Médecins Sans Frontières vaccinated over 132,500 people against cholera in South Sudan to prevent potential outbreaks in refugee camps. They administered oral vaccines to 105,000 refugees and 27,500 local residents with support from other organizations and the South Sudan health ministry. The remote area faces challenges with sanitation and access to clean water that increase the risk of cholera, so the vaccination campaign aims to add another layer of prevention alongside their medical preparedness.

1. South Sudan: Mass cholera vaccination http://www.msf.org.uk/articledetail.aspx?fId=Cholera_vaccinations_M...
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South Sudan: MSF vaccinates 132,500 against cholera
Date Published: 22/02/2013 04:07
Médecins Sans Frontières/Doctors Without Borders (MSF) teams have just completed a
preventive cholera vaccination campaign in and around the refugee camps in Maban County,
South Sudan.
One hundred and five thousand refugees in four camps and 27,500 residents of the area were
vaccinated, with the aim of preventing possible cholera cases.
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2. South Sudan: Mass cholera vaccination http://www.msf.org.uk/articledetail.aspx?fId=Cholera_vaccinations_M...
With the cooperation of the South Sudan Ministry of Health, MSF launched the vaccination campaign as
part of a cholera preparedness and prevention plan. The teams had already set up and pre-stocked
cholera treatment facilities in the camps, in case of an outbreak.
Potentially severe cholera outbreak
Children from the host community are vaccinated
against cholera in a village outside Bunj town.
© Corinne Baker/MSF
But the remoteness of the area and supply difficulties mean that a cholera outbreak would have the
potential to be severe.
So prevention is crucial alongside preparedness, and a vaccination campaign provides an extra layer of
prevention.
“The key for preventing cholera is to ensure sufficient access to clean drinking water, and to have
appropriate sanitation and hygiene facilities,” says Paul Critchley, MSF emergency coordinator in
Maban County.
“We are currently tackling an escalating hepatitis E outbreak in the camps, so we know that sanitation
conditions here are not yet adequate. Hepatitis E is spread in similar ways to cholera, and this
reinforces the need to do all we can to prevent cholera breaking out too.”
Logistical challenges
Gathered in four refugee camps located in an extremely harsh environment, around 110,000 refugees,
who have fled the ongoing conflict in neighbouring Sudan’s Blue Nile State, are entirely dependent on
humanitarian organisations.
With no easy access routes, it was a challenge for MSF to bring in 19 200-litre fridges, the generators
to keep them running and the 290,000 vials of vaccine.
Despite the logistical challenges, the innovative approach to cholera-prevention is justified in a situation
where a population is exceptionally vulnerable and where the consequences of an outbreak would be
particularly devastating.
An MSF team set up the cholera vaccination site.
© Corinne Baker/MSF
Oral vaccine
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3. South Sudan: Mass cholera vaccination http://www.msf.org.uk/articledetail.aspx?fId=Cholera_vaccinations_M...
The vaccine comes in the form of oral drops and was given to each person twice, with a gap of two to
three weeks between doses.
By deploying a substantial health promotion effort in advance, the teams were able to reach more than
132,000 people with both doses of the vaccine.
The MSF teams were supported by staff from GOAL, IOM, Medair, Relief International, Solidarités,
and the Ministry of Health.
“The logistical difficulty of this vaccination campaign highlights the need for further development of more
field-adapted vaccines,” says Dr Jennifer Cohn, medical director for MSF’s Access Campaign.
“While it is helpful that the vaccine is an oral administration, which assists in the ease of its
administration, it comes in one dose per vial and must be kept in a cold chain, which means the sheer
bulk and logistics of supplying some 290,000 doses makes using this vaccine challenging in locations
where it may have the greatest benefit.
An MSF team member administers the oral vaccine
from a vial © Corinne Baker/MSF
"The vaccine also must be given in two doses, at least 14 days apart. Ensuring both doses are given is
difficult in situations of disaster or with mobile populations.
"A formulation that can be packaged in multi-dose vials and can be used without strict cold chain would
greatly improve the logistical challenges of such important vaccination activities.
"Further, the price is an issue. If the cost could be reduced, that would further increase the scope for
widespread use of the vaccine.”
While providing individuals vaccinated with significant immunity to cholera, this vaccine alone does not
guarantee that there will be no outbreak. While the high vaccine coverage achieved will help to
substantially limit the spread of any outbreak, all efforts possible must still be made by the
organisations working on water and sanitation in the camps, both to control the hepatitis E epidemic,
and to limit the risk of a cholera outbreak.
MSF in Maban, South Sudan
MSF has worked in the refugee camps in Maban since November 2011 and is currently running three
field hospitals and seven health posts, providing around 5,500 consultations per week across the four
refugee camps.
More information on the and
MSF UK English Registered Charity No. 1026588 © Crown Copyright 2006
by Chameleon
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