KABALA, 7 July 2018 --- On 3 July 2018, the Ministry of Health and Sanitation in Sierra Leone commenced implementation of a 6-day reactive measles vaccination campaign in Koinadugu districts, aiming to protect all children aged between 6 months and 15 years against the disease. The targeted campaign has sought to reach an estimated 187,707 eligible children with the lifesaving vaccine during this period.

In June this year clusters of measles cases were reported among children in two remote rural communities in Koinadugu in the north of the country close to the border with the Republic of Guinea. Laboratory results revealed that 19 out of 23 samples analyzed were positive for the disease after which the Ministry of Health officially declared a measles outbreak in the area and on 14 June.

Measles is an epidemic-prone disease. According to the World Health Organization, three or more laboratory confirmed positive measles cases in a health facility or district within a month constitutes an outbreak. The disease is highly infectious, and can cause life-threatening complications and disability, including blindness especially in young children.

Measles is entirely preventable through vaccination. However, the disease remains the leading cause of childhood morbidity and mortality in the world. The disease is transmitted through contact with the nose and throat secretions of infected people released into the air when an infected person sneezes or coughs, and spreads easily in areas with low immunization coverage.

Records reviewed in the affected communities in Koinadugu showed that the children affected by the June outbreak were unvaccinated against the disease. These communities are located in some of the most remote areas of Sierra Leone, spread across difficult and hard to access mountainous terrain. Access to some parts of these communities can only be made on foot or on motorbikes over long distances, often covering stretches of more than 30 miles. For some villages, the nearest health facility may be located more than 20 miles away. 

Numa Kamara, is a widow and mother of three children in Yendeya Village, one of the affected communities. All three of Numa’s children suffered measles infections. She says the whole community was worried when the outbreak started in their village. “It reminded us of Ebola because the children were falling sick at the same time. The whole village was very concerned.” As a subsistence farmer, like many of the other affected families, Numa’s livelihood activities were interrupted during this period. “When they (children) were sick we could not go to the farm or engage in any other meaningful economic activities. We spent all the time looking after them.”

Though the affected children were treated, news of the vaccination campaign was welcome across the community. “When we heard that all of our children and those in other communities will be given medicine (vaccine) to protect them we felt very happy, because no one wants to see their children dangerously unwell,” Numa added.  Community engagement with health messages delivered by health workers and volunteers prior and during this campaign is helping to amplify the critical importance of vaccination in the community. “Now that our children are being protected against this disease, we will make sure that they get protection for the other diseases as well”. 

Measles vaccine is included in Sierra Leone’s routine vaccination services, available in public health facilities across the country. Two doses are administered to children at age 9 months and 15 months respectively when they are brought to the health facility by their caregivers. The routine services are supplemented by campaigns and outreach services to help ensure that missed children are reached. Despite these interventions, immunization performance in Koinadugu districts is relatively low, with particular challenges including the remoteness of the terrain, and highly mobile populations with frequent travel across the Guinea border. 

Dr. Francis Moses is the District Medical Officer in Koinadugu. He said the planning and resources put into this campaign would help to ensure that even the most remote settlements are covered and every child reached. “We hope to see an increase in measles vaccine coverage during this campaign. And we also hope this campaign will trigger increase in uptake of routine vaccination services even in the remote areas of this district,” he added. Dr Francis said his team will increase supervision and surveillance particularly in the most hard-to-reach areas so as to improve service uptake and to help prevent the occurrence of future outbreaks of vaccine preventable diseases.

With the technical and financial support of WHO, UNICEF and other partners, the Ministry has pooled staff from the national level and other parts of the country to support the Koinadugu district teams with the campaign. This includes support for vaccination planning, cold chain management and logistics, as well as community engagement and public awareness activities to promote the importance of vaccinations for every child.