Background
1.Initial assessment | Quantitative and qualitative information on background to the displacement, population, risk factors related to the main diseases and requirements in terms of resources through observation, interviews, sample surveys, mapping. |
Usually approximate, results may need to be corroborated later. | |
2.Measles immunization | Displacement, overcrowding and poor hygiene are factors that encourage emergence of large scale epidemics. |
Mass vaccination of children from 6 months to 15 years should be a priority during the first week. | |
3.Water and sanitation | Prevention of diarrhoeal diseases and survival |
Ensure immediate provision with temporary water supply until more permanent solutions (wells) can be found | |
Indicators in regard to water supply and latrines must be monitored. | |
4.Food and nutrition | Malnutrition is often associated with displacement |
Provision of food ration to cover daily minimum needs | |
Feeding programs for specific groups are supplementary feeding for moderately malnourished and therapeutic or intensive feeding for the severely malnourished. | |
5.Shelter and site planning | Provide protection from environment |
Prevent transmission of diseases with epidemic potential link to overcrowding and inadequate shelter | |
Ensure sufficient infrastructure for providing services (e.g. health facilities) | |
6.Health care in emergency phase | Create a decentralized network of health facilities |
Provide manuals and guidelines for standardization | |
Ensure medical material and drugs in sufficient quantity and quality – (i.e. Kits of essential drugs and material) | |
7.Control of communicable diseases and epidemics | Four greatest killers: measles, diarrhoea, acute respiratory infections and malaria |
Higher risk of communicable diseases: measles, cholera, shigellosis, meningitis etc. | |
Preventative measures are to be privileged when possible (e.g. vaccination campaigns) | |
8.Public health surveillance | Monitoring the health status of the population |
Daily collection of selected health data – only cover diseases or other health problems that can be controlled by preventive or curative interventions. | |
Most useful health indicator is the daily crude mortality rate | |
Objectives: warn of an impending epidemic, monitor the main diseases occurring In the population and measure the impact of health programs | |
9.Human resources and training | Determine staff requirements after identification of activities |
Human resources management including recruitment and training | |
Important to ensure the link with the community: Home visitors | |
10.Coordination | Must be organized at the onset of the crisis |
A good system involves: overall clear leadership with good communication lines and that overall policy is standardized |
Case presentation
Setting and context
Description of the intervention
Prioritizing vaccines and use of WHO framework
Considerations | Specific considerations | Assessment conclusion | |||||
---|---|---|---|---|---|---|---|
Epidemiological/ risk assessment | General risk factors: | Disease-specific risk factors: | |||||
Limited access to curative health services. Young population and high birth rate. Overcrowding. Insufficient water, sanitation and hygiene | Low population immunity: High risk for meningitis and cholera (no previous vaccination, no large outbreak in the past 3 years), pneumococcal disease, HiB and rotavirus (not yet introduced in EPI) | Overall specific risk High/moderate High | |||||
VPD high specific risk associated for: | |||||||
Measles, meningitis, cholera, polio, HiB, Pneumococcal disease and rotavirus | |||||||
High burden of disease: main child deadly diseases are respiratory tract infections and diarrhea. Seasonality Cold dry season | |||||||
Vaccine characteristics | Antigen | Type | Recommended dosage | VE 1 dose | Target pop | cm3/dose | |
Measles | Live attenuated | 1 dose | ~ 85% | > 6 m to 15y | 0.75–5.22 | Suitable for vaccination campaign two rounds (plus EPI) | |
Cholera (oral Sanchol°) | Inactivated | 2 doses | N/A | >_ 1y | 16.8–24.4 | Suitable for vaccination campaign two rounds | |
Polio | Live attenuated | 3 doses | ~ 50% | 6w to 5y | 0.24–3.2 | Suitable for vaccination campaign one round (plus EPI) | |
PCV | Inactivated | 2 doses | up to 70% | 6w to 5y | 4.8–15.7 | Suitable for vaccination campaign two rounds (plus EPI) | |
Pentavalent (DPT, HiB, Hep B) | Inactivated | 3 doses | N/A | 6w to 7y | 2.6–5.1 | Suitable for vaccination campaign three rounds (plus EPI) | |
MenAfriVac® A | Inactivated | 1 dose | ~ 75–95% | 1 to 29y | 2.6 | Suitable for vaccination campaign one round | |
Hep E | 3 doses | N/A | >16y | 132.6 | Suitable for vaccination campaign three rounds | ||
Rotavirus (Rotarix® liquid) | 2 doses | N/A | 6w to 2y | 17,1 | Suitable for vaccination campaign two rounds (plus EPI) | ||
Contextual constraints and facilitators | Ethical | Political | Security | Economic/logistic constraints | |||
No community opposition. Informed consent process possible at community and individual level. Target population displaced and host community for all vaccinations | Current EPI policy limiting immunization activities (no pentavalent, rotavirus, PCV). Measles, polio cholera and meningitis campaigns validated. Antecedent of cghPCV vaccination approved | The area of Minkaman is currently stable. No previous threats to immunization activities. No specific risk to health workers or those immunized | Funding available. Sufficient vaccine supply. Vaccination teams already identified and trained in both injectable and oral vaccines. Cold chain and infrastructure already available and in place | No major barriers for immunization activities. | |||
Further negotiation required to use antigens not yet included in the EPI. | |||||||
Conclusion | In addition to mass vaccination campaigns targeting diseases with epidemic potential (measles, polio, meningitis and cholera), we propose a series of campaigns with new and underutilized vaccines (pentavalent, pneumococcal and rotavirus) targeting the most common childhood vaccine preventable diseases AND follow up with routine vaccination activities. We believe such vaccination campaign achieving high coverage in a displaced population can have a very important impact on childhood morbidity and mortality. The 3 rounds of campaigns necessary are feasible in this setting with logistic and human resources available. |