Table 2 Risk analysis preventive vaccination, Minkaman
Considerations | Specific considerations | Assessment conclusion | |||||
|---|---|---|---|---|---|---|---|
Epidemiological/ risk assessment | General risk factors: | Disease-specific risk factors: | |||||
Limited access to curative health services. Young population and high birth rate. Overcrowding. Insufficient water, sanitation and hygiene | Low population immunity: High risk for meningitis and cholera (no previous vaccination, no large outbreak in the past 3 years), pneumococcal disease, HiB and rotavirus (not yet introduced in EPI) | Overall specific risk High/moderate High | |||||
VPD high specific risk associated for: | |||||||
Measles, meningitis, cholera, polio, HiB, Pneumococcal disease and rotavirus | |||||||
High burden of disease: main child deadly diseases are respiratory tract infections and diarrhea. Seasonality Cold dry season | |||||||
Vaccine characteristics | Antigen | Type | Recommended dosage | VE 1 dose | Target pop | cm3/dose | |
Measles | Live attenuated | 1 dose | ~ 85% | > 6 m to 15y | 0.75–5.22 | Suitable for vaccination campaign two rounds (plus EPI) | |
Cholera (oral Sanchol°) | Inactivated | 2 doses | N/A | >_ 1y | 16.8–24.4 | Suitable for vaccination campaign two rounds | |
Polio | Live attenuated | 3 doses | ~ 50% | 6w to 5y | 0.24–3.2 | Suitable for vaccination campaign one round (plus EPI) | |
PCV | Inactivated | 2 doses | up to 70% | 6w to 5y | 4.8–15.7 | Suitable for vaccination campaign two rounds (plus EPI) | |
Pentavalent (DPT, HiB, Hep B) | Inactivated | 3 doses | N/A | 6w to 7y | 2.6–5.1 | Suitable for vaccination campaign three rounds (plus EPI) | |
MenAfriVac® A | Inactivated | 1 dose | ~ 75–95% | 1 to 29y | 2.6 | Suitable for vaccination campaign one round | |
Hep E | 3 doses | N/A | >16y | 132.6 | Suitable for vaccination campaign three rounds | ||
Rotavirus (Rotarix® liquid) | 2 doses | N/A | 6w to 2y | 17,1 | Suitable for vaccination campaign two rounds (plus EPI) | ||
Contextual constraints and facilitators | Ethical | Political | Security | Economic/logistic constraints | |||
No community opposition. Informed consent process possible at community and individual level. Target population displaced and host community for all vaccinations | Current EPI policy limiting immunization activities (no pentavalent, rotavirus, PCV). Measles, polio cholera and meningitis campaigns validated. Antecedent of cghPCV vaccination approved | The area of Minkaman is currently stable. No previous threats to immunization activities. No specific risk to health workers or those immunized | Funding available. Sufficient vaccine supply. Vaccination teams already identified and trained in both injectable and oral vaccines. Cold chain and infrastructure already available and in place | No major barriers for immunization activities. | |||
Further negotiation required to use antigens not yet included in the EPI. | |||||||
Conclusion | In addition to mass vaccination campaigns targeting diseases with epidemic potential (measles, polio, meningitis and cholera), we propose a series of campaigns with new and underutilized vaccines (pentavalent, pneumococcal and rotavirus) targeting the most common childhood vaccine preventable diseases AND follow up with routine vaccination activities. We believe such vaccination campaign achieving high coverage in a displaced population can have a very important impact on childhood morbidity and mortality. The 3 rounds of campaigns necessary are feasible in this setting with logistic and human resources available. | ||||||