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While international attention is focused on the COVID-19-19 pandemic, measles continues to kill large numbers of people, mostly children, in the Democratic Republic of the CongoDRC), Central African Republic (CAR) and Chad. The world’s largest measles outbreak is still spreading DRC“That he’s also fighting an Ebola epidemic.” Since the outbreak it was first declared in DRC In June 2019, there were more than 332,000 measles cases across the country. The Chad measles outbreak has been going on for two years, since May 2018. CAR declared its measles outbreak in January 2020.
Together, these measles outbreaks have infected hundreds of thousands of children and killed thousands more. Some children die at home, have never received adequate medical care, or have only been seen by a traditional healer.
Doctors Without Borders / Doctors Without Borders (SPS) SPS teams have been responding to the measles epidemic in all three countries, providing outbreak response vaccines and treating children for the disease and other illnesses such as malnutrition. These efforts continue despite logistical and security challenges, even as COVID-19-19 A pandemic looms as a possible threat and distraction to governments, donors, and other health organizations.
Democratic Republic of the Congo: fighting measles in the shadow of Ebola
Dwarfed by the Ebola outbreak in the east of the country, the measles response in DRC It has been neglected from the start. Months passed before the epidemic was officially declared in June 2019. Vaccination campaigns organized by the authorities were marked by delays, coordination problems and the lack of support partners, many of whom focused on the Ebola response. . A complementary vaccination campaign, aimed at reaching previously lost children, was repeatedly postponed before it was finally carried out in late 2019.
All these factors have contributed to the high number of victims of the disease. DRC. More than 6,200 people have died from measles, of which about 85 percent are children under the age of 5. That’s almost three times the death toll from Ebola (2,268 deaths, according to the World Health Organization), yet the measles epidemic receives only a fraction of the attention and resources it deserves.
“Today, the total number of cases may have been reduced, but the epidemic is far from over,” says Emmanuel Lampaert, SPS operations coordinator at DRC. “Some areas even report increases [in the number of cases], and there are around 100 health areas where urgent action is needed. “
“Since January, more than 50,000 cases and 600 deaths have already been officially reported,” says Lampaert. “But many areas with increasing numbers of cases and deaths are not included in the latest national measles response plan.”
From Haut-Uélé to Kongo Central, from North Ubangi to South Kivu, SPS Teams have been deployed in a dozen provinces DRC Only in 2020. This year we have vaccinated more than 260,000 children against measles, while we have treated more than 17,500 who already had the disease. Last year, SPS He vaccinated 816,000 children against measles and cared for more than 50,000 patients with the disease.
Silent killers, but few medications available.
As in many remote places in DRCThe cost of “silent killers” such as measles, malaria, diarrhea, and respiratory infections are well known to local people.
“The needs here are enormous, but the supply of medicines to the health centers is problematic,” says Gédéon Mushadi, the chief physician of the health area. “The few medicines available in health facilities do not cover the needs.”
Alphonsine Ekima, 43, and her family have felt the terrible impacts of this crisis. Six weeks ago, her three-year-old daughter, Marie, died of measles. She was buried the same day as her cousin, who died of the same disease. “Marie was the fourth girl to be taken from me,” says Alphonsine.
Each delay, each obstacle fuels the outbreak
In this already difficult context, the COVID-19-19 pandemic has created more barriers to vaccinate children against the disease.
“Implement preventive measures to reduce the spread of COVID-19-19 is vital to protect communities and health personnel, especially in a country like DRC where the health system is very limited, “says Lampaert.” Unfortunately, these measures are having an impact on the overall response to measles, including transporting vaccines, assembling dedicated teams, and launching vaccination campaigns. “
These obstacles are affecting efforts to control the measles epidemic, says Lampaert.
“Each delay and each obstacle increases the risk that the epidemic will continue to spread, killing more children,” says Lampaert. “The same thing happened during the Ebola outbreak in West Africa, when measles vaccination activities were discontinued, leading to a resurgence of the disease.”
“COVID-19-19 will sow the seeds of other health crises “
Today, with all eyes focused on the threat of COVID-19-19, SPS teams continue to respond to other health emergencies such as measles, in DRC and beyond.
“As we adapt our approach to the coronavirus pandemic and support the response to it, it is important to remember that a single track approach to COVID-19-19 will sow the seeds of other major health crises, “says Lampaert.” Reducing vaccines, nutritional support, or preventing malaria in the face of a public health crisis will lead to other crises, worsening the situation. Neglecting other health problems would make us complicit in many more future deaths. “
Central African Republic: a chronic health emergency
After many years of violence and insecurity, the Central African Republic (CAR) is in a state of chronic health emergency. Many of the country’s 5 million people, more than 700,000 internally displaced people due to insecurity, do not have access to medical care. Many children have not been vaccinated.
Under these conditions, a preventable but highly contagious disease such as measles can spread rapidly. In January 2020, the Ministry of Health declared a national measles epidemic.
In support of the health authorities, SPS launched a massive campaign to vaccinate more than 340,000 children against measles in seven health zones across the country.
