Recurrent Measles Outbreaks in

Nigeria: Status on Humanitarian

Health Response

Dr Sebastiao Nkunku

Technical Officer EMC

IST WA

WEST AND CENTRAL AFRICA INTER-SECTORAL AND INTER-AGENCY REGIONAL

TECHNICAL MEETING ON THE HUMANITARIAN RESPONSE IN NORTHERN NIGERIA

STATES

DAKAR, MARCH 05, 2014

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Outline of Presentation

Current epidemiological situation of Meales

Outbreak in Nigeria

Background of Meales Outbreak in Nigeria

Current Humanitarian Health Response

Challenges

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Current epidemiological situation of measles

outbreak in Nigeria

Status on 28th February 2014

3046 cases and 22 deaths reported

Affected states:

Adamawa, Bauchi, Kano, Katsina, Gombe, Yobe, Kebbi,

Kaduna, Gombe, Borno,

Status on 29th December 2013:

57892 cases and 347 deaths reported

569 Laboratory confirmed cases reported since W1, 2013

Affected states:

Sokoto, Kebbi, Kaduna, Zanfara, Adamawa, Katsina , Bauchi

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Quarterly Distribution by country of all Measles Cases by

Final Classification From Q1 2012 To Q3 2013

Q4_2012 Q1_2013

Q2_2013 Q3_2013

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Background

• Nigeria has a very large population at risk of measles in

the African Region due:

– Large population

– Potential areas for outbreaks due to high population

density.

• Large land mass with quite a number of settlements in

hard to reach places which make the vaccination

services very inaccessible.

• Nigeria strengthened the Routine immunization

programme through adoption of the Reaching every

ward Approach in 2005.

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Background Measles vaccination coverage

National Immunization Coverage Survey was conducted in the country in 2003, 2006, and 2010(calcul based using crude coverage (Card + History).

2003:

Coverage ranged from 36.30% in North West zone to 68.40% in South East zone.

The South West Zone, South South Zone, North Central Zone, and North East Zone recorded the following: 52.80%, 48.80%, 45.70% and 38.80% respectively, while the national level recorded a coverage of 43.10%.

2006:

All zones recorded remarkable improvement in coverage, with coverage ranging from 48.4% in NWZ to 78.10% in SWZ.

2010 :

Coverage reported ranged from 47.15% in NEZ to 82.35% in SEZ.

2010:Cumulatively, four zones (SSZ, SEZ, NWZ, and NCZ) showed gradual improvement in performance from 2003-2010.

o However, while two zones (SWZ and NEZ) recorded various degrees of decline in performance in 2010

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MCV Coverage 2003-2010-Missed children 2011 IMC

<5% (n=402)

5-10% (n=164)

>10% (n=135)

Data Source: IM Data

Figure 2: % Missed Children Jan/Feb 2011 IMC

No Data/Did not implement

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Performance from previous campaigns

Follow up campaign in 2005/2006 and catch up campaigns in 2008 and 2011: Outcome for 2011 was below expectation mostly in the northern States where many LGAs recorded >25% missed children.

Despite the successes in measles control progress towards a reduction in 2005/2006, the number of measles cases increased from 390 in 2006 to 2,553 in 2012 : Largely due to inability to sustain the gains of 2005/2006 elimination effort

Inability to achieve homogeneous high coverage quality measles campaigns in 2008 and 2010

Weak routine immunization, and poor demand creation for immunization up take.

By week 10 0f 2013,

9000 confirmed cases of measles and majority of the cases (76%) were between the ages of 9-59 months

More cases were seen in the northern States with a cumulative total of 49078 cases confirmed by laboratory, epilink and clinically.

The reason for the outbreak is attributed to low immunity within the target age group. 86% of the cases were zero doses.

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Suspected Measles cases in 2013

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Response to Measles Outbreak

Reactive Campaign to vaccinate at least 95% of the children between 9-59

months with measles vaccine.

Campaign was in two phases:

1st phase was for the 19 northern States plus FCT from 5-9 October with a target

of 15 978 622 children

2nd phase for 17 southern States from 2-6 November targeting 13 698 003

children.

Coordination bodies reactivated at national State and LGA levels :Training,

logistics, monitoring & evaluation and social mobilization

Membership:National Primary Health Care Development Agency had the

chairmanship, Federal Ministry of Health, National Agency for Food and drugs

Control (NAFDAC), UNICEF and WHO

Target: 29 834 821 children (9-59 months)

32 942 100 vaccines were received for the campaign

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Results of mass campaign 2013

17 004 058 children were vaccinated in the

North and 13 575 608 children were vaccinated

in the Southern ,making a total of 30 579 666

children vaccinated for measles.

Independent monitoring :Overall coverage of

92% with 9 States recording more than 10%

missed children for measles

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Measles admnistrative Coverage in Northern and

Southern Nigeria

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Measles admnistrative Coverage in Northern( Oct 2013)

and Southern Nigeria(Nov 2013)

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Missed Children by state, Oct 2013

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Proportion of missed children by LGA of

Northen Nigeria- Oct—Nov 2013

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Contribution to Routine immunization, the calculation was zero

doses 9-11 months divided by the RI target which is 4%% of total

population based on 2006 census.

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IMC Contribution to Routine Immunization:

An overall zero dose of 24% was recorded in the

north with 9% in the in 9 months -11 months

age group

Only 5% in the South with just 2% in the 9-11

months age group of the vaccinated children.

The proportion varied from State to State with

Kano State recording the highest zero doses in

under ones (18%) and 36% in 12-59 months

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Conclusion

There is a need to strengthen routine immunization

efforts to sustain the gains of the campaign:

Given its large population

The high population density making it potential

areas for outbreaks

As a prone epidemic country with complex

emergency situation in the northern part,

The is a need to reinforce the surveillance

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