DRC changes measles strategy amidst world's largest outbreak

NAIROBI —The death toll from the measles outbreak in the Democratic Republic of the Congo reached 6,000 this week. As the cases mount, the government and global health partners have called for a reframing of the response, including expanding the ongoing vaccination campaign to include older children.

Since the beginning of last year, about 310,000 suspected cases of measles have been reported across the country — figures that are underreported, according to Médecins Sans Frontières. It’s the largest outbreak in the country in decades, with a higher fatality rate of cases than previous years.

It’s also the worst outbreak of the disease in the world, amid an unprecedented rise in measles cases globally.

This deadly outbreak of this highly contagious disease has been overshadowed by the Ebola crisis in the eastern part of the country, meaning there has been less attention and resources available for the measles outbreak, according to Dr. Vincent Sodjinou, incident manager for measles in DRC for the World Health Organization. The Ebola crisis in the country has claimed over 2,200 lives. Over 3,700 cases of measles have been reported in active Ebola transmission zones, UNICEF told Devex. This has been a challenge for health workers because Ebola and measles patients have similar symptoms.

As the measles outbreak rages on, the DRC government and global health partners are reexamining their approach and have approved a new response plan this week for the next six months, which aims to put an end to the outbreak.

“This new plan has taken into account lessons learned from the previous plan,” Sodjinou said.

Some of the weaknesses in the response at the national and provincial levels include inadequate mobilization of resources, the limitations on the vaccination campaign to only include children under 5, late positioning of vaccines, weak integration of nutrition interventions into the response, low involvement of community and religious leaders, as well as weak surveillance in some areas, said Dr. Xavier Crespin, chief of health at UNICEF in DRC.

In 2018, routine measles immunization coverage in DRC was only 57%. Some of the reasons behind low levels of vaccination in the country include shortages of the measles vaccine in the country and lack of access for many people to health facilities, according to MSF. There is also a need to keep the vaccine cold for maximum effectiveness, which is challenging in rural areas.

In Ebola-affected areas, limited capacity of health workers has led to a decline in measles immunizations. In July, the first measles vaccination campaign to occur in an area of active Ebola transmission was launched. Because measles vaccination campaigns involve the congregation of people to receive the immunization, health workers have taken extra steps to ensure these meeting sites have not led to increased transmission of Ebola, Sodjinou said.

Over the past year, the DRC Ministry of Health, WHO, Global Alliance for Vaccines and Immunization, and other partners have vaccinated 18 million children under the age of 5 against measles in response to the outbreak.

But as the cases continue to mount, it has become clear to responders that this limited vaccination campaign isn’t sufficient to contain the disease. A quarter of the reported caseload include children older than 5 years old. Because of this, children up to 14 years old are now included in the vaccination campaign.

“We need to target these children to be sure that the circulation of the virus is interrupted,” Sodjinou said.

The new response plan aims to vaccinate at least 95% of children aged 6 months to 14 years old by June, Crespin said.

While measles vaccination is part of the routine immunization package in DRC, the recommended second dose is not currently provided, Sodjinou said. This is problematic because young children aren’t always immune to measles after the first dose, he said. The new plan also intends to roll out a second dose for children across the country.

But in order to make this a reality, more vaccines and logistical support are needed, Crespin said. To implement the new plan, the humanitarian sector is calling for an increase of $40 million to the response. The majority of these funds — $33.5 million — is earmarked for implementing the expanded vaccination campaign, Sodjinou said.

Other changes in the response plan include a focus on the integration of nutrition programming within measles case management, Sodjinou said. Measles is especially deadly for malnourished children.

There is also a new focus on strengthening community engagement, he said. Previously, the communication efforts around the outbreak were focused primarily on educating communities around the vaccination campaigns. Now, the government and its partners aim to provide communities with more information on how to handle cases at the household level, how to avoid infection, and the steps they should take when a child shows symptoms, including avoiding traditional healers.

“We focused too much on just the vaccinations at the beginning. Now we are trying to give the same commitment to the other components of the response,” Sodjinou said.

Update, Jan. 10, 2020: This article has been updated to reflect the number of measles cases in active Ebola transmission zones.