MSF has expanded its measles programme in the Kano state of northern Nigeria to include active surveillance in areas around the state capital. The programme expansion is aiming to reduce the case-fatality rate, which is currently over 20%. The measles outbreak was first detected by the joint Kano State Ministry of Health and MSF sentinel surveillance system in November 2000. MSF started its intervention in two hospitals in Kano city in March. Since then, over one thousand children have been admitted to the hospitals, with over 156 fatalities.

"The numbers of daily admissions are still rising," says Christa Hook, Health Advisor at the MSF headquarters in Amsterdam. "Although it is difficult to give a general picture, we feel that the epidemic may not yet have reached its peak." MSF has expanded its cooperation with the federal and state Ministries of Health to include active surveillance in the outlying health centres, where severe cases can be referred to the hospitals in Kano city.

Children whose cases are not too serious will receive treatment as outpatients. Measles cause pneumonia, severe diarrhoea, loss of skin and it can have serious cerebral effects. Once admitted, case management involves administration of antibiotics, oral-rehydration salts and/or IV fluids, and vitamin A.

An unexpected side-effect of the current epidemic is the discovery that many of the children who got measles had been vaccinated in the past against the disease. "It is too early yet to draw any conclusions why these vaccinations to such a large extend do not work," says Dr. Hook. "It could be anything from ineffective vaccins to weaknesses in the cold-chain systems that are necessary for these vaccins." The discovery means that more children than anticipated are at risk by the deadly disease. More research is needed to clarify these matters.