Insecurity and complicated logistics hamper vaccination efforts
“The logistical challenges and costs of establishing a large-scale vaccination campaign in such remote and isolated parts of the country are enormous,” says Ester Gutiérrez, SPSHead of mission in CAR. “You can only get to many of these areas by plane. Our mobile teams often spend several days in the field to reach the most remote villages. “
“Insecurity is another problem,” says Gutiérrez. “In the area between Bria and Ouadda in the center of the country, for example, the fighting prevented us from carrying out our planned medical and vaccination activities.”
Keeping vaccines cold in areas without reliable electricity is a big challenge. Zacharie Musangu is a veteran SPS staff member who started working with us in his native country DRC in 2004. Now in CAR At our temporary base in the small town of Baboua, near the border with Cameroon, the logistics expert gets up every morning at 3:00 a.m. to prepare vaccines for the eight mobile teams that take them by car or motorcycle to remote villages in the district.
“The most important part is keeping the same temperature when vaccines are taken from the freezers at our base, what we call the active cold chain, the passive cold chain in cooler boxes that our mobile teams take to the sites of vaccination”. Zacharie says “It is a very delicate procedure.”
Children shouldn’t die of measles
Parallel to the vaccination campaign, SPS the teams also treat children who are already sick with measles. Since early 2020, more than 6,200 suspected measles cases have been reported and treated by SPS in the Ouham region and the health districts of Nangha Boguila and Bossangoa in the north of the country.
Yvonne Zongagofo has taken her stepson Maxime to a health post that SPS Supports in the town of Benzambe, several hours by car from the town of Bossangoa. Maxime has been sick for three days. He has a fever and does not want to eat.
“I have insisted with my family on taking Maxime to the health post; I knew it was measles,” says Yvonne. “We haven’t had anyone sick with this disease for years, but I recognized the symptoms because I remember the last epidemic, when I was a child.”
“Back then, traditional medicine was the only remedy, and there was no NGOs [nongovernmental organizations], doctors or hospitals in this region, “continues Yvonne. “Today the situation has slightly improved. We have a little more access to health care, but it is not enough. Children continue to die in my community. “
After the consultation at the health post, Maxime is taken to the SPS-supported hospital in Bossangoa, where a special measles ward has been established.
“Children shouldn’t die of a preventable disease like measles,” says Adelaide Ouabo, SPS medical coordinator “Unlike the new coronavirus, we have had a measles vaccine for decades, and we must ensure that as many children as possible have access to it.”
Chad: twin measles and coronavirus outbreaks
As concerns grow about the spread of COVID-19-19 in Chad, parts of the country are still trapped by a two-year measles epidemic that is increasing in intensity and shows no signs of slowing down, leaving the country at risk of twin crises.
Officially declared in May 2018, 118 of 126 health districts in Chad have now been affected by measles, with the southern provinces near the border with CAR facing a rapid increase in cases.
Measles epidemics have been reported in some 28 health districts. During the first three months of 2020, the Ministry of Public Health reported 7,412 suspected measles cases, with the highest number of cases reported in the Beboto, Kyabe and Goundi health districts.
Malnutrition adds to the dangers for young children.
A SPS The emergency response team traveled to affected regions, including Beboto, in February, after the Ministry of Public Health alerted SPS that measles cases in the district had doubled in a matter of weeks.
There, the team vaccinated 25,177 children aged six months to nine years against measles. In response to high malnutrition rates in the region that have weakened the immune systems and contributed to the spread of the virus, 10,432 children were also examined and 1,191 were treated for severe acute malnutrition.
SPS Supervising nurse Ngueremi Yary Roger says that upon arrival in the district, the team found that some families reported that three or four children had recently died of the disease. Patients stayed home or used traditional medicines instead of trying to access local health facilities.
Our team at Beboto also worked closely with community leaders to raise awareness about measles prevention and how suspected measles patients could access free medical treatment in SPS-supported health services. We donate medical kits, measles vaccines, and water and sanitation supplies to the health district to enable case management by local teams under the supervision of Beboto health district authorities.
From the beginning of February to the middle of April, we also carried out a vaccination campaign in the Kyabé region in southern Chad, targeting children aged six months to five years. Due to the many cases of malaria and malnutrition, SPS It also provided general pediatric care and treated children with measles, in addition to vaccination activities.
More than 60,000 children were vaccinated in Kyabé last month for SPS teams
COVID-19-19 fears threaten to overshadow other health needs
From the first COVID-19-19 case in Chad was confirmed on March 19, most humanitarian organizations and donors have turned their attention to COVID-19-19 prevention activities.
A measles vaccination campaign of the Ministry of Public Health and supported by UNICEF and GAVI is scheduled for this year, but he fears great COVID-19-19 outbreak can threaten that.
“Although COVID-19-19 is the emergency situation that attracts the full attention of the country and donors, the response to the measles epidemic remains our top priority, “he says. SPS Head of Mission Seidina Ousseini. “We must focus and push for a mass vaccination campaign.”
“Chad has been facing an economic crisis since 2015. The government simply does not have the capacity or the funds to respond to COVID-19-19 and measles at the same time, “says Ousseini. “It is important to remember that as donor funds continue to be diverted to COVID-19-19 activities, we must continue to do what we can to help combat measles and ensure that other health services are not neglected to avoid a catastrophic situation in which all these problems merge into an even bigger problem. “
Distributed by APO Group on behalf of Doctors Without Borders (SPS)
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