206178 Solar-powered community response to a measles outbreak among IDP in eastern Burma

Tuesday, November 10, 2009: 9:24 AM

Thomas J. Lee, MD, MHS , Global Health Access Program, Berkeley, CA
Brent Scharschmidt , Global Health Access Program, Berkeley, CA
Catherine I. Lee, MPH , Global Health Access Program, Berkeley, CA
Htoo Htoo Eh , Karen Dept. of Health and Welfare, Berkeley, CA
Paw Khu , Karen Dept. of Health and Welfare, Berkeley, CA
Jennifer Leigh, MPH , Field Director, Global Health Access Program, San Francisco, CA
Htee Moo , Karen Dept. of Health and Welfare, Berkeley, CA
Adam K. Richards, MD, MPH , Global Health Access Program, Berkeley, CA
More than 500,000 internally displaced persons in eastern Burma remain vulnerable to vaccine-preventable infectious diseases, a direct result of military government restrictions preventing access by international NGOs, along with poor infrastructure such as a lack of roads and electricity. A major measles outbreak occurred in IDP populations in eastern Burma along the border with Thailand during 2008. The sole source of healthcare for these populations is a community-based organization, the Karen Dept. of Health and Welfare (KDHW), which organized a vaccination campaign in response using a solar-powered cold chain.

KDHW operates 35 health clinics in eastern Burma providing care for 100,000 IDPs, all staffed and managed by local health workers. From April to September 2008, measles outbreaks were reported by four clinics, with a total of 512 cases reported among the 16,685 IDPs receiving services from these clinics. Blood samples for a small number of cases were collected and sent to a Thai hospital for confirmatory testing (IgM).

Outbreak response teams were trained and sent to the affected areas to immunize children 6 months 14 years of age, with a goal of 90% vaccine coverage per WHO standards of measles outbreak control. These teams worked together with local health workers to educate and mobilize the IDP communities for mass vaccination, the first-ever immunizations for the vast majority of children in these areas. Solar-powered refrigerators installed at a subset of clinics were central to the campaign, allowing the health worker teams to reach villages in areas with no other electrical infrastructure.

From May to September 2008, KDHW provided measles or MMR vaccine to 7,223, or 88.1% of children 6 months 14 years living within the target areas of six clinics, including three of the four reporting measles outbreaks. One outbreak area was inaccessible due to presence of the Burmese military. There were four confirmed deaths.

Political and security constraints often limit healthcare access for IDPs, leaving them vulnerable to vaccine-preventable diseases such as measles. These results highlight the capacity of local health organizations to provide effective public health interventions, aided by a solar-powered cold chain, to otherwise inaccessible IDPs, thus limiting the impact and the spread of infectious diseases.

Learning Objectives:
- Discuss the logistical obstacles inherent to providing health services to the population of eastern Burma - Highlight the vulnerability of these populations to easily preventable diseases - Describe how solar-powered cold chains can help achieve high immunization coverage in an active conflict setting

Keywords: Immunizations, Access and Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the immunization coordinator for the Global Health Access Program, and helped organize the measles outbreak response in fall 2008. I have two years experience working with the Karen Dept. of Health and Welfare doing cross-border work into eastern Burma.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.