Vaccination

Kinshasa, November 6, 2009 – Last month, seven vaccination sites operated by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) came under fire during attacks by the Congolese army against the Forces Démocratiques de Libération du Rwanda (FDLR) in North Kivu, Democratic Republic of Congo (DRC). Thousands of civilians had gathered at the sites. MSF denounces this clearly unacceptable abuse of humanitarian aid for military purposes.

In this interview, Dr. Fournier describes why a global response to the H1N1 pandemic must in the short term focus not only on vaccination, but on reducing mortality worldwide by emphasizing the identification and treatment of the most severe cases; and argues why access to the vaccine in the future must be based on medical need, not purchasing power of wealthy countries.

MSF is providing treatment to those infected, and has launched a vaccination campaign for approximately 400,000 children between six months and 15 years of age.

Since April, an outbreak of measles has been sweeping through the town of Guri El and nearby areas in the Galgaduud region of South and Central Somalia. So far, MSF has treated 403 patients for measles-related complications in the area.

During the last four months, MSF teams in cooperation with the national health officials have been moving quickly, following the epidemic trend, to help treat tens of thousands of patients and to proceed swiftly on a massive vaccination campaign for 7.5 million people.

This year’s meningitis outbreak in northern Nigeria has already led to the deaths of over 1,500 people. Doctors Without Borders/Médecins Sans Frontières (MSF), in cooperation with the Nigerian Ministry of Health, is carrying out a mass vaccination campaign as well as undertaking the very important task of treating the patients who are suffering from the disease.

More than 1,900 people affected by meningitis have died since the beginning of this year in an area of sub-Saharan Africa known as the meningitis belt. In Nigeria, Niger and Chad alone, MSF medical teams have treated more than 56,000 sick patients. The organization is currently vaccinating a total population of more than seven million in the three countries, the biggest vaccination campaign MSF has ever carried out.

Several countries in West Africa are facing a major meningitis epidemic. In Nigeria, this is the worst meningitis epidemic the country has experienced since 1996.

“It’s true that vaccinations stop the epidemic from spreading, but without emergency medical treatment for patients with meningitis, the number of lives lost would be catastrophic," says MSF doctor Nico Heijenberg.

Following an outbreak in eastern Chad, MSF is currently vaccinating children between six months and 15 years against measles. As a nurse, Lenny Krommenhoek was part of this vaccination team for five weeks. Following her recent return, she wrote about the enormous logistical challenges she faced during her mission and her very personal experience in this remote part of the world.

Meningitis, a disease responsible for thousands of deaths in Africa, is currently spreading in several West African countries. While ensuring quick access to treatment for those already infected, MSF is also starting mass vaccination campaigns in Nigeria and Niger and is closely following the situation in other countries in the region. MSF is planning to vaccinate between 4 million and 5 million people against meningitis.

Luis Maria Tello, MSF emergency coordinator in Zimbabwe, encountered a devastating scene when he arrived in the town of Chegutu, 100 miles south of the capital Harare, on December 12, 2008. “The situation was absolute chaos. There were no beds and patients everywhere,” said Tello. “People were dying of thirst because there was no water. Dead people were lying everywhere."

This expulsion has serious medical and humanitarian consequences for the population of Darfur, one of which is that the outbreaks of meningitis in Kalma camp and at the base of Jebel Marra mountain range will possibly go without a medical response.

On February 18, 2009, MSF started a massive measles vaccination campaign in the district of Adré in Eastern Chad, along the Sudan border. MSF teams have up to today vaccinated 19,000 children against measles.

MSF has mobilized significant human and logistical resources to fight an ongoing measles epidemic in the district of Abéché, Chad.

MSF is taking part in a vaccination campaign targeting 525,000 people in response to an outbreak of yellow fever in Sierra Leone. The five-day campaign started on January 10.

New York, New York, December 1, 2008—A partial dose of a commonly used vaccine against meningitis may be as effective as a full dose, according to newly published research in PLoS Neglected Tropical Diseases. Fractional dosing would enable large-scale vaccination campaigns during epidemics, especially at a time of global vaccine shortages.

Both the displaced and the residents in North Kivu lack the most basic living standards, such as good hygiene conditions, clean water, food, and healthcare. As a result, there are disease outbreaks.

At the beginning of May, at the request of the health ministry of Niger, MSF provided backup assistance for a meningitis epidemic in the Dosso region. Here, Issiaka Abdou, MSF emergency co-ordinator, talks about the operation.

In Niger, a meningitis mass-vaccination campaign launched by MSF, in cooperation with the local Ministry of Health (MoH), has ended. The aim was to prevent a large-scale epidemic after a number of cases had been reported in late March. More than 300,000 people were vaccinated in 20 days with positive results—the spread of the epidemic was stemmed.

