Humanitarian Health Action

Zimbabwe Measles Immunization and Child Health Days campaign 2010

Summary of events: 24 May to 2 June 2010

Background

Zimbabwe's nationwide measles vaccination campaign officially ended 2 June and successfully immunized more than 5 million children in response to an outbreak that, since September 2009, had seen almost 8000 suspected cases reported and more than 500 deaths.

Measles, also called rubeola, is a highly contagious respiratory infection caused by a virus that results in an estimated 20 million cases worldwide every year. Infected people transmit the virus by coughing and sneezing. An estimated 9-in-10 susceptible [Susceptible here means lacking immunity against measles .] people who come into contact with someone infected with measles will themselves contract the virus.

Zimbabwe experienced declining immunization coverage from 1996 to 2004 when coverage stabilized due to the introduction of Supplemental Immunization Activities (SIAs) that included Child Health Days, the Child Health Week strategy, Reach Every District (RED) approach among others.

Declining coverage, combined with measles outbreaks reported in the Southern African region [South Africa started March 2009; Namibia late 2009; Lesotho November 2009], provided fertile ground for an outbreak of measles in Zimbabwe.

Source: WHO Zimbabwe
Map of Zimbabwe showing districts affected by measles

Measles outbreaks started occurring in Zimbabwe in September 2009, with 8173 suspected cases and 517 deaths reported up until 23 May 2010. Some 512 of the reported deaths occurred at community level, while 517 of the 1414 blood specimens received by the polio-measles laboratory were confirmed as positive for measles - 9.9% of these had been vaccinated. A total of 61 of Zimbabwe's 62 districts had reported at least one laboratory confirmed measles case, while 52 districts confirmed measles outbreaks.

Health Cluster partners conducted a rapid assessment of the outbreaks and recommended to scale up the country's measles response. The Health Cluster is coordinated by the Ministry of Health and Child Welfare (MOHCW) and the World Health Organization.

Measles Indicators

  • Suspected Cases 8173
  • Confirmed cases 517
  • Community deaths 505
  • Institutional deaths 12
  • Districts with laboratory confirmed outbreaks 52

A national measles taskforce was formed following that assessment, which came up with a strategy to respond to the outbreak by focusing on a mass immunization campaign, social mobilization activities, continued management of people with measles still being reported and surveillance.

Milestones
  • 23-26 February: Rapid assessment by Health Cluster partners in all districts.
  • 29 March: Press conference as measles outbreak reaches critical level.
  • 22-25 April: Measles rapid assessment (Knowledge Actions and Practices) with Apostolic faith members in six selected locations in Matabeleland North (Bubi district), Midlands (Kwekwe district); Bulawayo, Chitungwiza, Harare and Mutare Cities.
  • 7 May: Meeting with leaders of the Johann Marange Apostolic sect in Mutare by Parliamentary Portfolio committee on health.
  • 20 May: Summit with Apostolic faith leaders.
  • 24 May: Breakfast meeting with partners and government stakeholders in the immunisation programme.
  • 24 May: Launch of the National Immunization Days/Measles Vaccination Campaign in Harare.
  • 24 May-2 June: Campaign conducted.
  • 2-4 June: Mop-up campaigns in Bulawayo city, Beitbridge, Gokwe South and Seke districts.
The campaign

The measles vaccination campaign was launched on 24 May 2010 and officially ended on 2 June 2010. Some provinces, namely Matabeleland South, Midlands and Mashonaland East, requested extensions to reach newly registered schools and hard-to-reach communities in Bulawayo city, Beitbridge, Gokwe South and Seke districts respectively.

Coverage by Province
  • Manicaland 101%
  • MashCentral 91%
  • MashEast 98%
  • MashWest 97%
  • MatNorth 90%
  • MatSouth 93%
  • Midlands 96%
  • Masvingo 101%
  • Bulawayo 83%
  • Chitungwiza 97%
  • Harare 97%
  • National 96%

Updated figures [Figures expected to change until 100% completeness of data is attained (8 June 2010)] indicate that by day 10; 5,106,648 children had been vaccinated against measles [Populations on the ground were higher in some areas than those projected by the Central Statistics Office; each district was given a 5% buffer stock of vaccines that sufficed]; 1,667,547 of those were in the six months to five-year-old category, which is most vulnerable to measles, and 3,439,101 between five and 15 years. Some 1,616,133 children also received Vitamin A supplements. See the graph abowe for district coverages.

During the final National Immunization Days (NIDS) coordination meeting on 11 June, the final figures and field reports shall be shared and recommendations made based on the campaign. The post-survey campaign will be held from 16 June-2 July at provincial level to focus on districts with low coverage. The national and provincial training for the survey will take place 9-14 June.

Key lessons learnt during the campaign
  • This ambitious vaccination campaign succeeded due to the strong coordination among Health Cluster partners, corporate companies and other stakeholders, including the Ministry of Education, Sports and Culture.
  • Dialogue with religious and cultural objectors was successful in persuading them to send their children for vaccination in most parts of the country. MOHCW and partners must continue to engage with these groups to ensure continued health services for members of their communities, especially mothers and children aged under five.
  • District outreach programmes must be revitalised and supported to prevent accumulation of unvaccinated children, which would make the country vulnerable to outbreaks of measles and other vaccine preventable diseases. Special consideration is needed for districts with difficult terrain and those lacking public transport systems.
  • Interpersonal contact, although time consuming, is the best means of social mobilization. While few in number, the Village Health Workers (VHW) played a crucial role in registering children aged under five years and ensuring they were vaccinated. Before the campaign, they also supported health workers to conduct house-to-house searches for ill children to reduce community deaths. The VHW programme is the bridge between the community and the formal health system and it must be scaled up to support health promotion and other community health programmes.
  • Waste management systems at provincial and national levels need upgrade. Special arrangements had to be made to incinerate medical waste from the campaign, there is a need to ensure that all provinces have at least one fully functional incinerator to encourage proper disposal of medical waste.
  • Daily coordination meetings (national, provincial and district level) were useful in identifying problems and rectifying them. This allowed for adjustment of the strategy to suit conditions in the field.
  • The pre-campaign assessment was critical in identifying gaps at district level before the campaign. These gaps mainly related to cold chain facilities and transport and were immediately resolved.
For more information, please contact:

Wendy Julias
World Health Organization
+263 (4) 253 724
+263 (91) 243 1408
Email: JuliasW@zw.afro.who.int

Share