"We literally ran from camp to camp, vaccinating, but the measles moved faster than we could. In the last camp along the road it got among the malnourished children. One in ten of them died." - MSF field doctor, Sudan Each year, about one million people die of measles. Most of these are young children. Unless the population has been recently immunised, measles is usually one of the five major causes of death in an emergency situation.

The others are diarrhoea, malnutrition, malaria and pneumonia or acute respiratory tract infections. The symptoms of measles are high fever, sore red eyes, cough, and a fine rash of small spots that covers the body. How measles kills The rash of measles covers not only the skin but also the internal body surfaces of an affected child. This is what causes the complications of measles.

The rash affects the intestines, and this leads to diarrhoea. It affects the eyes, causing the characteristic redness, and also the covering of the brain, called the meninges, and this causes the child to be irritable.

The rash also affects the inner surfaces of the lungs, and this inflammation allows secondary infections to take hold, leading to pneumonia. It is usually one of these complications, and especially pneumonia or diarrhoea, that is the direct cause of death during a bout of measles. Measles so weakens a child that he or she is easily tipped into malnutrition.

The high fevers of measles can also precipitate vitamin A deficiency, which can in turn lead to a blinding disease called xerophthalmia. Both of these nutritional conditions can lead eventually to death.

Managing an epidemic

Epidemics of measles should no longer occur, but they do. In countries where war or civil strife have disrupted health services, sometimes over a period of many years, whole generations of children may grow up without having been immunised.

Preventing measles

The tragedy of measles is that it is entirely preventable. In many countries the national Ministry of Health has implemented an Expanded Programme on Immunisation, which is usually known by its abbreviation, EPI. This targets all young children and vaccinates them against a total of six diseases, of which measles is one. There are many places, however, where civil strife, war, population displacement or sheer poverty have prevented immunisation taking place. It is in these situations that MSF will implement mass immunisation campaigns.

The other classical situation where MSF teams set up mass campaigns is during an influx of refugees. The target age group for a mass measles campaign is usually from 6 months to 12 years. A preventive dose of vitamin A is usually given at the same time as the measles injection. These campaigns may cover tens of thousands of children. The logistics of organising such a campaign are complex.

One of the most important aspects is the cold chain, which is the unbroken series of refrigerators and insulated cool-boxes that carried the sensitive measles vaccine from its place of procurement to the field where it is to be administered. To speed up mass campaigns MSF has developed immunisation kits that contain all the needles, syringes and other equipment needed by our teams in order to be able to start work immediately in an emergency.

An example - Preventing an outbreak of measles

In 1988, following an outbreak of violence in neighbouring Burundi, more than 50,000 refugees suddenly crossed the border into southern Rwanda. There were already reports of measles among the local villagers and given the extreme crowding of the refugees the MSF exploratory team there feared a major outbreak. The team estimated the target population of ages 6 months to 12 years at some 20,000 children.

They ordered the necessary quantities of vaccines and supplies by radio. During the following 24 hours they made certain that the cold chain in the local hospitals and dispensaries could store their vaccines, and at the same time began briefing and training the national staff and volunteers on how the campaign would proceed. When the vaccines arrived they started work at once.

Travelling along the border to all the sites where the refugees had come to rest they were able to complete the campaign within a period of three days. Subsequent to this there was no outbreak of measles among those refugees and a major risk was thus averted.

How MSF teams treat measles patients

In spite of our efforts to immunise all children at risk there are still cases of measles to be dealt with. In many countries where MSF works the population has not been immunised for many years because of warfare or civil unrest disrupting preventive health programmes.

There is no specific treatment against the measles virus. Thus MSF teams concentrate on treating the complications of measles. Chest infections, especially the most severe form known as pneumonia, are treated with antibiotics. Diarrhoea is treated with oral rehydration solution. And all children with measles are given a preventive dose of vitamin A.