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Viewing cable 06NAIROBI1939, MEASLES AND POLIO INCIDENCE AND RESPONSE IN

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Reference ID Created Released Classification Origin
06NAIROBI1939 2006-05-04 10:19 2011-08-24 01:00 UNCLASSIFIED Embassy Nairobi
VZCZCXYZ0000
PP RUEHWEB

DE RUEHNR #1939/01 1241019
ZNR UUUUU ZZH
P 041019Z MAY 06
FM AMEMBASSY NAIROBI
TO RUEHC/SECSTATE WASHDC PRIORITY 1468
RUCNDT/USMISSION USU NEW YORK 6940
RUEHDS/AMEMBASSY ADDIS ABABA 8490
RUEHBS/AMEMBASSY BRUSSELS 1672
RUEHRO/AMEMBASSY ROME 4910
RUEHGV/USMISSION GENEVA 3914
RHEHNSC/NSC WASHDC
UNCLAS NAIROBI 001939 
 
SIPDIS 
 
AIDAC AFDROUGHT 
 
SIPDIS 
 
STATE FOR AF/E, NGAREY, MGONZALES 
USAID/W FOR AA/DCHA, WGARVELINK, LROGERS 
DCHA/OFDA FOR GGOTTLIEB, PMORRIS, CGOTTSCHALK, 
KCHANNELL 
DCHA/FFP FOR JDWORKEN, PMOHAN 
AFR/EA FOR JBORNS 
USUN FOR EMALY 
ADDIS ABABA FOR JAUGSBERGER 
BRUSSELS FOR PLERNER 
ROME FOR FODAG 
GENEVA FOR NKYLOH 
NSC FOR JMELINE, TSHORTLEY 
 
E.O. 12958:  N/A 
TAGS: EAID SO KE ET
SUBJECT:  MEASLES AND POLIO INCIDENCE AND RESPONSE IN 
SOMALIA, ETHIOPIA, AND KENYA 
 
 
Summary 
 
1.  Since 2005, isolated measles and polio cases 
surfaced in drought-affected Somalia, Ethiopia, and 
Kenya.  Increased migration by pastoralists during the 
drought has raised concerns of a widespread, regional 
outbreak.  In response, the U.N. Children?s Fund 
(UNICEF) and World Health Organization (WHO) quickly 
organized massive immunization campaigns in 
collaboration with national health agencies. 
 
Populations at Risk 
 
2.  Vaccine preventable diseases such as measles and 
polio continue to pose serious health threats in 
Somalia, Ethiopia, and Kenya, where these diseases tend 
to place a disproportionately high burden on already 
vulnerable communities.  Poor nutrition, lack of water, 
and limited health services have weakened immune 
systems, placing millions of children at risk of 
contracting opportunistic diseases.  Increased in- 
country and cross-border migration by pastoralists in 
search of water and pasture during the drought 
increased concern over the spread of the viruses. 
 
3.  The risk of disease outbreaks is exacerbated by low 
immunization coverage in the three countries.  UNICEF 
estimates that only 10 percent of people in drought- 
affected regions of Somalia and 38 percent countrywide 
are immunized against measles and polio.  Measles 
immunization rates are similarly low in drought- 
affected areas in neighboring Ethiopia (as low as 9 
percent in Borena Zone) and Kenya (less than 30 percent 
in Wajir and Mandera districts), according to UNICEF. 
Children are routinely vaccinated at birth for a wide 
variety of viruses; however, the measles vaccination 
cannot be administered until nine months of age and 
many parents do not return to health facilities for 
this later vaccination.  Other factors attributing to 
the low coverage rates in the countries include the 
constant migration of pastoralists, making them 
difficult to locate and reach during campaigns, and the 
ongoing insecurity in some areas of the countries, 
hindering access during campaigns. 
 
