MSF fights measles epidemic and starts therapeutic feeding in Chadian capital

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The transport and storage of the 300,000 vaccine doses needed for the campaign make for a huge challenge. Vaccines are sensitive products which lose their potency when exposed to heat, a real problem in N'Djamena where temperatures easily reach 40 degrees.

Measles are an aggravating factor for malnutrition. For that reason MSF has decided to do, in parallel with the vaccination campaign, a nutritional screening with a so-called MUAC-test. The first results indicate high numbers of cases of severe malnutrition.

After having vaccinated over 40,000 children in the Bousso district, 300kms south of N'Djamena, MSF medical teams have now joined their colleagues in the capital of Chad. More aid workers continue to arrive to take some pressure of the teams on the field.

With over 4,400 measles cases reported in the city early April, the emergency now calls for both preventive and curative medical action. N'Djamena, a city with an estimated population of one million, is facing the risk of a very long and very lethal epidemic. MSF has deployed a team of 30 specialists to help fight the threat.

A massive vaccination campaign started on May 11 and aims to immunise an estimated 280,000 children. MSF has opened 29 mobile vaccination sites, in collaboration with the Ministry of Health.

The transport and storage of the 300,000 vaccine doses needed for the campaign make for a huge challenge. Vaccines are sensitive products which lose their potency when exposed to heat, a real problem in N'Djamena where temperatures easily reach 40 degrees. The success of the immunization campaign depends to a large extend upon the quality of the "cold chain", the combination of measures used to keep the vaccines between +2° and +8°C at all times.

"You don't freeze a thousand ice packs in a few minutes," explains Valentin Omari Sefu, logistical coordinator for this intervention. "It usually takes a week to organise such a massive campaign, but we managed to do it in three days by bringing back frozen packs and two freezers from Bousso. It's a terrible ten hours journey and we got almost stuck twice."

Maintaining the cold chain is only one of the difficulties in an urgent and massive campaign like this one. Installed in temporary shelters, the medical staff must follow strict guidelines to reach the target of 1,000 immunisation per team per day. Timing is crucial to cut the spread of the epidemic.

Measles are an aggravating factor for malnutrition. For that reason MSF has decided to, in parallel with the vaccination campaign, do a nutritional screening with a so-called MUAC-test. The first results indicate high numbers of cases of severe malnutrition. MSF has already sent two nutritional kits with the equipment necessary to weigh, measure, register and feed one hundred severely malnourished children each, and opened three therapeutic feeding centres under the supervision of a nutritional medical nurse. Severely malnourished children must be intubated and need very close medical and nutritional monitoring.

As the number of infections keeps growing, MSF is also providing medical support and drugs to 17 health centres for the less severe cases. The most severely infected patients are referred to the Union and Sultan Kasser Hospital, where MSF specialists assist the resident staff in treating the concomitant infections, such as pneumonia.

While MSF is trying to take control of the epidemic in the capital, new measles cases have been reported from two southern districts, Salamat and Moyen Chari, more then 600 km away from N'Djamena. Assessment teams are on their way to evaluate the situation.