from seeking treatment. In this context, epidemiological surveillance fails, and actual figures are not made available to health authorities. The recognition of the epidemic and the response have therefore been delayed.

MSF began its intervention in April in Malemba Nkulu health zone. The epidemic had been gaining ground; we quickly had to expand our activities to other areas. We vaccinated children between six months and fifteen years old, and we supported the health centers for the management of simple cases through donations of medicines, staff training, and supervision. We also have teams in hospitals to treat children with complications. Around Manono, for example, severe malnutrition rates are alarming, at over 10 percent in some areas. And 90 percent of the children we hospitalize suffer from malaria, which is why we decided to focus on these two pathologies as well.

MSF has been working in DRC since 1981. In Katanga and in the border regions, MSF vaccinated more than 962,900 children between six months and fifteen years of age and supported nearly 30,000 children affected by the disease since the beginning of the response to the measles epidemic.