A botched measles vaccination campaign has left 15 young children dead and dozens more sickened in the rural town of Kapoeta in South Sudan early last month. Government inquiry found that unsanitary and unsafe vaccination practice, which saw children as young as 12 years old administering the vaccines, caused the deaths of children under the age of five. Another 32 children were sickened with fever, diarrhea, and vomiting following the vaccination. The campaign, which vaccinated about 300 people, was carried out by the country’s Ministry of Health. The vaccines were provided by UNICEF, while funding and technical advice came from the World Health Organization (WHO).
A investigation carried out by the National Adverse Events Following Immunization Committee (AEFI) revealed that severe sepsis and toxicity resulting from contaminated vaccine were the main causes of deaths in children. The AEFI report found that the vaccination team did not adhere to the WHO’s immunization safety standards. According to the report, the team that vaccinated the children were neither qualified nor trained for the campaign. The report also revealed that a single reconstitution syringe was used for multiple vaccine vials for the entire duration of the campaign instead of discarding it after single use. This lead to the contamination of the vials and the subsequent infection in children.
In addition, the report found that the vaccination team did not follow the WHO’s cold chain protocols as specified in the Measles Supplementary Immunization Activities guidelines. According to the report, the vaccines were stored in a building with no cold chain facility for four days, thus affecting the quality of the vaccines. A WHO spokesperson said the organization released a field book that underscored the importance of training and hygienic practices in immunization. The spokesperson also said that the WHO will take measures to prevent the same crisis in the future.
“The WHO role in vaccination training extends only to training the county or hub supervisor. The training protocols that are used for training the county or hub supervisor are expected to be used to train at the lower levels…In particular, WHO will be examining how we select, supervise and manage the training of all those involved in vaccination campaigns in South Sudan to prevent or mitigate this type of tragedy in the future,” WHO spokesman Tarik Jasarevic was quoted in saying in LATimes.com.
“Ministry of Health, WHO and UNICEF express our deep regret and sadness at the passing of the children. This tragic event could have been prevented by adhering to WHO immunization safety standards…Vaccination is one of the most basic and critical health needs in emergencies to protect populations from the risk of contracting deadly but preventable diseases. The risk of measles and other Vaccine Preventable Diseases in South Sudan remains extremely high because of the challenges being faced by the health system. The country has experienced significant measles outbreaks among unprotected population caused by a backlog of unvaccinated children in areas of insecurity,” a joint statement by the WHO and UNICEF read.
The Ministry of Health has tapped a multi-agency administrative committee to assess the AEFI report and provide appropriate recommendations for further actions to improve immunization service delivery.
Measles continues to be a huge public health burden in South Sudan. In fact, United Nations (U.N.) data showed that nearly 3,000 people contracted the disease and 28 people died of the infection in 2016 alone. The data also found that 665 people have already been infected and at least one person died of measles so far this year. According to the U.N., the risk of measles infection in South Sudan remains extremely high.