Since January, thousands of children have developed measles in Niger. MSF has sent medical teams to Maradi and Zinder, the regions with the highest numbers of measles cases, to prevent the spread of this highly contagious disease.

Laboratory tests have confirmed the presence of the Ebola virus in samples collected in western Uganda, on the border with the Democratic Republic of Congo. According to the Ugandan Ministry of Health, a total of 64 suspected cases and 21 deaths have been reported in the villages of Kykyo and Bundibugyo. The first Doctors Without Borders/Médecins Sans Frontières (MSF) teams arrived in Bundibugyo, the epicenter, on December 1.

New York, 11 April 2007 – Since cholera was confirmed in Mogadishu on March19, 2007, the international humanitarian medical aid organization Doctors Without Borders/Médecins Sans Frontières (MSF) has treated more than 800 patients. However the recent worsening violence is making it increasingly difficult for patients to access MSF's cholera treatment center (CTC), which opened two weeks ago. The fighting is also preventing MSF national staff from reaching other areas of the city.

MSF has been quick to respond to meningitis epidemics in several countries in Africa's "meningitis belt." In the four countries–Burkina Faso, Sudan, Uganda and the Democratic Republic of the Congo (DRC-where the epidemic threshold has been reached MSF's first response was to evaluate the outbreak, identify the strain of meningitis, and treat people infected with the disease.

Southern Sudan has paid one of the highest prices among countries affected by meningitis this year. Several teams from Doctors Without Borders/Médecins sans Frontières (MSF) are caring for those affected by the deadly epidemic and vaccinating the population at risk throughout a number of states in the region. To make matters worse, cholera is quickly progressing in a number of areas.

New York, Ouagadougou, March 23, 2007 – The meningitis epidemic that emerged in Burkina Faso at the end of February continues to spread. The most recent statistics issued by the health authorities in mid March show 801 deaths and 10,796 suspected cases since the beginning of the year. While two-thirds of the country is in an epidemic phase or on alert, the capital, Ouagadougou, is affected. Doctors Without Borders/Médecins Sans Frontières (MSF), already assisting hospitalized patients in the capital, is now stepping up its response. A cargo plane carrying vaccines for 540,000 people arrived on Saturday, March 17 with the necessary cold chain equipment, and MSF meningitis specialists are present in the county.

MSF began a meningitis vaccination campaign in Juba, the capital of southern Sudan, on March 14, vaccinating the population at risk in three health zones in the capital city. Approximately 160,000 people between the ages of 2 and 30 will be vaccinated. Below is a synopsis of the second day of vaccinations, March 15, from one of the 12 sites.

During the past weeks, teams from Doctors Without Borders/Médecins Sans Frontières (MSF) assisted in the vaccination of over 860,000 people against meningitis, a contagious and potentially fatal infection of the brain membrane.

Doctors Without Borders/Médecins Sans Frontières (MSF) has completed a mass meningitis-vaccination campaign in two districts of the West Nile region of Uganda, supervising the vaccination of 291,000 people and assisting with the vaccination of 333,000 more.

In the coming days, a 52-person team will vaccinate everyone from 2 to 30 years of age in the Adi health zone, in eastern Democratic Republic of Congo (DRC). Dr. Alena Koscalova has been one of the medical coordinators for Doctors Without Borders/Médecins Sans Frontières (MSF) in the DRC for more than two years. She is currently in charge of the meningitis vaccination campaign and answers our questions about the effort.

Barely two months into Africa's dry season, there are several countries facing severe outbreaks of meningitis. Doctors Without Borders/Médecins Sans Frontières (MSF) is already responding to epidemics in the Democratic Republic of Congo, southern Sudan, and northern Uganda.

Since the first cases of meningococcal meningitis A were confirmed in two districts of the West Nile region of northern Uganda in early January, MSF has been working closely with the Ugandan Ministry of Health (MoH) and the World Health Organization (WHO) to reduce mortality, minimize the spread of the epidemic, and strengthen the epidemiological-surveillance system.

Atlanta, November 15, 2006 — In research presented at the 55th Annual Meeting of the American Society of Tropical Medicine and Hygiene (ASTMH), the international emergency medical aid organization Doctors Without Borders/Médecins Sans Frontières (MSF) and its research affiliate, Epicentre, showed how rapid, mass vaccinations can reduce the toll inflicted by measles epidemics in Africa. In light of these and other findings, MSF feels there is enough evidence for the WHO to revise its current policy recommendations, which doubts the effectiveness of mass immunization once an epidemic has started, stating that such campaigns would be undertaken too late to have any meaningful impact.

