MEASLES AND POLIO INCIDENCE AND RESPONSE IN

UNCLAS NAIROBI 001939

SIPDIS

AIDAC AFDROUGHT

SIPDIS

STATE FOR AF/E, NGAREY, MGONZALES
USAID/W FOR AA/DCHA, WGARVELINK, LROGERS
DCHA/OFDA FOR GGOTTLIEB, PMORRIS, CGOTTSCHALK,
KCHANNELL
DCHA/FFP FOR JDWORKEN, PMOHAN
AFR/EA FOR JBORNS
USUN FOR EMALY
ADDIS ABABA FOR JAUGSBERGER
BRUSSELS FOR PLERNER
ROME FOR FODAG
GENEVA FOR NKYLOH
NSC FOR JMELINE, TSHORTLEY

E.O. 12958: N/A
TAGS: EAID SO KE ET
SUBJECT: MEASLES AND POLIO INCIDENCE AND RESPONSE IN
SOMALIA, ETHIOPIA, AND KENYA


Summary


1. Since 2005, isolated measles and polio cases
surfaced in drought-affected Somalia, Ethiopia, and
Kenya. Increased migration by pastoralists during the
drought has raised concerns of a widespread, regional
outbreak. In response, the U.N. Children?s Fund
(UNICEF) and World Health Organization (WHO) quickly
organized massive immunization campaigns in
collaboration with national health agencies.

Populations at Risk


2. Vaccine preventable diseases such as measles and
polio continue to pose serious health threats in
Somalia, Ethiopia, and Kenya, where these diseases tend
to place a disproportionately high burden on already
vulnerable communities. Poor nutrition, lack of water,
and limited health services have weakened immune
systems, placing millions of children at risk of
contracting opportunistic diseases. Increased in-
country and cross-border migration by pastoralists in
search of water and pasture during the drought
increased concern over the spread of the viruses.


3. The risk of disease outbreaks is exacerbated by low
immunization coverage in the three countries. UNICEF
estimates that only 10 percent of people in drought-
affected regions of Somalia and 38 percent countrywide
are immunized against measles and polio. Measles
immunization rates are similarly low in drought-
affected areas in neighboring Ethiopia (as low as 9
percent in Borena Zone) and Kenya (less than 30 percent
in Wajir and Mandera districts),according to UNICEF.
Children are routinely vaccinated at birth for a wide
variety of viruses; however, the measles vaccination
cannot be administered until nine months of age and
many parents do not return to health facilities for
this later vaccination. Other factors attributing to
the low coverage rates in the countries include the
constant migration of pastoralists, making them
difficult to locate and reach during campaigns, and the
ongoing insecurity in some areas of the countries,
hindering access during campaigns.

Somalia


4. According to UNICEF, measles outbreaks have been
reported throughout Somalia, primarily due to the low
immunization coverage rates. From November 1 to
December 31, 2005, 760 measles cases and 48 deaths were
confirmed in Mogadishu and Baidoa towns, where
immunization coverage is higher than in many rural
areas (37 percent in Mogadishu compared to 9 percent in
Bay Region),raising concerns that outbreaks would
increase in drought-affected areas.


5. In March, WHO and UNICEF carried out supplemental
immunization activities for measles targeting 2.5
million children in the most drought-affected regions
of Bay, Gedo, Middle and Lower Shabelle. Preliminary
reports estimate that 70 percent of children between 9
months and 15 years were covered in the districts
reached. A second phase of the campaign is ongoing in
Banadir, Galgadud, Lower Shabelle, Hiran, and parts of
Mudug and Middle Shabelle regions. Similar campaigns
were conducted in Somaliland and Puntland in December
2005 and January 2006 following outbreaks in late 2005.
WHO and UNICEF are preparing to conduct campaigns in 13
districts not covered in March.


6. Somalia was polio free from October 2002 through
June 2005. According to WHO, 202 wild polio cases have
been confirmed since July 2005, of which 17 were
identified in 2006. Cases were initially concentrated
in Mogadishu, Banadir Region where a total of 158 cases
surfaced in 2005. An emergency vaccination campaign
managed to stop the outbreak in Banadir, where only 4
cases have been reported in 2006; however, the virus
has spread to new regions, including Lower Shabelle,
Bay, Sool, Middle Shabelle, Gedo, Mudug, Lower Juba,
and Bari.


7. In response, UNICEF and WHO organized a round of
sub-National Immunization Days (NIDs) from March 26 to
April 1, targeting approximately 1.4 million children
under five. A second round was carried out from May 2
to 4. Additional sub-NIDs are scheduled for June 4 to
6 and July 9 to 11. Given the extent and coverage of
the polio virus outbreak, the U.N. considers Somalia as
one of the greatest threats to the global eradication
of the virus.

Ethiopia


8. In early January 2006, health officials raised
concerns over the increasing number of measles cases
reported in the last five months in southeastern and
eastern Ethiopia. More than 370 cases of measles were
reported from July to December 2005 in Afar Region,
while 195 cases were reported in Somali Region between
July and October. Fears emerged of outbreaks and
increased mortality as severe drought conditions
continued in the most critical areas of Borena Zone,
Oromiya Region, and across Somali Region.


