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Editor, Senior Moderator
PLoS Curr. 2018 Feb 2;10. pii: ecurrents.dis.bb5f22928e631dff9a80377309381feb. doi: 10.1371/currents.dis.bb5f22928e631dff9a80377309381feb.
[h=1]Infectious Disease Risk and Vaccination in Northern Syria after 5 Years of Civil War: The MSF Experience.[/h] de Lima Pereira A[SUP]1[/SUP], Southgate R[SUP]2[/SUP], Ahmed H[SUP]3[/SUP], O'Connor P[SUP]4[/SUP], Cramond V[SUP]5[/SUP], Lenglet A[SUP]6[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]Introduction:[/h] In 2015, following an influx of population into Koban? in northern Syria, M?decins Sans Fronti?res (MSF) in collaboration with the Koban? Health Administration (KHA) initiated primary healthcare activities. A vaccination coverage survey and vaccine-preventable disease (VPD) risk analysis were undertaken to clarify the VPD risk and vaccination needs. This was followed by a measles Supplementary Immunization Activity (SIA). We describe the methods and results used for this prioritisation activity around vaccination in Koban? in 2015.
[h=4]Methods:[/h] We implemented a pre-SIA survey in 135 randomly-selected households in Koban? using a vaccination history questionnaire for all children <5 years. We conducted a VPD Risk Analysis using MSF 'Preventive Vaccination in Humanitarian Emergencies' guidance to prioritize antigens with the highest public health threat for mass vaccination activities. A Measles SIA was then implemented and followed by vaccine coverage survey in 282 randomly-selected households targeting children <5 years.
[h=4]Results:[/h] The pre-SIA survey showed that 168/212 children (79.3%; 95%CI=72.7-84.6%) had received one vaccine or more in their lifetime. Forty-three children (20.3%; 95%CI: 15.1-26.6%) had received all vaccines due by their age; only one was <12 months old and this child had received all vaccinations outside of Syria. The VPD Risk Analysis prioritised measles, Haemophilus Influenza type B (Hib) and Pneumococcus vaccinations. In the measles SIA, 3410 children aged 6-59 months were vaccinated. The use of multiple small vaccination sites to reduce risks associated with crowds in this active conflict setting was noted as a lesson learnt. The post-SIA survey estimated 82% (95%CI: 76.9-85.9%; n=229/280) measles vaccination coverage in children 6-59 months.
[h=4]Discussion:[/h] As a result of the conflict in Syria, the progressive collapse of the health care system in Koban? has resulted in low vaccine coverage rates, particularly in younger age groups. The repeated displacements of the population, attacks on health institutions and exodus of healthcare workers, challenge the resumption of routine immunization in this conflict setting and limit the use of SIAs to ensure sustainable immunity to VPDs. We have shown that the risk for several VPDs in Koban? remains high.
[h=4]Conclusion:[/h] We call on all health actors and the international community to work towards re-establishment of routine immunisation activities as a priority to ensure that children who have had no access to vaccination in the last five years are adequately protected for VPDs as soon as possible.
PMID: 29511602 PMCID: PMC5815631 DOI: 10.1371/currents.dis.bb5f22928e631dff9a80377309381feb
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[h=1]Infectious Disease Risk and Vaccination in Northern Syria after 5 Years of Civil War: The MSF Experience.[/h] de Lima Pereira A[SUP]1[/SUP], Southgate R[SUP]2[/SUP], Ahmed H[SUP]3[/SUP], O'Connor P[SUP]4[/SUP], Cramond V[SUP]5[/SUP], Lenglet A[SUP]6[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]Introduction:[/h] In 2015, following an influx of population into Koban? in northern Syria, M?decins Sans Fronti?res (MSF) in collaboration with the Koban? Health Administration (KHA) initiated primary healthcare activities. A vaccination coverage survey and vaccine-preventable disease (VPD) risk analysis were undertaken to clarify the VPD risk and vaccination needs. This was followed by a measles Supplementary Immunization Activity (SIA). We describe the methods and results used for this prioritisation activity around vaccination in Koban? in 2015.
[h=4]Methods:[/h] We implemented a pre-SIA survey in 135 randomly-selected households in Koban? using a vaccination history questionnaire for all children <5 years. We conducted a VPD Risk Analysis using MSF 'Preventive Vaccination in Humanitarian Emergencies' guidance to prioritize antigens with the highest public health threat for mass vaccination activities. A Measles SIA was then implemented and followed by vaccine coverage survey in 282 randomly-selected households targeting children <5 years.
[h=4]Results:[/h] The pre-SIA survey showed that 168/212 children (79.3%; 95%CI=72.7-84.6%) had received one vaccine or more in their lifetime. Forty-three children (20.3%; 95%CI: 15.1-26.6%) had received all vaccines due by their age; only one was <12 months old and this child had received all vaccinations outside of Syria. The VPD Risk Analysis prioritised measles, Haemophilus Influenza type B (Hib) and Pneumococcus vaccinations. In the measles SIA, 3410 children aged 6-59 months were vaccinated. The use of multiple small vaccination sites to reduce risks associated with crowds in this active conflict setting was noted as a lesson learnt. The post-SIA survey estimated 82% (95%CI: 76.9-85.9%; n=229/280) measles vaccination coverage in children 6-59 months.
[h=4]Discussion:[/h] As a result of the conflict in Syria, the progressive collapse of the health care system in Koban? has resulted in low vaccine coverage rates, particularly in younger age groups. The repeated displacements of the population, attacks on health institutions and exodus of healthcare workers, challenge the resumption of routine immunization in this conflict setting and limit the use of SIAs to ensure sustainable immunity to VPDs. We have shown that the risk for several VPDs in Koban? remains high.
[h=4]Conclusion:[/h] We call on all health actors and the international community to work towards re-establishment of routine immunisation activities as a priority to ensure that children who have had no access to vaccination in the last five years are adequately protected for VPDs as soon as possible.
PMID: 29511602 PMCID: PMC5815631 DOI: 10.1371/currents.dis.bb5f22928e631dff9a80377309381feb
Free full text