Since August 20, more than 650 cases of typhoid fever, including 90 cases of peritonitis and intestinal perforation and around 20 deaths, have been reported in Kikwit, Bandundu Province, in the Democratic Republic of Congo (DRC). A team from MSF is providing support to Kikwit's main hospital to ensure treatment of patients.

Dr. Jean-Paul Delain, a 53-year-old pulmonary specialist from Avignon, France, arrived in the village of Akuem, in Sudan's Bahr el Ghazal State, at the end of March to evaluate whether the area was in the midst of a meningitis outbreak.

Kinshasa/Brussels, March 13, 2006 - The international humanitarian aid organization Doctors Without Borders/Médecins Sans Frontières (MSF) is launching a massive measles vaccination campaign in Mbuji Mayi (Kasai Oriental province), the second largest city in the Democratic Republic of Congo (DRC). In only a few weeks, MSF teams will vaccinate an estimated 550,000 children under the age of 5.

On February 27, Doctors Without Borders/Médecins Sans Frontières (MSF) launched a massive meningitis vaccination campaign in the Maradi region of Niger. Five hundred thousand people are expected to be vaccinated initially. MSF teams are also treating people who have already contracted this highly-contagious infectious disease.

Cases of meningitis were reported during the first week of January in the Welayita region of the Kendo Kocha and Bolo Sore woredas (administrative units), in southern Ethiopia.

To halt a yellow fever epidemic in central Sudan's Kordofan province, medical teams from MSF, working with Sudanese health officials, led a mass vaccination campaign in Abu Gebeiha and Rashad, two of the province's largest towns.

Dr. Philippe Guérin, scientific director of Epicentre, a nonprofit epidemiological research partner of Doctors Without Borders/Médecins Sans Frontières (MSF), states that natural disasters do not cause epidemics. He details the risks and priorities in the wake of the Kashmir earthquake, as he had done after the Tsunami.

On August 24, MSF sent its first team consisting of one medical doctor, one nurse, and two logisticians, to West Sumba in order to investigate reports of a measles outbreak that had killed five people in the sub-district of Kodi. They soon found that the outbreak had already spread into 6 of West Sumba's 15 sub-districts.

After having vaccinated more than 40,000 children in the Bousso district, 186 miles south of N'Djamena, MSF medical teams have now joined their colleagues in the capital of Chad.

It has been six weeks since the World Health Organization (WHO) confirmed an outbreak of Marburg fever in Angola. Today, the epidemic is still not under control, and as of April 30 there have been 271 deaths out of 301 confirmed cases.

April 28, 2005, N’Djamena/New York - A measles epidemic has hit at least three provinces in Southern and Eastern Chad, as well as the capital, N’Djamena. Doctors Without Borders/Médecins Sans Frontières (MSF) has started to provide emergency assistance by treating patients with measles, continuing assessments, and carrying out vaccination campaigns.

Ten days after an outbreak of Marburg Hemorrhagic Fever was officially confirmed in Angola, Doctors Without Borders/Médecins Sans Frontières (MSF) teams are working on the front line of operations.

Ten days after an outbreak of Marburg Hemorrhagic Fever was officially confirmed in Angola, Doctors Without Borders/Médecins Sans Frontières (MSF) teams are working on the front line of operations.

Abeche, Chad, 28 January 2005 - The international medical humanitarian aid organization Doctors Without Borders/Médecins Sans Frontières (MSF) is launching a meningitis vaccination campaign in eastern Chad, following a recent outbreak among refugees from Sudan's Darfur region. The campaign is aimed at protecting thousands of people in the area from the highly infectious disease, which is particularly threatening in the overcrowded camps.

Philippe Guérin is an epidemiologist in charge of epidemiological studies at Epicentre, Doctors Without Borders/ Médecins Sans Frontières’ (MSF) partner organization. In the following interview, he takes stock of the medical consequences of the tsunami and explains that the risk of epidemics is not a result of the disaster itself, but rather the potential consequence of people being displaced from their homes.

Over the past 18 months, MSF has vaccinated more than 500,000 children in a continuing campaign against measles in some of the most inaccessible areas of the Democratic Republic of Congo (DRC). MSF nurse Jessica Nestrell is coordinating the vaccination campaign.

In August, MSF began the sixth phase of a preventative measles vaccination campaign in the Democratic Republic of Congo (DRC), which will take the total number of immunizations to nearly 500,000.

New York, April 28, 2004 - Because of the lack of appropriate, urgently needed aid, the health of displaced people in Sudan's Darfur region - particularly children - is radically worsening, according to the international medical aid organization Doctors Without Borders/Médecins Sans Frontières (MSF).

Mary Jo Frawley, an American RN and veteran of six MSF field missions, joined an MSF team this winter for a measles vaccination campaign in the remote mountain villages of Tajikistan.

by Elena Dubrovskaya, a freelance journalist specializing in Central Asian affairs