The crowding and placement of refugee and IDP camps are conducive to disease outbreaks.
Measles is a very contagious acute viral disease primarily affecting children. It is spread by direct person-to-person contact.
In densely-populated settings, the disease spreads quickly, especially if immunisation coverage is low.
In camps, a single case is considered an epidemic.
Seventy-five percent of measles cases experience at least one complication.
Measles is one of the deadliest diseases in refugee camps when there is no mass measles vaccination campaign during the initial phase of the crisis. Without appropriate treatment, the case fatality rate can reach 20%. So prevention is essential during the initial phase of a displaced population influx.
A) Target population
Vaccination is targeted at children aged 6 months to 15 years. An early dose is administered at the age of 6 months, and is followed up with another dose at the age of 9 months.
Ideally, the immunisation coverage should be over 95%.
B) Campaign strategy
Vaccination campaigns are one-off interventions that aim to vaccinate a large number of people in a short period of time. They require a lot of human and other resources, an approach tailored to the context, and good coordination.
The planning stage is key. Good preparation reduces the chances of unforeseen problems and makes operations more efficient.
The teams draw up a map of the sites and gather demographic data in order to estimate the number of people to be vaccinated.
Children aged 6 months to 15 years make up 45% of the total population.
Once the needs have been assessed, the orders are sent and then staff recruitment and planning for the number of vaccination teams and sites begins.
To ensure the safety of injections, all vaccines are administered using auto-disable syringes – non-reusable, single-use injection equipment – and safety containers for collecting and burning used injection materials.
Tools for collecting vaccination data are prepared in advance: the vaccination card, the tally sheet and the summary sheet. The data are used to monitor, from day to day, whether objectives have been met.
C) Vaccination logistics
Médecins Sans Frontières has developed standardised equipment sets, pre-packaged as kits and modules, which simplify needs assessment and supply management.
Cold chain organisation is an important aspect, and ensures the quality of the vaccines, which have to be stored at the recommended temperatures.
Mass vaccination campaigns generate a lot of waste. The waste circuit must be well-organised and secure at every level. Waste collection and disposal must be supervised.
Training for medical and logistics staff is essential, and should be done before the campaign starts.
A few days before the vaccination campaign, the public information campaign begins. It continues throughout the campaign in each sector of the camp. Messages should contain only the essential points.
Messages may need to be adjusted to address rumours or raise the awareness of a group that is opposed to vaccination.
Vaccination begins once everything is available and ready.
A follow-up strategy should be planned before the campaign, in order to maintain high immunisation coverage and reduce the risk of epidemics.
That strategy should offer multiple opportunities to vaccinate, at every contact: when new people arrive at the camp’s reception centre, in care activities like health centres and mobile teams, and in inpatient departments like maternity, paediatrics and feeding centres.
Immunisation is an effective means of prevention. Measles remains the top priority in emergencies.
Other vaccines – like meningitis, yellow fever and cholera vaccines in endemic countries – may also be considered.
The availability of new vaccines like Haemophilus and pneumococcus offer the possibility of reducing mortality and morbidity right from the initial phase of an emergency. The risks and benefits must be weighed against the extra resources and workload involved, and priorities established.