Somalia 
 
4.  According to UNICEF, measles outbreaks have been 
reported throughout Somalia, primarily due to the low 
immunization coverage rates.  From November 1 to 
December 31, 2005, 760 measles cases and 48 deaths were 
confirmed in Mogadishu and Baidoa towns, where 
immunization coverage is higher than in many rural 
areas (37 percent in Mogadishu compared to 9 percent in 
Bay Region), raising concerns that outbreaks would 
increase in drought-affected areas. 
 
5.  In March, WHO and UNICEF carried out supplemental 
immunization activities for measles targeting 2.5 
million children in the most drought-affected regions 
of Bay, Gedo, Middle and Lower Shabelle.  Preliminary 
reports estimate that 70 percent of children between 9 
months and 15 years were covered in the districts 
reached.  A second phase of the campaign is ongoing in 
Banadir, Galgadud, Lower Shabelle, Hiran, and parts of 
Mudug and Middle Shabelle regions.  Similar campaigns 
were conducted in Somaliland and Puntland in December 
2005 and January 2006 following outbreaks in late 2005. 
WHO and UNICEF are preparing to conduct campaigns in 13 
districts not covered in March. 
 
6.  Somalia was polio free from October 2002 through 
June 2005.  According to WHO, 202 wild polio cases have 
been confirmed since July 2005, of which 17 were 
identified in 2006.  Cases were initially concentrated 
in Mogadishu, Banadir Region where a total of 158 cases 
surfaced in 2005.  An emergency vaccination campaign 
managed to stop the outbreak in Banadir, where only 4 
cases have been reported in 2006; however, the virus 
has spread to new regions, including Lower Shabelle, 
Bay, Sool, Middle Shabelle, Gedo, Mudug, Lower Juba, 
and Bari. 
 
7.  In response, UNICEF and WHO organized a round of 
sub-National Immunization Days (NIDs) from March 26 to 
April 1, targeting approximately 1.4 million children 
under five.  A second round was carried out from May 2 
to 4.  Additional sub-NIDs are scheduled for June 4 to 
6 and July 9 to 11.  Given the extent and coverage of 
the polio virus outbreak, the U.N. considers Somalia as 
one of the greatest threats to the global eradication 
of the virus. 
 
Ethiopia 
 
8.  In early January 2006, health officials raised 
concerns over the increasing number of measles cases 
reported in the last five months in southeastern and 
eastern Ethiopia.  More than 370 cases of measles were 
reported from July to December 2005 in Afar Region, 
while 195 cases were reported in Somali Region between 
July and October.  Fears emerged of outbreaks and 
increased mortality as severe drought conditions 
continued in the most critical areas of Borena Zone, 
Oromiya Region, and across Somali Region. 
 
9.  As of April 13, WHO reports that 76 percent of 
zones throughout the country have confirmed at least 
one suspected measles case.  Outbreaks have been 
confirmed in several zones of Afar, Amhara, and Oromiya 
regions.  However, WHO reported no confirmed outbreaks 
in the drought-affected areas of Somali Region or 
Borena Zone.  [Note:  An outbreak of measles is defined 
as three or more laboratory confirmed cases in a health 
facility or district in one month.  End note.] 
 
10.  Response activities are underway as the first 
phase of a measles vaccination campaign, along with 
Vitamin A supplementation, was launched in Somali 
Region and Bale and Borena zones, Oromiya Region on 
March 24.  Bale, Borena, and Guji zones have completed 
follow-up campaigns, targeting children 6 to 59 months 
of age and coverage results are pending.  In Somali 
Region, the first phase of the measles follow-up 
campaign targeting children 6 to 59 months has been 
completed, with results pending, while the second phase 
is still ongoing. 
 
11.  USAID/OFDA has provided 300,000 U.S. Dollars (USD) 
to UNICEF for the deployment of 16 mobile health teams 
throughout Somali Region to provide on-the-spot health 
and nutrition screenings and treatment, including 
measles vaccination and vitamin A supplementation. 
 
