Democratic Republic of Congo : Confronting a measles epidemic in Katanga
February 22, 2011
In late January, Médecins Sans Frontières (MSF) and the Ministry of Health of the Democratic Republic of Congo launched a measles vaccination campaign in province of Katanga. In order to halt the spread of an epidemic, teams must vaccinate approximately 1.2 million children.
MSF teams working with the Ministry of Health had barely concluded a vaccination campaign in Likasi district when they set out for Lubumbashi, capital of the DRC's Katanga province. On February 4, teams went into several neighborhoods to begin vaccinating nearly 920,000 children between 6 months and 15 years old against measles. Measles can be fatal among children and vaccination remains the only form of prevention.
"The epidemic began to appear in scattered fashion," says Dr. Northan Hurtado, an MSF primary care physician. "At the start, in mid-October, rural areas were most affected. Then the cases started increasing in urban areas." By mid-January, as the epidemic spread, 3,885 children in Likasi district had contracted measles. Of that number, 31 died. Lubumbashi was less hard-hit, with 791 children falling ill. It was thus necessary to start vaccinating quickly to halt the epidemic, but organizing a major vaccination campaign is no simple task. The strategy was developed in consolation with national authorities and partners, such as the World Health Organization, although approaches differed.
The health authorities wanted to organize a large number of small, five-person teams, as would be assembled for a monitoring or catch-up campaign. However, MSF recommended a smaller number of larger teams – 12 people – to address the urgent nature of the epidemic. "Our strategy is based on a rigorous approach to quality," Dr. Hurtado explains. "By deploying fewer teams, we can better supervise the quality of the teams' work – administering the vaccine, for example – and keep better control of the cold chain, which is critical to preserving the vaccine." Eventually, they reach an agreement and when supply delivery problems were resolved, the campaign got underway in Likasi. Between January 25 and 31, the Congolese Ministry of Health and MSF vaccinated 190,733 children.
The effort required mobilizing significant numbers. Fifty-four teams were assembled for Likasi district. Under the guidance of a nurse/team leader, three nurses prepared the vaccine and performed the inoculations. A registrar completed the vaccination record, a nurse's aide administered Vitamin A (a critical supplement for preventing possible complications from measles) and a recorder noted the number of children vaccinated. Drivers were also needed for the vehicles transporting staff and supplies and security guards were necessary, too.
Protecting the cold chain until the time of vaccination
In logistical terms, maintaining the cold chain is essential to preserve the vaccination. Measles vaccine is supplied freeze-dried and transported in coolers, along with the solvent needed to prepare it. The teams set off in vehicles with a huge cooler that holds 2,500 doses of vaccine and the equivalent amount of solvent. When they arrive at the pre-arranged site, they set up supplies, tables, chairs and vaccine carriers, which are small coolers that will hold vaccine that has been reconstituted with the solvent.
A line is set up to avoid crowding, but mothers are already there with their children. They have heard the announcements delivered by megaphone in their neighborhoods or on the radio, instructing them to bring their children. Within one day, a team will vaccinate an average of 1,200 to 1,300 children in Lubumbashi, an urban area. The campaign should take about 10 days. During that time, a two-person team, composed of a logistician and a nurse, will oversee the operations, ready to step in in the event of a problem.
This form of organization has been tried and tested over the course of campaigns that MSF has run in many countries. Before vaccinations even begin, medical personnel are trained on how the campaign will be conducted. The last phase is a vaccination coverage survey, which identifies any remaining at-risk areas where people have not been vaccinated. If such pockets are identified, a team must administer more vaccinations in those areas because the goal is to vaccinate at least 90% of children and stem the spread of the virus. Goal achieved for Likasi district: the vaccination coverage rate topped 99 percent.