Liberia: No vaccinations for months has put children at risk

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Ebola has badly impacted public health services in Liberia. Many medical structures, unable to handle infected patients, have closed at some point during the outbreak after dozens of health personal died fighting it. Today most facilities are still providing reduced services compared to before the outbreak. As the result, the population struggle accessing medical care for non-Ebola related diseases. MSF operations in Liberia are therefore shifting towards supporting the public health system. MSF has opened a paediatric hospital in Monrovia on March 23 and assists JDJ Memorial Hospital as well as 23 clinics in safely resuming activities. © Adolphus Mawolo/MSF

Routine vaccination activities in Ebola-affected West African countries have been significantly reduced since the outbreak began. In Montserrado County, Liberia, MSF recently conducted a measles vaccination campaign with adapted safety protocols. Philippe Le Vaillant, MSF representative in Liberia, talks about the need to increase vaccination coverage while rebuilding confidence in medical services.

Q. How did the Ebola epidemic affect children’s routine vaccination in Liberia?

Philippe Le Vaillant: Like every other medical service in the country, the Ebola outbreak has significantly reduced vaccination activities too. The Liberian authorities reported that the number of children vaccinated monthly had dropped by 60% at the end of 2014. Measles vaccination coverage also fell, to 58%, while the minimum acceptable level should be at least 80% to protect against the virus. As of January, an estimated 92,000 children below one-year old in Liberia had not been vaccinated at all and are therefore today vulnerable to various preventable childhood diseases.

Q. Have immunization activities resumed since the number of new Ebola cases has dropped so low in Liberia?

PLV: In Monrovia, the majority of health facilities have reopened and most of them are able to provide routine immunization. But health workers first need reassurance before performing injections, as contact with blood is one of the main risks of contamination. People are also still afraid to seek care in medical facilities. One of our priorities is to overcome the loss of confidence in the health system, of both healthcare workers and patients, through training and community awareness.

Q. A recent publication suggests that a massive regional measles outbreak might occur due to lower coverage rates. How likely is this to happen?

PLV: A measles outbreak had actually been declared in January 2014 in Conakry, Guinea, just before the Ebola epidemic began. At the start of March this year, MSF teams recorded approximately 180 measles cases in the Liberian capital city. Beyond figures and forecasts, it is essential to reinforce surveillance and investigation of suspected cases, while restoring higher vaccination coverage is urgently needed.

Q. How is MSF supporting measles cases and vaccination in Liberia?

PLV: In Montserrado County, MSF has supported health centers with donations and training, such as how to isolate and care for infected children. We are also working with the Liberian health authorities and their partners to reinforce surveillance and mapping.

On March 18 and 19, our teams performed a two-day measles vaccination campaign in Peace Island. This Monrovian neighborhood had reported the highest number of measles cases. Five hundred children aged six months to 5 years have since been vaccinated. Reinforced infection prevention protocols were implemented during this campaign, including systematic fever screening and a medical questionnaire, disinfecting gloves between every injection, shorter waiting lines, amongst others. Our objective was also to show that it is possible to safely vaccinate in an Ebola context.

We expect that the lessons learnt from this limited pilot campaign will now help organizing the mass vaccination the Liberian authorities have planned for this May. Ideally we would also immunize the children against other pathologies (polio, tetanus, diphtheria, pertussis…) and distribute vitamin A as well as preventive treatment against malaria, especially with the rainy season about to start. So far in this outbreak, the risk of contamination with Ebola excluded the possibility to vaccinate. Hopefully that is changing.

MSF opened the Ebola management centre ELWA 3 in Monrovia in August 2014 while the Liberian Ministry of Health will take over the facility as of end March. A transit unit for suspected Ebola patients at Redemption Hospital has been running since November. MSF’s Ebola management center in Foya was closed last December after Lofa County was officially declared Ebola-free. Since the beginning of the epidemic, 670 patients have survived Ebola within MSF’s facilities in Liberia.

MSF rapid response teams have also been recently deployed in Grand Bassa, Grand Cape Mount and Margibi counties to help health authorities responding to local outbreaks.

Last October, MSF teams distributed antimalarial preventive treatment in the western part of Liberia’s capital city, targeting approximately 600,000 people.

On 21 March MSF 2015 opened a new paediatric hospital in order to increase the capacity to treat non-Ebola-related medical emergencies in Monrovia. This 24/7 hospital started with 46 beds for children under five years-old, with the capacity to extend up to 100 beds.