9. As of April 13, WHO reports that 76 percent of
zones throughout the country have confirmed at least
one suspected measles case. Outbreaks have been
confirmed in several zones of Afar, Amhara, and Oromiya
regions. However, WHO reported no confirmed outbreaks
in the drought-affected areas of Somali Region or
Borena Zone. [Note: An outbreak of measles is defined
as three or more laboratory confirmed cases in a health
facility or district in one month. End note.]


10. Response activities are underway as the first
phase of a measles vaccination campaign, along with
Vitamin A supplementation, was launched in Somali
Region and Bale and Borena zones, Oromiya Region on
March 24. Bale, Borena, and Guji zones have completed
follow-up campaigns, targeting children 6 to 59 months
of age and coverage results are pending. In Somali
Region, the first phase of the measles follow-up
campaign targeting children 6 to 59 months has been
completed, with results pending, while the second phase
is still ongoing.


11. USAID/OFDA has provided 300,000 U.S. Dollars (USD)
to UNICEF for the deployment of 16 mobile health teams
throughout Somali Region to provide on-the-spot health
and nutrition screenings and treatment, including
measles vaccination and vitamin A supplementation.


12. Ethiopia was polio-free from January 2001 through
December 2004. However, following outbreaks in
Nigeria, Chad, and Sudan, the first cases of polio were
reported in Tigray Region in December 2004. Since that
time, 24 cases of wild polio have been confirmed in the
country to date, with cases confined to Amhara,
Oromiya, and Tigray regions. The importation of
poliovirus into Ethiopia represents a significant

health concern as routine immunization coverage of
three doses of oral polio vaccine (OPV) is only an
estimated 66 percent countrywide.


13. Following the confirmed importation of polio in
December 2004, Ethiopia implemented NIDs in April, May,
July, October, and November 2005 aiming to reach the 15
million children under 5 countrywide. In addition, two
sub-NIDs in March and September 2005 targeted more than
3 million children living in polio-affected areas.
Coverage data indicates the campaigns reached 96
percent of the target population during the October and
the November NIDs.


14. Since the detection of the last two wild
poliovirus cases on December 6, 2005, in East Hararghe
Zone, Oromiya Region, and on February 1, 2006, in Wag
Hamra Zone, Amhara Region, one sub-NID was conducted
and reached 12 million children under the age of 5
years in Tigray, Amhara, Oromia Addis Ababa, Somali,
Harari, and Dire Dawa regions. Due to the crisis in
Somali and the southern Oromiya regions, second round
polio immunization campaigns are being combined with
measles and other interventions in some locations. To
achieve high coverage, single intervention house-to-
house polio campaigns were conducted in the zones where
recent wild poliovirus surfaced.


15. Additional rounds of supplementary immunization
activities are planned for October and November 2006.
With surveillance one of the major strategies of the
polio eradication initiative, WHO Surveillance Officers
are integrating supportive supervision for routine
immunization in active surveillance visits.

Kenya


16. According to the Kenya Ministry of Health (MOH),
health facilities throughout the country confirmed
1,600 measles cases and 41 fatalities since October

2005. WHO reports that the early cases surfaced in
urban areas, such as Nairobi and Garissa towns, where
large numbers of Somali immigrants reside. The measles
virus has since appeared in 39 districts throughout the
country.


17. In response to the increasing number of cases, the
MOH and UNICEF embarked on an extensive measles
immunization campaign, targeting over 500,000 children
under five. The ongoing campaign, from April 29 to May
5, is focusing on 16 high-risk districts, including
Marsabit, Mandera, Wajir, Garissa, Isiolo, Tana River
and Nairobi. The MOH has deployed 1,500 health workers
to 450 centers in these districts. In addition to the
measles vaccine, health workers will provides children
with vitamin A supplements to boost immune systems.
Social mobilization activities, such as advocacy
meetings, house to house campaigns, and dissemination
of educational materials, are being carried out by
local and international organizations in conjunction
with the campaign. A second phase of the campaign is
scheduled for June and will cover remaining districts.


18. In 2006, USAID?s Office of U.S. Foreign Disaster
Assistance (USAID/OFDA) provided 350,000 U.S. dollars
to UNICEF to carry out emergency nutrition and health
interventions, such as immunization campaigns.


19. As of May 1, Kenya remains polio free. However,
as a preventive measure, MOH and UNICEF are providing
polio vaccinations to children under five in the


current measles immunization campaign. Previous
supplemental immunization activities for polio were
carried out in February and April 2005.

Conclusions


20. Weakened immune systems, low immunization rates,
cross-border migration, and limited access to
vulnerable populations have increased the potential for
large-scale disease outbreaks in Somalia, Ethiopia, and
Kenya. WHO and UNICEF, in collaboration with local
health officials, have quickly responded to emerging
outbreaks with massive and coordinated immunization
campaigns.


21. Constant surveillance and supplementary
immunization activities are required to prevent the
spread of measles and polio. USAID will continue to
monitor outbreaks and vaccination campaigns in the
region and will provide assistance to appropriate
partners when necessary.

BELLAMY