The West Africa Ebola Virus Disease (EVD) epidemic has affected the hardest hit countries, Guinea, Liberia and Sierra Leone,  in many adverse ways. This includes focusing most or all health care resources on EVD while the plethora of health and disease issues have been neglected.

Public domain image/Mondo Magic
Public domain image/Mondo Magic

UNICEF is helping governments and communities restart stalled immunizations amid a surge in measles cases in Ebola-affected countries, where health systems are overwhelmed and tens of thousands of children are left vulnerable to deadly diseases.

“Measles is a major killer of children that can easily be stopped through a safe and effective vaccine,” said Manuel Fontaine, UNICEF Regional Director for West and Central Africa. “But immunization rates have dropped significantly, further threatening children’s lives.”

In Guinea, where a measles outbreak was declared in early 2014 – prior to Ebola – the number of confirmed measles cases increased almost fourfold, from 59 between January and December 2013 to 215 for the same period in 2014, according to WHO. In Sierra Leone, the figure tripled from 13 to 39 over the same period.

In Liberia, which had reported no measles in 2013, four cases have been confirmed in Lofa County, one of the areas hardest hit by Ebola.

The increase in cases of measles – a highly contagious disease – is of particular concern as a drop in immunization coverage rates has left children vulnerable at a time when measles transmission traditionally peaks in West Africa, between December and March.

Health systems are overstretched by efforts to manage the Ebola crisis, and people are avoiding health facilities for fear of contracting Ebola. As a result, preliminary figures clearly show that vaccine coverage rates have fallen sharply this year.

In Liberia, for example, government data shows that monthly measles immunization coverage against target dropped from 71 per cent in May 2014, to 55 per cent in October, with only about 50 per cent of health facilities reporting.

While vaccination campaigns that involve large crowds have been put on hold, UNICEF and partners are intensifying carefully guided routine immunizations to rapidly reduce the number of unimmunized children.

In Guinea, UNICEF is supporting activities to step up routine vaccinations, whose initial phase, in late November and early December 2014, covered communities that had not had any Ebola cases for 42 days.

In response to the cases in Liberia, UNICEF, the Ministry of Health and other partners, including WHO, are conducting periodic intensification of routine immunization (PIRI) to vaccinate children under the age of 5 and provide them with vitamin A supplementation. This was completed in eight counties, is under way in four, and is set to begin in the other three.

As vaccinators venture out to provide lifesaving vaccines, which in many cases are long overdue, they also help with the control of the Ebola outbreak. In compliance with infection prevention and control (IPC) procedures and WHO guidelines on immunization in the context of an Ebola outbreak, UNICEF is providing not only vaccines, but also kits that include gloves and infrared thermometers for vaccinators. Vaccinators are being trained on infection prevention and control measures, supervision during immunization activities, and on how to conduct outreach sessions in areas which have not reported an Ebola case for 42 days.

Breaking the cycle of Ebola transmission and improving health services, including vaccinations, must go hand in hand in order to defeat the virus and to prevent large-scale child deaths.

UNICEF is playing a major role in the response, promoting behaviour that can help stop transmission, setting up Community Care Centres – where patients can be supported by their families and communities, with a referral system for any complicated cases – and providing essential supplies. It is also helping train community health workers, providing psychosocial support to Ebola-affected children and ensuring access to the clean water and waste management systems that are essential to preventing new infections.

“The best way we can help children is by stopping Ebola, while at the same time strengthening health systems,” said Fontaine.  “We need to restore faith in the health system and offer communities regular opportunities for their children to get the vaccines they need to stay healthy.”

“Vaccinators and other health workers who are in the frontline need to feel protected so they can deliver life-saving interventions in the context of Ebola,” Fontaine added.