Chad Situation Report, 22 May 2020

HIGHLIGHTS

• Measles cases on the rise in Chad
• MSF undertakes mass vaccination campaigns
• Impact of COVID-19 on measles vaccination

EMERGENCY RESPONSE

Measles cases on the rise as vaccination activities drop amid COVID-19 fears

As attention and resources are shifting more and more towards COVID-19 prevention and response activities in Chad, the country is still grappling with a persistent measles epidemic that shows no signs of slowing down. 118 out of 126 health districts in Chad have been affected since the epidemic outbreak in May 2018, with southern provinces facing a rapid increase in cases. As of 30 April 2020, 28 health districts were in a declared measles epidemic. The Ministry of Public Health reported 7,635 suspected cases, with the highest number of registered cases in Beboto, Kyabe and Goundi health districts.

MSF undertakes mass vaccination campaigns

In February, and before the first COVID-19 case in Chad was confirmed on 19 March, a Médecins Sans Frontières (MSF) emergency response team travelled to measles-affected regions, including Bebote, which is the most heavily impacted. As a result, 25,177 children aged between six months and nine years were vaccinated against measles. 10,432 children were also screened and 1,191 treated for severe acute malnutrition in response to the high rates of malnutrition in the region that have weakened immune systems thereby contributing to the spread of the virus.

The MSF team in Beboto worked closely with community leaders to inform them on measles prevention and patients’ free access to medical treatment in MSF-supported health facilities. Awareness-raising activities were crucial as some patients were reported to be staying home or resorting to traditional medicine instead of accessing local health facilities. MSF donated medical kits, measles vaccines, and water and sanitation supplies to the health district to enable case management by local teams under the supervision of the health district authorities.

From 3 February to 12 April, MSF also carried out a vaccination campaign in the Kyabé region of southern Chad, targeting children between six months and five years old. Because of the many cases of malaria and malnutrition, MSF also provided general paediatric care and treated children with measles in addition to vaccination activities. More than 60,000 children were vaccinated in Kyabé last month, April, by MSF teams.

Since the beginning of the outbreak in 2018, MSF has been striving to attain a 95% children vaccination coverage, in order to achieve ‘herd immunity’. However, Chad is far from reaching this goal. UNICEF estimates measles immunization coverage in Chad to be only 37%. No complete national vaccination campaign has been undertaken since 2015.

Impact of COVID-19 on measles vaccination

A measles vaccination campaign by the Ministry of Public Health and supported by UNICEF and GAVI is planned for this year but fears of the expanding COVID-19 outbreak may threaten this activity. It is important to ensure that, while the government, donors and partners are responding to the COVID-19 emergency, the measles epidemic is not forgotten. Any delay in the measles vaccination response due to COVID-19 may have a worse mortality/morbidity impact than COVID-19 itself.

To enable the campaign to go ahead, vaccinating children at home, following a "door-to-door" strategy, is one option to reduce gatherings and ensure vaccination campaigns do not contribute to the spread of COVID-19. Gatherings of less than 50 people are still possible, provided queues respect physical spacing measures and that everyone - patients, family members, and of course health workers - can receive personal protective equipment (PPE). The shortage of PPE in Chad is unfortunately adding another layer of difficulty to the measles response, combined with the difficulty of bringing international staff and other medical supplies into the country. Despite all challenges, MSF will continue to assist communities fighting the potentially life-threatening disease in Chad.

In addition to the extensive work on the measles response, on 10 May, MSF signed a provisional agreement with the Ministry of Public Health to enable its team to provide COVID-19 epidemiologic monitoring, health and hygiene promotion, and treatment of cases in public health centers in N’Djamena and other areas. It is expected that the support from MSF to the Chadian Government will help relieve some of the burden from the public health system and allow health care personnel and facilities to more efficiently curb the spread of COVID-19, which in turn will allow for the prevention and treatment of other health emergencies, including measles.

Read the full article “Nearly two years on measles epidemic in Chad is not under control” on the MSF website