12.  Ethiopia was polio-free from January 2001 through 
December 2004.  However, following outbreaks in 
Nigeria, Chad, and Sudan, the first cases of polio were 
reported in Tigray Region in December 2004.  Since that 
time, 24 cases of wild polio have been confirmed in the 
country to date, with cases confined to Amhara, 
Oromiya, and Tigray regions.  The importation of 
poliovirus into Ethiopia represents a significant 
 
health concern as routine immunization coverage of 
three doses of oral polio vaccine (OPV) is only an 
estimated 66 percent countrywide. 
 
13.  Following the confirmed importation of polio in 
December 2004, Ethiopia implemented NIDs in April, May, 
July, October, and November 2005 aiming to reach the 15 
million children under 5 countrywide.  In addition, two 
sub-NIDs in March and September 2005 targeted more than 
3 million children living in polio-affected areas. 
Coverage data indicates the campaigns reached 96 
percent of the target population during the October and 
the November NIDs. 
 
14.  Since the detection of the last two wild 
poliovirus cases on December 6, 2005, in East Hararghe 
Zone, Oromiya Region, and on February 1, 2006, in Wag 
Hamra Zone, Amhara Region, one sub-NID was conducted 
and reached 12 million children under the age of 5 
years in Tigray, Amhara, Oromia Addis Ababa, Somali, 
Harari, and Dire Dawa regions.  Due to the crisis in 
Somali and the southern Oromiya regions, second round 
polio immunization campaigns are being combined with 
measles and other interventions in some locations.  To 
achieve high coverage, single intervention house-to- 
house polio campaigns were conducted in the zones where 
recent wild poliovirus surfaced. 
 
15.  Additional rounds of supplementary immunization 
activities are planned for October and November 2006. 
With surveillance one of the major strategies of the 
polio eradication initiative, WHO Surveillance Officers 
are integrating supportive supervision for routine 
immunization in active surveillance visits. 
 
Kenya 
 
16.  According to the Kenya Ministry of Health (MOH), 
health facilities throughout the country confirmed 
1,600 measles cases and 41 fatalities since October 
2005.  WHO reports that the early cases surfaced in 
urban areas, such as Nairobi and Garissa towns, where 
large numbers of Somali immigrants reside.  The measles 
virus has since appeared in 39 districts throughout the 
country. 
 
17.  In response to the increasing number of cases, the 
MOH and UNICEF embarked on an extensive measles 
immunization campaign, targeting over 500,000 children 
under five.  The ongoing campaign, from April 29 to May 
5, is focusing on 16 high-risk districts, including 
Marsabit, Mandera, Wajir, Garissa, Isiolo, Tana River 
and Nairobi.  The MOH has deployed 1,500 health workers 
to 450 centers in these districts.  In addition to the 
measles vaccine, health workers will provides children 
with vitamin A supplements to boost immune systems. 
Social mobilization activities, such as advocacy 
meetings, house to house campaigns, and dissemination 
of educational materials, are being carried out by 
local and international organizations in conjunction 
with the campaign.  A second phase of the campaign is 
scheduled for June and will cover remaining districts. 
 
18.  In 2006, USAID?s Office of U.S. Foreign Disaster 
Assistance (USAID/OFDA) provided 350,000 U.S. dollars 
to UNICEF to carry out emergency nutrition and health 
interventions, such as immunization campaigns. 
 
19.  As of May 1, Kenya remains polio free.  However, 
as a preventive measure, MOH and UNICEF are providing 
polio vaccinations to children under five in the 
 
 
current measles immunization campaign.  Previous 
supplemental immunization activities for polio were 
carried out in February and April 2005. 
 
Conclusions 
 
20.  Weakened immune systems, low immunization rates, 
cross-border migration, and limited access to 
vulnerable populations have increased the potential for 
large-scale disease outbreaks in Somalia, Ethiopia, and 
Kenya.  WHO and UNICEF, in collaboration with local 
health officials, have quickly responded to emerging 
outbreaks with massive and coordinated immunization 
campaigns. 
 
21.  Constant surveillance and supplementary 
immunization activities are required to prevent the 
spread of measles and polio.  USAID will continue to 
monitor outbreaks and vaccination campaigns in the 
region and will provide assistance to appropriate 
partners when necessary. 
 
BELLAMY