Mass vaccination campaign to protect more than 4 million children (4 766 214) against a measles outbreak in conflict-affected states in north-eastern Nigeria is planned to start this week.
 

The two-week campaign, which starts on 13 January, will target all children aged from 6 months to 10 years in accessible areas in Borno, Yobe and Adamawa States.

"This measles vaccination campaign is an emergency intervention to protect more than 4 million children against a highly contagious and sometimes deadly disease," says Dr Wondimagegnehu Alemu, WHO Representative in Nigeria. "Massive disruption to health services in conflict-affected areas for many years has deprived these children of essential childhood vaccinations. In addition, many of them have severe malnutrition, making them extremely vulnerable to serious complications and death from measles."

Polio programme provides crucial support

WHO is supporting the 3 state Primary Healthcare Development Agencies to prepare for the campaign; working with partners including UNICEF, the United States Centers for Disease Control (CDC) and other health nongovernmental organizations. WHO is providing expertise in areas including logistics, data management, training, social mobilization, monitoring and evaluation, supportive supervision (human resource) and waste management.

"Nigeria’s well-established polio vaccination programme provides a strong underpinning for the campaign," says Dr Alemu. "Population data from the polio programme has been essential to guide planning for the measles campaign. We are also able to make use of staff that have vast experience in providing health services in very difficult and risky areas."

High insecurity, difficult terrain and lack of functioning health facilities add to the enormous logistical challenges of organizing a large mass vaccination campaign that requires assembling and training more than 4000 vaccination teams and ensuring the vaccine is kept within cold chain conditions (+2⁰ to 8⁰ C) in a climate where average daytime temperatures are above 30⁰ C.

The vaccination teams for this campaign are made up of 7 people including a supervisor, vaccinators (health workers), record keepers, community mobilizers and town criers. The teams will also give children deworming medication and vitamin A supplements at the same time as the measles vaccination.

To prevent double vaccinations especially in schools and camps for displaced people, vaccination cards will be issued to all vaccinated children as well as the use of pen markers to mark their thumbs.

Earlier campaigns show results

From early September to 18 December 2016, WHO-established Early Warning, Alert and Response System (EWARS) reported more than 1500 suspected measles cases in Borno State. More than 77% of children aged less than 5 years in Borno State have never received the measles vaccine and this is the age group where most cases have occurred.

The Borno State Ministry of Health, with support from WHO and partners, has already vaccinated more than 83 000 children aged 6 months to 15 years living in camps for IDPs (internally displaced people) where measles cases had been reported. These campaigns have started to show results, with a reduction of measles cases around the camps.

Children have missed out on essential vaccinations

The humanitarian crisis caused by conflict in Borno State has resulted in more than 1.4 million IDPs living in more than 100 camps, amongst a host population of about 4.3 million people.

With levels of malnutrition as high as 20% in some populations in Borno State, these children are particularly vulnerable to diseases like measles, malaria, respiratory infections and diarrhoea. The combination of malnutrition, malaria and measles increased child deaths up to 4 times higher than what is considered the emergency threshold (8 deaths per 10 000 children aged under 5 years per day).

Measles is a highly contagious, serious disease that is one of the leading causes of death in young children. In 2015, there were more than 134 000 measles deaths globally; most of them were in children aged less than 5 years.

During 2000-2015, measles vaccination prevented an estimated 20.3 million deaths making measles vaccination one of the best buys in public health.